EBOLA and EBOLA and MARBURGMARBURG

Viral InfectionsViral Infections

Dr.T.V.Rao MDDr.T.V.Rao MD

Viral Hemorrhagic feversViral Hemorrhagic fevers

• The term viral hemorrhagic fever refers to a The term viral hemorrhagic fever refers to a clinical syndrome characterized by acute clinical syndrome characterized by acute onset of fever accompanied by nonspecific onset of fever accompanied by nonspecific findings of malaise, prostration, diarrhea,and findings of malaise, prostration, diarrhea,and headache. Patients frequently show signs of headache. Patients frequently show signs of increased vascular permeability, and many increased vascular permeability, and many develop bleeding diatheses. The hemorrhagic develop bleeding diatheses. The hemorrhagic fever viruses represent potential agents for fever viruses represent potential agents for biologic warfare because of capability of biologic warfare because of capability of aerosol transmission, high morbidity,and aerosol transmission, high morbidity,and mortality associated with infection, and ability mortality associated with infection, and ability to replicate in cell culture in high to replicate in cell culture in high concentrations., The important infecting concentrations., The important infecting agents are Ebola and Marburg agents are Ebola and Marburg

Ebola and Marburg VirusEbola and Marburg Virus

• Ebola and Marburg viruses are highly Ebola and Marburg viruses are highly virulent in humans and non human virulent in humans and non human primates, ends in death.primates, ends in death.

• Both the viruses are identified to Both the viruses are identified to cause African hemorrhagic feverscause African hemorrhagic fevers

FilovirusFilovirusFilo is LatinFilo is Latin for for ThreadThread

• Marburg and Ebola Marburg and Ebola are members of the are members of the FiloviridaeFiloviridae

• Appear as long Appear as long threads,threads,

• Can be U shaped,Can be U shaped,• Genome 19 kb longGenome 19 kb long• Enveloped viruses.Enveloped viruses.• A single stranded, A single stranded,

unregimented, -unregimented, -Helical, –ve sense Helical, –ve sense RNA genomeRNA genome

• 80 nm Diameter80 nm Diameter

Events on EbolaEvents on Ebola

• Ebola virus were discovered in 1976 with Ebola virus were discovered in 1976 with occurance of two severe epidemics of occurance of two severe epidemics of hemorrhagic fever in Sudan and Zaire.hemorrhagic fever in Sudan and Zaire.

• The Epidemic invloved > 500 persons and The Epidemic invloved > 500 persons and killed > 400 infected individual.killed > 400 infected individual.

• The importance of epidemic lies with in The importance of epidemic lies with in each outbreak hospital staff become each outbreak hospital staff become infected through close contact with infected through close contact with patients, their blood and excreta.patients, their blood and excreta.

• The mean time of death from onset to The mean time of death from onset to symptoms is 7 – 8 days.symptoms is 7 – 8 days.

Events on MarburgEvents on Marburg

• Marburg Viruses were discovered in Marburg Viruses were discovered in 19671967

• First identified in Laboratory workers First identified in Laboratory workers exposed to tissues of African green exposed to tissues of African green Monkeys imported to Germany and Monkeys imported to Germany and Yugoslavia.Yugoslavia.

• Transmission from patients to Medical Transmission from patients to Medical personal occurred with highly mortality.personal occurred with highly mortality.

• Marburg virus can infect Guinea pigs, Marburg virus can infect Guinea pigs, Mice, Hamsters, MonkeysMice, Hamsters, Monkeys

Epidemic Outbreaks of Epidemic Outbreaks of MarburgMarburg

• Out breaks occured Out breaks occured in Kenya, South in Kenya, South Africa, Democratic Africa, Democratic Republic of Congo.Republic of Congo.

• Recent outbreak in Recent outbreak in Angola in 2005Angola in 2005

Ebola PatientEbola Patient

Reservoir HostsReservoir Hosts• Reservoirs can be a Reservoirs can be a

Rodent or BatRodent or Bat• Humans infected Humans infected

accidentallyaccidentally• Monkeys are not Monkeys are not

proved as reservoirs proved as reservoirs as die with infection as die with infection earlyearly

• Infected humans are Infected humans are rich source of rich source of infections to others.infections to others.

• By direct contact with By direct contact with blood and body fluids blood and body fluids of infected persons of infected persons can spread the can spread the diseasedisease

Spread of InfectionsSpread of Infections

• Transmission appears to be associated Transmission appears to be associated with contamination of Blood, Blood with contamination of Blood, Blood stained body fluids or tissues.stained body fluids or tissues.

• Nosocomial spread is common mode of Nosocomial spread is common mode of spread, Doctors and Nurses at risk spread, Doctors and Nurses at risk when attending the patients.when attending the patients.

• Transmission by sexual intercourse Transmission by sexual intercourse has been on record from a case of man has been on record from a case of man infecting his wife 83 days after initial infecting his wife 83 days after initial infection.infection.

Viral ReplicationViral Replication

• The viruses are The viruses are grown in variety of grown in variety of cell lines includingcell lines including

VeroVero

M A 104M A 104

S W 13 cellsS W 13 cells

Filoviruses replicates Filoviruses replicates in the cytoplasam in the cytoplasam

Pathology and Pathology and PathogenesisPathogenesis

• The viruses belong to The viruses belong to group of Filovirusesgroup of Filoviruses

• The viruses have The viruses have tropism fortropism for

Cells of macrophage Cells of macrophage systemsystem

Dendritic cellsDendritic cells Interstitial fibroblastsInterstitial fibroblasts Endothelial cellsEndothelial cells

Mode of SpreadMode of Spread

Virus infect several Virus infect several OrgansOrgans

• High titer of High titer of viruses are viruses are found infound in

LiverLiver Spleen,Spleen, LungsLungs KidneysKidneys BloodBlood Other Body Other Body

fluidsfluids

How the Illness is How the Illness is Presented in Marburg and Presented in Marburg and

EbolaEbola FeverFever• Head acheHead ache• Sore throat Sore throat • Muscle painMuscle pain• Abdominal pain,Abdominal pain,• VomittingVomitting• DiarrheaDiarrhea• Incubation period 3 -9 Incubation period 3 -9

days in days in MarburgMarburg• In In EbolaEbola 2 – 21 days. 2 – 21 days.

Serious manifestation of Serious manifestation of Ebola and MarburgEbola and Marburg

Internal and Internal and External External bleeding,bleeding,

Shock,Shock,

DeathDeath

DiagnosisDiagnosis

• Viruses are Viruses are isolated from Blood isolated from Blood by cell culture on by cell culture on Vero cells ( Vero –Vero cells ( Vero –E 6 )E 6 )

• ELISA for antigen ELISA for antigen detectiondetection

• ELISA for IgMELISA for IgM• RT - PCRRT - PCR

Control of InfectionControl of Infection

• Isolation facilities Isolation facilities within the Hospital within the Hospital remain the most remain the most important important effective measure.effective measure.

• Barrier nursing Barrier nursing remain the basic remain the basic need in control of need in control of infection spreadinfection spread

The health care workers The health care workers shouldshould

AvoidAvoid

Infected Infected Blood,Blood,

secretions,secretions,

Tissues,Tissues,

WastesWastes

Treatment of Ebola and Treatment of Ebola and MarburgMarburg

• Antiviral drugs are not availableAntiviral drugs are not available• Interferons are not effectiveInterferons are not effective• To date no VaccineTo date no Vaccine• Electrolyte correctionsElectrolyte corrections• Dealing with hemorrhagic Dealing with hemorrhagic

complicationscomplications..

Barrier Nursing remains Barrier Nursing remains the only best option in the only best option in

PreventionPrevention

Created for Health Created for Health awarness on awarness on FilovirusesFiloviruses

Dr.T.V.Rao MDDr.T.V.Rao MD

EmailEmail

doctortvrao@gmail.comdoctortvrao@gmail.com