Ebola physical examination

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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]

1. ↑ 1.0 1.1 1.2 Feldmann, Heinz; Geisbert, Thomas W (2011). "Ebola haemorrhagic fever". The Lancet. 377 (9768): 849–862. doi:10.1016/S0140-6736(10)60667-8. ISSN 0140-6736.
2. ↑ Formenty, Pierre; Hatz, Christophe; Le Guenno, Bernard; Stoll, Agnés; Rogenmoser, Philipp; Widmer, Andreas (1999). "Human Infection Due to Ebola Virus, Subtype Côte d'Ivoire: Clinical and Biologic Presentation". The Journal of Infectious Diseases. 179 (s1): S48–S53. doi:10.1086/514285. ISSN 0022-1899.
3. ↑ Gradon J (2000). "An outbreak of Ebola virus: lessons for everyday activities in the intensive care unit". Crit Care Med. 28 (1): 284–5. PMID 10667555.
4. ↑ Borchert, Matthias; Mutyaba, Imaam; Van Kerkhove, Maria D; Lutwama, Julius; Luwaga, Henry; Bisoborwa, Geoffrey; Turyagaruka, John; Pirard, Patricia; Ndayimirije, Nestor; Roddy, Paul; Van der Stuyft, Patrick (2011). "Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned". BMC Infectious Diseases. 11 (1): 357. doi:10.1186/1471-2334-11-357. ISSN 1471-2334.
5. ↑ Ndambi R, Akamituna P, Bonnet MJ, Tukadila AM, Muyembe-Tamfum JJ, Colebunders R (1999). "Epidemiologic and clinical aspects of the Ebola virus epidemic in Mosango, Democratic Republic of the Congo, 1995". J Infect Dis. 179 Suppl 1: S8–10. doi:10.1086/514297. PMID 9988156.CS1 maint: Multiple names: authors list (link)
6. ↑ Bwaka MA, Bonnet MJ, Calain P, Colebunders R, De Roo A, Guimard Y; et al. (1999). "Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients". J Infect Dis. 179 Suppl 1: S1–7. doi:10.1086/514308. PMID 9988155.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
7. ↑ Feldmann H, Geisbert TW (2011). "Ebola haemorrhagic fever". Lancet. 377 (9768): 849–62. doi:10.1016/S0140-6736(10)60667-8. PMC 3406178. PMID 21084112.CS1 maint: PMC format (link)