Ebola Primer

Ebola virus has been front-page news recently and the arrival of Dr. Kent Brantley at Emory University Hospital in Atlanta was the first Ebola infected patient to be transported to the U.S. for care.  This required a specially equipped air evacuation plane for transport from Liberia to Atlanta and for Emory University Hospital to work with the CDC to set up a special isolation unit for his care.  The concern for human to human spread of the virus is highlighted because spread of the virus to health care workers (Dr. Brantley and the U.S. nurse Nancy Writebol being prime examples) is a large part of the reason this is newsworthy.

Ebola virus disease is caused by at least 3 species of viruses in the Ebolavirus genus of the family of viruses called filoviridae. These three species, Bundibugyo evolavirus, Zaire ebolavirus, and Sudan ebolavirus have caused the known large scale Ebola virus disease outbreaks in Africa.  Another species called Reston ebolavirus is found in the Phillipines and although it has caused infection in humans it has not been known to be associated with illness or death of humans to date.

Ebola virus disease is an extremely severe illness in most cases.  Symptoms typically include high fever and chills, muscle pain and extreme weakness, headache, headache and sore throat.  These symptoms are typically followed by severe multisystem disease including kidney and liver failure, rash, gastrointestinal symptoms including vomiting and diarrhea, and often both internal and external bleeding. Death rates in most of the major outbreaks have exceeded 90% although in the current epidemic in Liberia for unknown reasons the death rate at least among the 45 health care workers who have become infected has been somewhat lower.

Ebola virus is believed to have fruit bats as its primary host.  In all of the areas where large scale outbreaks have occurred in areas where specific types of fruit bats are common. Other animals, especially other primates including chimpanzees and gorillas have noted, and spread to humans from these animals and others acting as accidental hosts, just as humans are accidental hosts when they become infected by ebola virus.

In West Africa it is believed that humans can become infected when they handle ill or dead infected animals.  Then human-to-human spread can occur through contact with infected body fluids of those infected with the virus, either through direct contact or by contact with environmental objects that have become contaminated by virus-containing body fluids or secretions.

Health care workers are at risk in the course of caring for patients with Ebola virus disease.  The vomiting, diarrhea and bleeding disorder these patients often exhibit makes avoiding exposure to the virus a challenge even when attempting to use proper protective attire.

The specially designed isolation unit at Emory Hospital in Atlanta where Dr. Bentley is receiving care is undoubtedly using the absolute best safety precautions. Still the risk of transmission of the virus to health care workers is real.  This risk of a wider-scale human-to-human outbreak in the U.S. seems exceedingly low, but it is just that risk that I suspect makes the return of Dr. Bentley to Atlanta so newsworthy.

For a more complete discussion of the history of Ebola virus disease and the virology see this WHO article.

Chikungunya Virus: The Latest Exotic Illness in the U.S.

Another disease previously not documented to have been acquired in the  continental US surfaced this month. A case of Chikungunya virus infection was diagnosed in a man in Florida on about July 15th, and in a Florida woman shortly thereafter.. I have to admit that this caught my eye primarily because of the unusual nameContinue Reading

Perception is Reality – Sort of Anyway

I found this NPR piece on the different perceptions of an episode of care from the patients vs. the medical team’s prespectives.  The patient gets extraordiary care yet feels neglected and almost abused.  A quick read you’ll enjoy. Heart of the Matter: Treating the Disease Instead of the Person Too often, especially in emergent orContinue Reading

World Cup Science

As the US prepares to play its first game in Brazil at the 2014 FIFA World Cup, I had a chance to peruse the most recent Scientific American and several soccer related articles.  This is available online, and for the science oriented fan of the beautiful game it’s worth a look.  Here are a fewContinue Reading

This Month in the Medical News

Followers may have noted that I’ve not very much  posted in a while.  This is primarily due to spring migration.  As an avid birder, I have been spending nearly every free daylight hour, and some non-daylignt hours afield enjoying this miracle of nature.  The neotropic songbirds and Arcitc breeding shorebirds have been racing past toContinue Reading

Should You Choose a Doctor with Poor Online Ratings?

Maybe so.  Common reasons for poor ratings of physicians online include refusal to prescribe antibiotics for viral illnesses and refusal to prescribe opioid pain medications upon demand.  Physicians are under pressure to “perform” well on patient satisfaction surveys,  to reign in the prescription opioid abuse epidemic and to limit prescribing of antibiotics for self-limited illnessesContinue Reading

Should Deer Populations be Reduced to Control Lyme Disease?

Lyme disease has reached epidemic proportions in America, especially in the East.  An estimated >30,000 cases of Lyme disease will be diagnosed and reported in the U.Sl this year and many more cases will go undiagnosed or unreported. This issue is close to my heart because the daughter of a good friend continues her battle toContinue Reading

DIY Hay Fever Therapy- The Time is Now

Do-it-yourself (DIY) management is now something many if not most hay fever sufferers can effectively accomplish. The approval of an over-the-counter nasal corticosteroid, Nasacort OTC in October 2013 makes this the first spring where the drug most of us prescribe as the mainstay of hay feverpre therapy is available without a prescription. This is anContinue Reading

The Price of Success: A Hepatitis C Update

In the United States Hepatitis C recently passed HIV as a cause of death.  The USPSTF has recommended screening all baby boomers for Hepatitis C, i.e. those born between 1945 and 1965, with a category B strength of recommendation. This makes Hepatitis C screening a preventative service that is covered by all insurance policies withoutContinue Reading

Rib Fractures Up Close and Personal

Friday was sunny, Mt Rainier was out (of the rain and clouds) and was calling to Kay and me last Friday. We were the first car up the road to Paradise right behind the ambulance.  Maybe this was a bad omen.  We got to the parking area, chatted with some overnight campers, and started toContinue Reading