“Ebola virus disease (EVD) is an acute and often fatal viral infection caused by a virus belonging to the family Filoviridae (family Ebolavirus)”. EVD is one of the most common hemorrhagic fevers in central and eastern western Africa. The disease is caused by a single-stranded RNA Flavovirus with frequent replication on dendritic cells macrophages and monocytes. The virus then uses several strategies to attack its host including migration to the gut liver and lymph nodes resulting in disseminated infection. There are five known strains of EVD: Ebola virus (formerly Zaire). Ebola virus) Bundibugyo virus Sudan virus Taï Forest virus and Reston virus. Of the five viruses, only the Reston virus has not infected humans. The remaining species have mortality rates ranging from 30-90% depending on the specific outbreak.
EVD originates from animals and spreads to humans through hunting and consumption of bush meat or contact with dog feces. Once a person is infected with EVD, the virus spreads through contact with body fluids or reuse of unsanitary needles. “Distribution of Centers for Disease Control as a category A drug also designates EBOV as a bioterrorism threat making this virus a biodefense research priority”.
The Ebola virus has gone through 25 outbreaks since the first human cases were reported in 1976. The outbreaks have occurred mainly in west African countries and some in the east and central regions. There have been more than 26000 serious deaths from the virus recorded in western Africa. “The outbreak of Ebola virus disease (EVD) in West Africa has been described as one of the most devastating health crises of the 21st century. It has caused more than 11000 deaths”. The top three outbreaks have occurred in Sierra Leone Guinea and. Liberia. Available statistics from each outbreak vary and likely do not adequately reflect the prevalence of the disease due to a lack of health reporting. Also contributing to this crisis is a lack of education recovering from civil war with a failing economy driven by urbanization overpopulation or migration to isolated rural communities and lack of transportation to health facilities.
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Ebola virus has the following signs and symptoms:
1. Early Stage
- abdominal pain
- asthenia (extreme)
- back pain
- fever (>37.5⁰C)
- sore throat
2. Mid Stage
- capillary leak
- Dyspnea/respiratory distress
- low blood pressure
- nausea and vomiting
- rash (macropapular)
3. Late Stage
- hemorrhage (external/internal)
- multi-organ failure
- shock (hypovolemic and septic)
Other symptoms of EVD, although rare, include encephalopathy, hepatomegaly, enlarged lymph nodes, and seizures. 
There are very few studies on the comorbidities seen in patients with Ebola. The most common co-morbidity seen in patients with Ebola is malaria. A study of epidemiologic clinical and outcome resources revealed that 72% of 90 patients with Ebola also developed malaria. Just one other one the comorbidity found in the study was diabetes mellitus (2% of the 90 patients).
There is currently no licensed vaccine or treatment for the Ebola virus. But recent research has focused on experimental drugs and antiretroviral therapy and many other drugs are used to treat the many symptoms experienced by Ebola patients. The following are the current drugs and treatments against the Ebola virus:
1. Prevention and treatment of infections with antibiotics:
- Oral rehydration solution
- Ringer lactate
6. Supportive care and analgesics for treatment of all symptoms:
- Electrolyte supplements
- Opioid analgesics (ex. morphine)
- Protein-rich oral supplements
The following is a list of experimental drugs and therapies currently being tested by researchers for potential usefulness in treating Ebola:
- ZMapp (best known emerging drug to date; experimental drug that has shown therapeutic benefit for Ebola in humans) .
- TKM-Ebola (proven to be protective in non-human primates and administered to a limited number of patients under emergency programs);
- Brincidofovir (shown in vitro activity against Ebola; administered to patients under emergency protocol; future trial planned in West Africa)
- Favipiravir (effective against Ebola in mice; future human trials planned to start in West Africa)
- BCX-4430 (not yet studied in humans, but has shown activity against Ebola virus in nonhuman primates and rodents)
- AVI-7537 (increased survival in non-human primates infected with Ebola virus)
- Interferon amiodarone clomiphene and chloroquine (other drugs under investigation are of uncertain benefit for Ebola in humans)
- cAd3-ZEBOV and rVSV-ZEBOV (two experimental vaccines currently in human trials in the US)
- Convalescent whole blood or plasma (limited evidence suggests transfusions from convalescent patients may reduce mortality, but investigative trials are planned)
Diagnostic Tests/Lab Tests/Lab Values
The diagnostic gold standard for confirmation of Ebola virus is reverse transcription polymerase chain reaction (RT-PCR) . It is capable of detecting the virus in patients at both early and late stages of the disease. Another useful diagnostic test that is highly specific but not universal Available is the antigen capture enzyme-linked immunosorbent assay (ELISA) . Laboratory tests combined with RT-PCR for molecular detection of Ebola virus are the QIAGEN QIAamp Viral RNA Mini Kit and MagMAX Pathogen RNA/DNA Kit (Life Technologies). these two methods For purification of RNA from whole blood samples. Ebola virus-specific antibodies (IgM and IgG) can also be tested to indicate the presence of the disease. 
Laboratory test results that do not confirm the presence of Ebola virus but may be abnormal if an individual has the disease include: Elevated serum creatinine or urea levels Elevated serum glucose levels and elevated serum aspartate aminotransferase levels. Chest radiographs may also be performed in patients with respiratory symptoms. 
Ebola virus disease (EVD) is primarily found in Africa, where it originated in some species of bats and primates such as gorillas and apes. Both hosts are known “hosts” of Ebola virus disease and both can be affected by the disease. Spread to humans in two ways: hunting and eating Bushmeat or eating food contaminated with bat droppings. Once a human is infected, Ebola virus disease is spread through contact with bodily fluids (blood, sweat, vomiting, diarrhea, saliva, feces, urine, genital secretions, and breast milk). Risk remains even if disease develops on its own due to viral shedding Spread through contact with semen, breast milk, saliva, feces, tears and possibly urine. Other transmission mechanisms include reuse of improperly sterilized needles and lack of clean water for handwashing. 
While this is the scientific explanation for the Ebola Virus, there are myths surrounding this disease and making people in Africa mistrustful. The first myth is that a plane full of witches crashed and caused the first epidemic. The second myth is that a snake was released from cover coffin made and owned by an unknown husband went to murder. So there is a stigma attached to this disease.
The Ebola virus can affect most systems throughout the body including but certainly not limited to: 
- Coagulopathy (increased fibrin degradation products, decreased clotting factors, and thrombocytopenia)
- Adrenal insufficiency (impaired hormone secretion, leading to hypotension, hypovolemia, and renal sodium loss)
- GI hemorrhage (lower and upper)
- hepatocellular lesions
- hepatocellular necrosis
- liver damage
- systemic inflammatory response
- metabolic encephalopathy
- conjunctival infection
- acute kidney injury
- renal dysfunction
Medical management is a careful process of isolating symptom management and experimental drug therapy. Ebola has an incubation period of up to 21 days, during which time patients may be asymptomatic. There are three stages of Ebola with different symptoms. this The first stage is usually less symptomatic and may include headache, myalgias, and fever >37.5°C. The second stage includes various gastrointestinal symptoms such as nausea, vomiting, diarrhea and dehydration. The final stage is recovery or deterioration, including neurological changes Collapse and internal or external bleeding lead to death. 
Once a patient is suspected of having Ebola, they are placed in isolation in order to prevent the spread of the virus. The patient is then tested for the presence of Ebola (see Diagnostic Tests for additional information). At the same time whoever the patient came into contact within the last 21 days is required and a BID temperature reading is required in order to rule out the presence of a fever that may indicate the spread of the virus. The virus usually does not spread until symptoms occur but if hospitalization is not possible and early non-EVD significant symptoms may not be caught until symptoms have been present for several days. “The most common symptoms reported at symptom onset and observed in 2014 were fever (87.1%) fatigue (76.4%) loss of appetite (64.5%) vomiting (67.6%) . fever (65.6%) headache (53.4%) abdominal pain (44.3%) and unexplained bleeding (18%)”.
After isolation, the patient undergoes a thorough medical examination in order to rule out other infections and confirm the presence of the Ebola virus. The assessment includes but is not limited to temperature respiratory blood pressure and physical examination. Then the patient does the identified symptoms begin to respond. Fluid and electrolyte replacement is initiated in order to combat fluid deficiency caused by inflammation and diarrhea. Medications such as paracetamol and opioid analgesics are administered to combat the first stages of fever and arthritis. Anti-inflammatory drugs administered orally or intravenously in an attempt to reduce the amount of inflammation. In addition to these, other medications may be given as the virus progresses depending on the symptoms experienced by the patient. There are currently no drugs proven to prevent Ebola but two drugs are. test phase that may be available to the public in the future. There are several emerging therapies designed to combat the Ebola virus. Most were created during the most recent Ebola outbreak. As it was an emergency situation, many of the treatments have not have been tested to see if they are beneficial or if there are any long-term side effects. (For more information see Diagnositc Tests and Medications)
Physical Therapy Management
A very important aspect of physical therapy management related to Ebola is the ability to recognize early signs and symptoms of disease and refer patients to physicians for treatment . A key part of this is taking a deep dive into the patient’s medical history, paying special attention to Information about recent travel to areas where Ebola is endemic, or if the patient has been in contact with someone diagnosed with Ebola. Another factor that can aid in early identification is knowing the possible signs and symptoms of the virus (especially since These can be vague and nonspecific in the early stages of the disease) and the patient should be thoroughly examined . Physiotherapists may also need to educate patients planning to travel to areas of Africa where Ebola is present about infection risk information. Exposure and Prevention. The best resource for individuals to obtain this information is the Centers for Disease Control and Prevention website: www.cdc.gov/vhf/ebola/
Another way that physical therapy management may be relevant to Ebola cases is in treating patients who have survived the virus and are recovering. Post-Ebola syndrome is present in nearly all survivors of the disease who report symptoms that persist or develop after an acute episode After illness and discharge from hospital  70% of patients experience musculoskeletal pain consisting of myalgia and arthralgia, which has become a major health concern for these individuals . Difficulty walking with unexplained pain in specific areas (such as knees, thighs, and back) Extensive musculoskeletal and joint pains have been reported as problems experienced by these patients affecting their function. Most musculoskeletal symptoms are currently treated with analgesics.  However, since physiotherapists specialize in treating musculoskeletal Condition and ability to restore and improve an individual’s function It stands to reason that Ebola survivors with post-Ebola syndrome would benefit greatly from physical therapy.
Ebola initially has many nonspecific symptoms, and once symptoms begin, they can resemble many different diseases. Some of these symptoms include fever, fatigue, nausea, vomiting, abdominal pain, diarrhea, rash, headache, muscle pain and general weakness. symptomatic disease Similar to what Ebola might be mistaken for:
Campylobacter and related infections : www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/i-campylobacter-i-and-related-infections
Oki Mushi Disease : www.merckmanuals.com/professional/infectious-diseases/intestinal-protozoa/cryptosporidiosis
Lassa Arthritis: www.merckmanuals.com/professional/infectious-diseases/arboviridae-arenaviridae-and-filoviridae/lassa-fever.
Septic Shock : www.merckmanuals.com/professional/critical-care-medicine/sepsis-and-septic-shock/sepsis-and-septic-shock10001.
Case Reports/ Case Studies
1. Kreuels B Wichmann D Emmerich P Schmidt-Chanasit J de Heer G Schmiedel S et al. A case of severe Ebola virus infection complicated by Gram-negative bacterial sepsis. New England Journal of Medicine 2014;371(25):2394-2401. Available from: CINAHL. 
2. Liddell A Davey R Mehta A Varkey J Kraft C Uyeki T et al. Characteristics and clinical management of 3 patients with Ebola virus disease, including the first domestic case of infection in the United States. Annals of Internal Medicine 2015;163(2):81-90. Available from: MEDLINE. 
3. Lopaz M Amela C Ordobas M Dominguez-Berjon M Alvarez C Astray J et al. The first secondary case of Ebola outside Africa: Epidemiological characteristics and contact surveillance in Spain September-November 2014. European Monitoring: Bulletin Européen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin 2015; 20(1). Available from: MEDLINE.
4. Lyon G Mehta A Varkey J Brantly K Plyler L Ribner B et al. Treatment of two patients with Ebola virus infection in the United States. New England Journal of Medicine 2014;371(25):2402-2409. Available from: MEDLINE.
Centers for Disease Control and Prevention – Ebola Virus
World Health Organization – Ebola Virus Disease
Pan American Health Organization – Ebola
Doctors Without Borders – Ebola
Medline Plus – Ebola
- ↑ Jump up to:1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Beeching N, Fenech M, Houlihan C. Ebola virus disease. BMJ 2014;349(7897):7348-5. http://www.bmj.com/content/349/bmj.g7348.full (accessed 3 April 2016).
- ↑ Jump up to:2.0 2.1 2.2 Zhang Y, Li D, Jin X, Huang Z. Fighting Ebola with ZMapp: spotlight on plant-made antibody. Science China. Life Sciences 2014;57(10):987-988. http://link.springer.com/article/10.1007/s11427-014-4746-7 (accessed 21 March 2016).
- ↑ Pettitt J, Zeitlin L, Kim D, Working C, Johnson J, Olinger G, et al. Therapeutic intervention of Ebola virus infection in rhesus macaques with the MB-003 monoclonal antibody cocktail. Science Translational Medicine 2013;5(199): 199ra113. http://stm.sciencemag.org/content/5/199/199ra113.full (accessed 23 March 2016).
- ↑ Jump up to:4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Barry M, Touré A, Traoré F, Sako F, Sylla D, Vanhems P, et al. Clinical Predictors of Mortality in Patients With Ebola Virus Disease. Clinical Infectious Diseases 2015;60(12):1821-1824. http://cid.oxfordjournals.org/content/early/2015/04/01/cid.civ202.full (accessed 2 April 2016).
- ↑ Jump up to:5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 Liddell A, Davey R, Mehta A, Varkey J, Kraft C, Uyeki T, et al. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States. Annals Of Internal Medicine 2015;163(2):81-90. http://annals.org/article.aspx?articleid=2292050 (accessed 23 March 2016).
- ↑ Jump up to:6.0 6.1 6.2 6.3 6.4 Boulton J. Ebola revisited: lessons in managing global epidemics. British Journal Of Nursing 2015;24(13):665-669. http://www.ncbi.nlm.nih.gov/pubmed/26153804 (accessed 3 April 2016).
- ↑ Van Bortel T, Basnayake A, Wurie F, Jambai M, Sultan Koroma A, Nellums L, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bulletin Of The World Health Organization 2016;94(3):210-214. http://www.who.int/bulletin/volumes/94/3/15-158543/en/ (accessed 3 April 2016).
- ↑ Jump up to:8.0 8.1 8.2 8.3 Scott J, Sesay F, Massaquoi T, Idriss B, Sahr F, Semple M. Post-Ebola Syndrome, Sierra Leone. Emerging Infectious Diseases 2016;22(4):641. http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article (accessed 21 March 2016).
- ↑ Barry M, Traoré F, Sako F, Kpamy D, Bah E, Touré A, et al. Ebola outbreak in Conakry, Guinea: epidemiological, clinical, and outcome features. Médecine Et Maladies Infectieuses 2014;44(11-12):491-494. http://fieldresearch.msf.org/msf/bitstream/10144/336621/1/Barry+M+-+2014+-+Ebola+Outbreak+in+Conakry%2C+Guinea.pdf (accessed 23 March 2016).
- ↑ Jump up to:10.0 10.1 Lyon G, Mehta A, Varkey J, Brantly K, Plyler L, Ribner B, et al. Clinical care of two patients with Ebola virus disease in the United States. The New England Journal Of Medicine 2014;371(25):2402-2409. http://www.nejm.org/doi/full/10.1056/NEJMoa1409838 (accessed 3 April 2016).
- ↑ Fletcher T, Fowler R, Beeching N. Understanding organ dysfunction in Ebola virus disease. Intensive Care Medicine 2014;40(12):1936-1939. http://www.ncbi.nlm.nih.gov/pubmed/25366120 (accessed 21 March 2016).
- ↑ Jump up to:12.0 12.1 Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Schmiedel S, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. New England Journal Of Medicine 2014;371(25):2394-2401.http://www.nejm.org/doi/full/10.1056/NEJMoa1411677 (accessed 2 April 2016).