Prof Dr Suhail N. Sheikh
PROFESSOR & H.O.D, Department of Repertory, Motiwala Homoeopathic Medical College & Hospital Nasik- 422222
Dr Noor S Sheikh, M.B.B.S
Consulting Family Physician
Ebola virus disease (EVD) also once known as Ebola haemorrhagic fever, is a severe and a fatal illness in humans and animals. The fatality rate in an infected person is of up to 90%. The outbreak of this infection first occurred in remote villages in Central and West Africa, near tropical rainforests. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The natural host of the Ebola virus is fruit bats of the Pteropodidae family. Severely ill patients require intensive supportive care. No specific treatment or vaccine is available at present for use in people.
Introduction: First of all we must understand what actually a virus is.Viruses are capsules with genetic material inside. They are very tiny. The infection viruses can cause varies from mild infectious diseases such as the common cold, influenza to severe illnesses such as HIV, Smallpox, and Bird flu to hemorrhagic fevers. They invade normal cells and multiply in those cells and produces viruses similar to them i.e. they can only reproduce inside a host’s living cell. This kills the cells and causes sickness in us. As this viruses live in our body cells it’s very difficult to kill them because medicines flow in the main blood stream and cannot reach this viruses easily. Antibiotics have no role in treating a viral infection. Only vaccines are helpful in preventing these diseases. That’s why some of the most serious communicable diseases known to medical science are viral in origin. Viruses pose a considerable challenge to the body’s immune system because they hide inside cells. T-lymphocytes which are special immune system cells can recognise and kill cells containing viruses as this infected cells surface are changed when the virus begins to multiply.
It is possible to vaccinate against many serious viral infections such as measles, mumps, hepatitis A and hepatitis B. But some viruses are capable of mutating from one person to the next. Vaccination for these kinds of viruses is difficult, because the viruses have already changed their format by the time vaccines are developed and these virus can keep dodging the immune system.
Different types of viruses.
The four main types of virus include:
- Icosahedral – the outer shell (capsid) is made from 20 flat sides, which gives a spherical shape. Most viruses are icosahedral.
- Helical – the capsid is shaped like a rod.
- Enveloped – the capsid is encased in a baggy membrane, which can change shape but often appears spherical.
- Complex – the genetic material is coated, but without a capsid.
What is ebola infection: Ebola hemorrhagic fever (Ebola HF) is one of a Viral Hemorrhagic Fevers. There are actually five Ebola viruses in the Ebola virus genus, with four of them known to infect humans causing Ebola virus disease, a highly lethal form of hemorrhagic fever. It is a severe form of disease and often fatal in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees). Ebola disease first appeared in 1976 in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo simultaneously. This disease originated in a village situated near the Ebola River, in the region of Yambuku, (Democratic Republic of Congo), from which the disease takes its name.
Genus Ebola virus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburg virus and genus Cueva virus. Genus Ebola virus comprises 5 distinct species:
- Bundibugyo ebolavirus (BDBV)
- Zaire ebolavirus (EBOV)
- Reston ebolavirus (RESTV)
- Sudan ebolavirus (SUDV)
- Taï Forest ebolavirus (TAFV).
BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa
As the natural reservoir of ebolaviruses has not yet been identified. How the virus first appears in a human at the start of an outbreak is yet unknown. But hypothetically the researchers say that the first patient became infected through contact with an infected animal. The risk assessment in endemic areas difficult as the source of infection is not identified. Health workers, attending doctors, family members and friends of the infected persons at the highest risk of contracting the disease.
Ebola infection is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa it has been documented the Ebola infection has been transmitted through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, which has been found ill or dead . It also spreads in the population through human-to-human transmission. When a person comes in direct contact with the blood, secretions, organs or other bodily fluids of infected people, and by indirect contact like environments contaminated with such fluids. In Africa, transmission of Ebola infection in healthcare settings has been associated with reuse of contaminated needles and syringes and with provision of patient care without appropriate barrier precautions to prevent exposure to virus-containing blood and other body fluids. The risk for person-to-person transmission of hemorrhagic fever viruses is greatest during the latter stages of illness when virus loads are highest. No Ebola infection has been reported in persons whose contact with an infected person occurred only during the incubation period (i.e., before onset of fever).
It’s also seen that during burial ceremonies where mourners come in direct contact with the body of the deceased person can also have the transmission of Ebola. Semen of a man who has recovered from Ebola infection can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
The first outbreak in West African countries began in Guinea in March 2014. And has now spread to Liberia and Sierra Leone.
Signs and symptoms
Ebola infection is a severe acute viral illness. It is characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
Symptoms of Ebola HF typically include:
Fever , Headache , Joint and muscle aches , Weakness , Diarrhea , Vomiting , Stomach pain , Lack of appetite
Some patients may experience:
- A Rash , Red Eyes , Cough , Sore throat , Chest pain , Difficulty breathing , Difficulty swallowing , Bleeding inside and outside of the body
Some people who become sick with Ebola HF are able to recover, while others do not. The reason behind this is yet not fully understood. But it’s seen that the patients who die due to this infection usually have not developed a significant immune response to the virus at the time of death.
The most important and challenging is the diagnosis of this disease, since this disease is difficult to diagnose clinically in the early stages of infection. As the early symptoms such as headache and fever are nonspecific to ebola viruses, hence there can be a missed diagnosis of the ebola HF cases.
But ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:
- Antibody-capture enzyme-linked immunosorbent assay (ELISA)
- Antigen detection tests
- Serum neutralization test
- Reverse transcriptase polymerase chain reaction (RT-PCR) assay
- Electron microscopy
- Virus isolation by cell culture.
Laboratory tests used in diagnosis include:
|Within a few days after symptoms begin||INVESTIGATION :
|Later in disease course or after recovery||INVESTIGATION :IgM and IgG antibodies|
Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
People are said to be infectious as long as their blood and secretions contain the Ebola virus. The incubation period is said to be from 2 to 21 days.
Treatment: NIH recently announced that it will begin a trial on Ebola vaccines this September 2014.Yet there is no other treatment or established cure for Ebola virus infection. Standard treatment for Ebola HF is still limited to supportive therapy. This consists of:
- Balancing the patient’s fluids and electrolytes.
- Maintaining their oxygen status and blood pressure.
- Treating them for any complicating infections.
Researchers at the University of Texas Medical Branch investigated the potential therapeutic role of two so-called ‘kinase inhibitors’ in interfering with Ebola virus: 1) the plant compound genistein 2) the pharmaceutical drug tyrophostin. Genistein was able to reduce harm from infection from a virus that causes an Ebola-like viral hemorrhagic fever (VHF) in hamsters.
The researchers sought to identify genistein and tyrophostin’s ability to inhibit viral entry of various viruses known to cause hemorrhagic fever, including Ebola.The study found both genistein and tyrophostin individually inhibit the entry of these viruses into the cells, both through interfering with endocytosis (the process by which a cell pulls in a virus) and uncoating proteins (the process by which a virus alters proteins on the surface of the host cell to gain entry). It was also observed that a synergistic effect occurred when genistein and tyrophostin were added together
- The prevention of Ebola HF presents many challenges. Because it is still unknown how exactly people are infected with Ebola HF, there are few established primary prevention measures.
- When cases of the disease do appear, there is increased risk of transmission within health workers. Health care workers must be able to recognize a case of Ebola HF earlier and isolation precautions or barrier nursing techniques method must be used. Diagnostic tests should be done immediately.
What is a Barrier nursing technique?
- It is wearing of protective clothing (such as masks, gloves, gowns, and goggles)
- The use of infection-control measures (such as complete equipment sterilization and routine use of disinfectant)
- And most important is isolation of Ebola HF patients from contact with unprotected persons.
The aim of all of these techniques is to avoid contact with the blood or secretions of an infected patient. If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented.
Homoeopathic medicines: As a preventative if an outbreak happens nearby, Crotalus Horridus 30C, one dose daily, until the threat is out of the area is the method many homeopaths familiar with this disease suggest. Crolatus Horridus also fits the Ebola virus nearly 95% symptom-wise!
Crotalus Horridus – Is to be considered for when there is difficulty swallowing due to spasms and constriction of the throat, dark purplish blood, and edema with purplish, mottled skin. HEMORRHAGE: FROM ANY ORIFICE. Passive, dark unclotted blood. In very sick, weakened persons with fever. Septic and zymotic fevers. SKIN: Mottled. Bluish spots. Jaundice. Ecchymosis. Erysipelas. Boils, carbuncles, surrounded by purplish skin. Gangrene. Network of blood vessels.
Bothrops – Is the remedy to think of when nervous trembling, difficulty articulating speech, sluggishness, swollen puffy face, black vomiting are present. Broken-down, hemorrhagic constitutions; septic states. Great lassitude and sluggishness; hemorrhages’ from every orifice of the body; black spots.
Lachesis mutus – When there’s delirium with trembling and confusion, hemorrhaging in any area, consider this remedy. Often, the person cannot bear tight or constricting clothing or bandages and feels better from heat and worse on the left side. Lachesis decomposes the blood, rendering it more fluid; hence a hemorrhagic tendency is marked. Purpura, septic states, diphtheria, and other low forms of disease, when the system is thoroughly poisoned and the prostration is profound.Gums swollen, spongy, bleed. Chilly in back; feet icy cold; hot flushes and hot perspiration.
Mercurius corrosivus – For copious bleeding, better when lying on the back with the knees bent up, delirium, headache with burning cheeks, photophobia, black swollen lip, metallic, bitter or salt taste in mouth.
Secale cornutum – For thin, slow, painless oozing dark hemorrhage with offensive odor, cold skin and tingling in the limbs. The individual wants to be uncovered and feels WORSE from motion.This produces an anaemic condition, coldness, numbness, petechiae, mortification, and gangrene. Haemorrhages; continued oozing; thin, fetid, watery black blood. Debility, anxiety, emaciation, though appetite and thirst may be excessive. Shriveled, numb; mottled dusky-blue tinge.
Echinacea – For when there’s sepsis or blood poisoning, fetid smelling discharges and enlarged lymph nodes.”Corrector of blood dyscrasia”. Acute auto-infection. Symptoms of blood poisoning, septic conditions generally. Foul discharges with emaciation and great debility. Chilliness, with nausea. Cold flashes all over back.
- NIH: National Institute of Allergy and Infectious Diseases.
- Bausch DG. Viral hemorrhagic fevers. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 389.
- Peters CJ. Marburg and ebola virus hemorrhagic fevers. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 164.
- World Health Organization
- NATIONAL CENTER FOR INFECTIOUS DIEASES.AND DISEASE CONTROL.
- University of Texas Medical Branch