Epidemiology

Clinical features

Diagnosis of marburg and ebola virus infections

Clinical management

Equipment and logistics

References

INTRODUCTION

The deadly 2014 to 2016 outbreak of Ebola virus disease (EVD) in West Africa underscored the severity of the threat posed by viral hemorrhagic fevers. New outbreaks in the Democratic Republic of the Congo in 2018 further highlighted the pervasiveness of Ebola and other viruses, such as the Marburg and Lassa viruses, in certain regions of Africa. Outbreaks of viral hemorrhagic fevers caused by filoviruses have been identified since 1967, but the use of clinical or biological data collected over time remains limited. Although symptoms reported by patients on admission to Ebola treatment centers (ETCs) are described in several publications, objective data required to make clinical decisions, such as body temperature, blood pressure, heart rate, respiration rate, and fluid balance, have not been systematically collected over the entire clinical course. Similarly, limited data exist on derangements of electrolytes and acid-base balance, renal and hepatic function, and blood coagulation. Epidemiologic data suggesting a very poor prognosis for viral hemorrhagic fevers must be interpreted in light of historically limited clinical evaluation and management. The prompt recognition and management of clinical, physiologic, and laboratory abnormalities on admission to an ETC should, in theory, improve outcomes. With this objective in mind, recommendations for basic clinical management for patients with EVD were created. However, important clinical questions remain, and additional research would likely help future patients with viral hemorrhagic fevers. With the exception of emerging specific anti-Ebola treatments, this article addresses different aspects of the clinical management of viral hemorrhagic fevers, particularly on filoviruses, based on scientific evidence to the extent it exists. Broader considerations, such as epidemiology and modes of transmission, are addressed when they are likely to influence clinical decisions.