Ebola Virus Explained Essay

Ebola computer computer computer virus Explained EssayIntroductionEbola virus is one of the close to virulent and fatal pathogens known to human. Ebola virus pestilents fool emerged from time to time since it was first sight in 1976 from the Democratic Republic of Congo, formerly known as Zaire, simply the largest known Ebola virus volcanic eruption up to date is ongoing at the time of writing this article, in West Africa. Approximately 550 000 cases atomic number 18 estimated to be account from Sierra Leone and Liberia by the 20th of January 2015. The transmission of the contagion to a number of countries including Guinea, Liberia, Sierra Leone, Nigeria and occasional cases being inform from USA, Canada, Netherland and India reveal the possible of the infection to get public depiction world widely. Despite this complaint being highly contagious, heart-threatening, and no specific treatment being found, it can be prevented with the recitation of proper infection preve ntion and control measures. The playing argona of the Ebola virus disease is important as that knowledge will pave the sort for the lessening of victims, the invention of an effective drug and will to a fault be efficacious in the management of a same epidemic.VirologyEbola virus is a piece of the family Filoviridae. As the name implies the virus is filamentous in shape. Marburg virus and Ebolavirus be the two main genera of the viral family which are medically important. Viruses of these two genera are studied and presented together receivable to their m each similarities in the life cycle, the native reservoirs, ways of transmission, clinical presentation, treatment and prevention measures. The only noned residue is that the Marburgvirus is spread by bat species adapted to open forests such as savannah whereas Ebolavirus is spread by bat species adapted to deep come down forests(1).Five subtypes of Ebolavirus namely, Ebolavirus zaire, Ebolavirus sudan, Ebolavirus rest on, Ebolavirus cote d Ivore, and Ebolavirus bundibugyo have been identified and named after the area in which they were first discovered(1). Of these E. Zaire was the first to be isolated and studied(1) and it is responsible for the about number of outbreaks(1) including the latest outbreak in 2014 in the lead which E. sudan accounted for of all Ebolavirus deaths(1). that for the slight lower fatality rate, E. sudan is more or less similar to E. zaire. The case fatality rate of E. sudan is reported as 40-60% and that of E. zaire as 60-90% (3).TransmissionEbola is signly contagious to human as a zoonosis. versatile species of fruit bats found by means ofout central and sub Saharan Africa as militarys (2),( 4). Contact with bats through bites and scratches or exposure to their secretions and excretions through broken skin or mucose membranes can cause the infection in humans (2), (4). The infection can also be transmitted through opposite end hosts. Those recorded from Afr ica are forest antelopes, porcupines, chimpanzees, gorillas, monkeys and former(a) non-human primates. Attacks during hunting these animals or handling infected animal carcasses have resulted in the introduction of the virus to the human population from the wild (1).The outbreak of the epidemic begins with the subsequent transmission of the infection from the index case to secondary individuals. An outbreak often begins from a single introduction to a human from the wild, which involves virus variants of little genetic mutation. Records reveal that outbreaks stemmed from multiple introductions lead to obvious chains of human to human transmission with a greater diversity in the virus variants(5).EVD is highly contagious. The infection may spread in the community and in the hospital environment through direct spot with infected personate fluids such as blood, secretions and excretions or wander of an shrill patient or through direct pass with contaminated textiles equivalent clothes and bed linen(1). One major reason for the rapid spread of the epidemic is the traditional funeral rituals, which admit cleansing of the cadaver, removal of hair experience nails, toe nails and clothing. People taking care of infected people including wellness care staff also have a high guess of contracting the disease. Moreover semen of male survivors is said to anticipate infected for up to 82 days after the onset of the symptoms. As large as the virus ashes in the body fluids the person remains infectious. Airborne transmission of Ebola virus is strongly suspect moreover is not yet experimentally proven.Clinical PresentationEVD caused by different strains of Ebola virus bring about different clinical features. Incubation period of Ebola virus is generally considered as 2 21 days. (1, 3) Ebola virus disease examines several(a) acutely developing constitutional prodromal symptoms which lead to a wide range of differential diagnosis including not only other vir al hemorrhagic fevers, notwithstanding also malaria (3), typhoid (3), cholera (1), other bacterial rickettsial and even non-infectious causes of bleeding.The evolution of the disease resembles that of a severe haemorrhagic fever. Patients present with high fever, temperatures being as high as 39-400C (3, 6), body aches and fatigue (3).Subsequently gastrointestinal symptoms such as epigastric pain nausea, vomits and /or diarrhoea without blood appear if fever persists until day 3 5 (6).After 4 5 days of illness (4) a macular roseola may appear but it may not be clear noticeable on dark skin (1). After this stage haemorrhage from different sites begin. Bleeding from both upper and lower digestive tract, respiratory tract, urinary tract, vagina in females can be ascertained (1, 3). Further petechiae on the buccal mucosa, skin and conjunctivae develop. Recurrent episodes of vomiting which prevents any oral divine guidance of fluids and large amounts of watery diarrhoea (5 or more liters per day) (6) contributes to a spacious fluid loss leading to dehydration. If fluid replacement is inadequate, prostration, severe lethargy and eventually hypovolaemic shock follows.Hypovolaemic shock has been reported in 60% of the cases (6). Despite the high body temperatures, patients acquire cold extremities due to fringy vasoconstriction. Rapid and thready pulses, tachypnea, oliguria or anuria can be observed (6). Simultaneously features such as asthenia chest and abdominal pain, pains in muscles and joints and headaches develop. Although in some cases cough and dyspnea proceed due to pulmonary haemorrhages, other respiratory symptoms notwithstanding for hiccups are uncommon (6). conjunctival injection is a common clinical feature. Neurologic symptoms that are normally seen are hypoactive and hyperactive delirium characterized by slowed cognitive functions, confusion, upthrust and rarely seizures (6). As the disease evolves internal bleeding can also start but gen erally by this time patients are already in a state of coma (1).It is reported that only 5% of the patients present with haemorrhage from gastro intestinal tract in the first place death. Most of the reported deaths have occurred due to shock during the 7th to 12th day of illness. Symptoms of 40% of the patients have improved around the 10th day though symptoms identical oral ulcers and thrush have developed. Most of the patients who survived up to the 13th day have shown a higher chance of ultimately getting recovered. Some patients who showed initial improvement of symptoms have developed neck rigidity and lowered levels of disposition which are associated with late mortality.PathologyExamination of autopsies and post-mortem biopsies is extremely useful in the study of the pathology of the ebola virus disease. Due to the biosafety risk to the autopsy personnel when handling specimens, pathological descriptions of only a limited number of cases are available (7).A common findin g of Haematoxilin and eosine stained tissue sections is oval shaped or filamentous eosinophilic intracellular inclusions which are formed by the accruement of nucleocapsids of the virus. These inclusions can be detected in macrophages, hepatocytes, endothelial cells, connective tissue fibroblasts etc. Immunohistochemical stains reveal viral antigens in cells of various infected tissues including macrophages, dendritic cells, epithelial cells of sweat and sebaceous glands, interstitial and tubular cells of the kidney, seminiferous tubules, endothelial cells and endocardial cells. In assenting necrotic cells and cell debris contain antigens in large quantities. Electron microscopy exhibits abundant free virus dissolveicles in dental consonant spaces, liver sinusoids, and interstitial cells of the testis and in dermic collagen. Karyorrhexis and caspase-mediated cell death are seen in the cells of the portal triads, macrophages of the red pulp of the spleen and in the tubular epithe lial cells of the kidney (7).Liver tissue shows the most symptomatic histopathological features including focal or widespread necrosis of hepatocytes and mild steatosis. Although usually inflammation is borderline, hyperplasia of kupfer cells and infiltration of mononucleate inflammatory cells is seen. Infected lung shows congestion, haemorrhage and intra-alveolar oedema but inflammation is not significant. Mild focal infiltrates of mononuclear inflammatory cells are known to occur in the lamina propria of the stomach small intestine and the colon. Skin biopsies reveal dermal oedema, focal haemorrhages, petechiae, ecchymoses, and macular rashes. The spleen and lymph nodes exhibit widespread lymphoid depletion due to apoptosis and necrosis. Inflammation of the kidney is not evident although acute tubular necrosis is a usual finding. Even though the endocardium of the heart contains viral antigens, the myocardium does not show any significant damage. Brain histology shows panencepha litis and perivascular infiltration of lymphocytes (7).PreventionWorld wellness organization (WHO) has recommended a set of infection prevention and control measures for health-care operate oners that include precautions that should be taken at different stages of managing EVD patientsStandard precautionsRegardless of the diagnosis it is recommended for health-care workers to take standard precautions when handling all patients, as it is difficult to name EVD patients during early stages of the disease. These are,Performing hand hygieneUsing disposable gloves in the lead touching materials probable of being contaminated with virusWearing centre protection and gown before involving in procedures which have a orifice of body fluids being projected.Hand hygieneHand hygiene must be performed using soap and water or alcohol-based hand rile solution, following WHO recommended technique,before wearing gloves and personal protective equipment (PPE)after an exposure to a patients bod y fluidsafter a contact with a contaminated surface or equipmentafter removing PPE.if hands are visibly soiledPersonal Protective Equipment (PPE)PPE should be worn before entering EVD patients care areas according to the recommended order by WHO and outback(a) before leaving the care area. Contact of a used PPE with any part of the face or non-intact skin should be avoided. The PPE includes,Non-sterile gloves of the correct size imperviable and disposable gown with long sleevesFace shieldPuncture disgustful and impermeable unkindly shoesPatient placement and management pretend or confirmed EVD patients should be isolated and if possible kept in single rooms. If not they must be placed in beds with at least 1m gap in between. Visitors must be restricted except for those who are needed for the well-being of the patient such as a childs parent.Management of used equipment and other materialsIt is recommended that equipment like stethoscopes should be decontaminated and sterilized be fore reuse, if separate equipment is not available. Parenteral medication equipment, surgical blades, syringes and needles should never be reused. They should be disposed in puncture broad bins. All non-sharp solid waste should be disposed in to leak-proof bags or bins.Used linen should be collected in leak-proof bags kept at the place of use. They should be washed with water and detergent, rinsed, soaked in 0.05% atomic number 17 for 30 minutes and then dried.All bins must always remain upright and should be sealed when full. Before being taken out of the wards the outer surfaces of these containers must be disinfected using 0.5% chlorine.Environmental cleaningdry cleaners should wear heavy-duty rubber gloves, and impermeable, puncture proof boots in addition to the PPE. Water and detergent must be used to clean the work surfaces and floors of the hospital. This should be practiced at least once a day. different contaminated surfaces and objects must be cleaned and disinfected using 0.5% chlorine.Handling of biological materialPerforming autopsies, post-mortem biopsies and other laboratory tests of tissue samples of EVD confirmed or suspected patients should be minimized and should only be performed by trained personnel. full phase of the moon PPE must be worn during handling specimens. All specimens should be delivered in clearly labeled, leak-proof, non-breakable, containers with disinfected outer surfaces.Dead bodies must never be washed or embalmed. They should be sealed in double bags, disinfected with 0.5% chlorine and inhumed promptly. Some cultural and religious rituals can be adapted if needed, but handling of the body must be kept to a nominal and full PPE must be worn at all times.In case of exposure to infected body fluidsAll current tasks must be safely and immediately stopped and PPE must be removed safely. Affected skin should be washed with soap and water and any affected mucous membranes like conjunctiva should be washed off with a pl enty of running water. The person should be checked for fever and other symptoms for 21 days.PathogenesisPathogenesis of Ebola virus shows a similarity to that of most of the other filoviruses which involves immunosuppression, change magnitude vascular permeability and coagulopathy (7, 18). Ebola virus enters the host though abrasions of the skin, though mucous membranes or though injection by accident. The virus enters monocytes, macrophages and dendritic cells and gets carried past via lymphatics to the circulation. It then spreads to the liver and spleen infecting tissue macrophages and fibroblastic reticular cells. The main cellular targets of the virus are macrophages, dendritic cells and kupfer cells. Ebola virus shows interaction between varieties of cellular proteins which is why the infection is characterized by broad tissue and organ tropism.ImmunopathologyIn most of the viral infections immune system plays a major subroutine in containing the infection from spreading. However the tissues and organs of fatal EVD cases show minimal inflammation, suggesting of impairment in the immune responses.It has been found that structural proteins of filoviruses e.g. VP24 (Virion protein) and VP35 inhibit interferon responses and thusly evade the host innate immunity. As previously mentioned, apoptosis of graphic killer cells and T lymphocytes is revealed in histopathology which explains the suppression of the adaptive immune responses.As in many another(prenominal) severe infections, Ebola virus infection also causes a massive release of unhealthy mediators and vasoactive substances. Even though the pro-inflammatory mediators abet inflammation and coagulation, the systemic spread of the infection is not effectively controlled. This is in all probability due to the vasodilation mediated by the vasoactive substances.endothelial dysfunction and coagulopathyThe virus invades endothelial cells and endocardial cells and causes injury (18). This results in int ernal haemorrhage, fluid and electrolyte imbalance and cardiovascular failure. Endothelial damage results in the platelet aggregation and consumption. The increased level of pro-inflammatory factors and the increased production of surface tissue factor protein in infected monocytes and macrophages promote the coagulation cascade. Due to the hepatocellular damage the production of coagulation factors, fibrinogen, protein C and S are also decreased .Collectively this results in disseminated intravascular coagulation.Other socio-economic problems tie in to Ebola virus epidemicsWhen considering the current outbreak, in addition to the huge number of lives that has been succumbed to the disease, it has created many other critical problems not only in Ebola dish countries, but in other African countries as well.Agriculture has the biggest contribution to the African economy. As many farmers have died of the epidemic and many have put away their farmlands in the fear of catching the dis ease, there is a huge ram shortage in these countries and a fall of food production. An emergence of a food scarcity in the near future is predicted by experts. burnt umber producing companies and many other industries are greatly affected by moil shortage. Nigeria and Ivory Coast are major cacao producing countries but most of the workers are migrants from Liberia and Guinea. International companies like Nestle and Mars have launched upbringing and fundraising programmes to prevent the spread of the infection among cacao workers.Many schools have been closed owing to the deadly infection surging through the country. Besides the concussion on education, the feeding programme carried on by the governments for children has come to a standstill as a consequence.Tourism is another sector hit by the epidemic. Even though Africa is a large continent large than Europe, USA and China combined tourists tend to see it as a single country since the Ebola epidemic has emerged. For instance , Tanzania, a famous wild life destination is an East African country, more than 6000 miles away from an Ebola hit land. It is reported that hotels of Tanzania have lost 50% of bookings for 2015 (21).Many African countries refuse to host international events and conferences due to the risk of the Ebola epidemic being introduced. For example, Morocco, the host of African Cup of Nations, which is scheduled to January 2015, requests a postponement. The government says, There is no way we can be lenient with the health and safety of the Moroccan citizens (24).