November 5, 2014
Pharmacists and Ebola: Identifying Disease onBaltimore—With pharmacists truly on the frontlines of U.S. healthcare, being able to identify Ebola virus disease (EVD) has become critically important.
the Front Lines
The problem is that without a definitive test, the disease is highly likely to be confused with other, more common conditions. In fact, an early case may be confused with flu, a later case assumed to be gastroenteritis, and a very late case identified as sepsis of any cause, according to a primer for healthcare providers, published recently in the journal Disaster Medicine and Public Health Preparedness.
Before raising an alarm about a possible Ebola case, however, an important first step is gathering epidemiological information about travel and exposure, according to the authors.
In a checklist, the CDC says Ebola should be suspected if a person who has had potential exposure to an Ebola patient or traveled to a country with an Ebola outbreak presents with a fever of 100.4°F or 38°C or higher, usually with additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage.
The specific test for Ebola, reverse transcriptase polymerase chain reaction (RT-PCR), is available in many state public health laboratories and at the CDC, according to the primer from the University of Pittsburgh Medical Center’s (UPMC) Center for Health Security in Baltimore and the university’s schools of medicine and public health in Pittsburgh.
According to the journal article, Ebola enters the host through mucous membranes, breaks in the skin—including micro-abrasions—and punctures. So, once the diagnosis of EVD is suspected or has been made, the patient should be isolated with droplet/contact precautions, and healthcare workers must use appropriate personal protective equipment, such as fluid-impervious gowns, gloves, respiratory protection, and eye protection.
The pathology of the disease in humans is actually not well understood, mainly because most cases of EVD have occurred in remote parts of Africa, according to the article. Instead, the authors point out, much of the available information has been extrapolated from experimental work in animals, including nonhuman primates.
While fever occurs in the vast majority of EVD cases, abnormal bleeding has occurred in only 18% of patients in the current West African epidemic. When bleeding does occur, it can manifest in a variety of ways, including petechiae, abnormal bruising, bleeding from puncture sites, or nasal, gastrointestinal, or vaginal bleeding.
In addition to pain, the biggest issues usually are vomiting and diarrhea that can create the kind of fluid loss seen in cholera, the article notes. Fever and nonspecific symptoms, such as fatigue, weakness, malaise, anorexia, headache, hiccups, and abdominal pain, typically begin suddenly after an incubation period that averages 8 to 10 days with a range of 2 to 21 days.
“Although sore throat can occur, other respiratory symptoms are not common,” according to the report. “At this stage, the disease is often indistinguishable from many other common diseases including, for example, influenza. Some patients progress no further than this and recover.”
Survival for Ebola patients usually hinges on the availability of high-level supportive treatment, such as fluid replacement. Standard critical care protocols for septic shock are recommended for patients at later stages of the disease, the primer notes.
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