An ED Dilemma: Ebola Symptoms Often Mimic Other Common Conditions

October 9th, 2016

BALTIMORE – If an isolated case of Ebola virus disease (EVD) shows up in a U.S. emergency department, it is highly likely to be confused with other, more common conditions, according to a new Ebola primer for clinicians.

In the absence of a clear epidemiological link such as travel or exposure history, 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 the primer, published recently in the journal Disaster Medicine and Public Health Preparedness.

“The size and ongoing nature of the West African outbreak makes it clear that the further importation of EVD to the United States will remain a real possibility for the indefinite future. American clinicians, particularly those who work in emergency medicine, critical care, infectious diseases, and infection control, should be familiar the fundamentals of EVD including its diagnosis, treatment, and control,” write the article’s authors from the University of Pittsburgh Medical Center’s Center for Health Security in Baltimore and the university’s schools of medicine and public health in Pittsburgh.

The primer cautions that routine laboratory testing may show a variety of nonspecific abnormalities at various stages of the illness, including lymphopenia, leukocytosis with a left shift, thrombocytopenia, elevated transaminases, and evidence of disseminated intravascular coagulation (DIC).

The more specific test for Ebola, reverse transcriptase polymerase chain reaction, is available in many state public health laboratories and at the CDC.

Once the diagnosis of EVD is suspected or has been made, the article describes steps that must be undertaken to prevent further spread of the disease, including isolation with droplet/contact precautions and healthcare workers using appropriate personal protective equipment such as fluid-impervious gowns, gloves, respiratory protection, and eye protection. According to the journal article, Ebola enters the host through mucous membranes, breaks in the skin -- including microabrasions -- and punctures.