Ebola physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]; João André Alves Silva, M.D. [3]

Overview[edit | edit source]

Ebola hemorrhagic fever is commonly associated with fever on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as tachycardia or relative bradycardia, orthostatic hypotension, and tachypnea. Physical examination may also be remarkable for abdominal tenderness and distension, evidence of mucosal or visceral bleeding, and neurological impairment.^[1][2][3]

Physical Examination[edit | edit source]

Appearance of the Patient[edit | edit source]

The general appearance of the patient depends on the stage of the disease. Typically, patients demonstrate prostration, may be nauseated and vomiting, and less commonly present with signs of hemorrhage, such as epistaxis or gingival bleeding. In later stages of the disease, patients are often brought with convulsions or are in a state of shock, stupor, or coma.^[4]

Vitals[edit | edit source]

Temperature[edit | edit source]

• High-grade fever is often present in more than 80% of patients. Fever is the most common presenting sign of Ebola virus infection.

Pulse[edit | edit source]

• Tachycardia
• Relative bradycardia

Blood Pressure[edit | edit source]

• Hypotension (SBP<90 mmHg and/or DBP<60 mmHg)
• Postural hypotension is common in dehydrated patients with inadequate volume repletion

Respiratory Rate[edit | edit source]

• Signs of respiratory difficulty may be present, such as:

• Intercostal retractions
• Paradoxical breathing
• Nasal flare

• Tachypnea often precedes death during final hours of infection.

Skin[edit | edit source]

Hemorrhagic manifestations tend to occur during the more severe stages of the disease and may include:^[1]

• Maculopapular rash on the trunk, usually between the 5th and 7th day of the condition, associated with different stages of erythema and desquamation, which is a valuable finding in differentiating Ebola from other diseases.
• Petechiae is a common finding
• Ecchymoses is a common finding
• Mucosal hemorrhages is a common finding
• Uncontrolled bleeding from venipuncture locals is a common finding

Eyes[edit | edit source]

• Conjunctival hemorrhage is a the most common sign of abnormal clotting
• Conjunctivitis

Nose[edit | edit source]

• Epistaxis may be present.
• Nasal discharge may be present.^[1]

Throat[edit | edit source]

• Mucosal hyperemia of the oral cavity is a common finding.
• Bleeding gums is a common finding.

Abdomen[edit | edit source]

• Abdominal tenderness may suggest pancreatitis, intestinal swelling, or mesenteric lymphadenopathy
• Abdominal distention may suggest paralytic ileus
• Tender hepatomegaly
• Splenomegaly

Extremities[edit | edit source]

• Edema may be present.

Neurologic[edit | edit source]

• Obtundation may be present.^[5][6][7]
• Stupor
• Coma

References[edit | edit source]