eMedicine Specialties > Infectious Diseases > Viral Infections

Ebola Virus: Treatment & Medication

Author: John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 2, 2008

Treatment

Medical Care

  • Presently, no specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever.
    • Ribavirin, an antiviral drug previously used in other types of viral hemorrhagic fever, has no demonstrable anti-Ebola activity in vitro and has failed to protect Ebola-infected primates.
    • During the 1995 outbreak in Kikwit, DRC, human convalescent plasma was used to treat 8 patients with proven Ebola disease. Only 1 of these patients died.
    • Human recombinant interferon alpha-2b used in conjunction with hyperimmune equine IgG delayed but did not prevent death in Ebola-infected cynomolgus macaques.
    • Four laboratory workers in Russia who had possible Ebola exposure were treated with a combination of a goat-derived anti-Ebola immunoglobulin plus recombinant human alpha-2 interferon. One of these patients had a high-risk exposure and developed clinical evidence of Ebola infection. All 4 patients recovered. Equine IgG containing high-titer neutralizing antibodies to Ebola protected guinea pigs and baboons but was not effective in protecting infected rhesus monkeys.
  • Supportive therapy with attention to intravascular volume, electrolytes, nutrition, and comfort care is of benefit to the patient.
    • Such care must be administered with strict attention to barrier isolation.
    • All body fluids (blood, saliva, urine, stool) contain infectious virions and should be handled with great care.
    • Patients who have died of Ebola should be buried promptly and with as little contact as possible.
  • Experimental therapies are being investigated.
    • DNA vaccines expressing either envelope GP or nucleocapsid protein (NP) genes of Ebola virus have been demonstrated to induce protection in adult mice exposed to Ebola virus. These vaccines were administered by coating gold beads with DNA expressing the genes for either GP or NP, and they were delivered by skin particle bombardment using a PowderJect-XR gene gun. Both vaccines induced measurable antibody responses detected by ELISA and induced cytotoxic T-cell immunity.
    • Another approach has been to raise neutralizing antibodies in goats or horses that are specific for the GP of Ebola. These may be useful in both vaccine design and prophylactic use.

Surgical Care

  • Surgical intervention generally follows a mistaken diagnosis in which Ebola-associated abdominal signs are mistaken for a surgical abdominal emergency. Such a mistake often is fatal for the patient and for any surgical team members who become contaminated with the patient's blood.

Consultations

  • Whenever the diagnosis of Ebola or any other viral hemorrhagic fever is considered, the US Centers for Disease Control and Prevention, along with local and state health officials, should be contacted.
  • Prompt consultation with an infectious diseases physician should be made, and strict barrier isolation should be instituted.
  • No attempt should be made to culture the virus, except when performed in a maximum-containment biosafety level 4 laboratory with laboratory personnel wearing positive-pressure suits equipped with high-efficiency particulate air filters and an umbilical-fed air supply.

Diet

  • Nutrition is complicated by the patient's nausea, vomiting, and diarrhea.
  • Intravascular volume repletion is one of the most important supportive measures.

Activity

  • Recovery often requires months. Weight gain and return of strength are slow.
  • Ebola virus continues to be present for many weeks after resolution of the clinical illness.
  • Semen from men recovering from Ebola infection has been shown to contain infectious virus, and Ebola has been transmitted by sexual intercourse involving recovering men and their sex partners.

Medication

Presently, no specific anti-Ebola viral agents are available. Recent work has demonstrated that nucleoside analogue inhibitors of S-adenosylhomocysteine hydrolase (SAH) inhibited EBO-Z viral replication. SAH is a cell-encoded enzyme that, when inhibited, indirectly inhibits transmethylation reactions required for viral replication.

Passive immunity has been attempted using equine-derived hyperimmune globulins and human-derived convalescent immune globulin preparations. Although these preparations are not proven in preventing or modifying human Ebola hemorrhagic fever, some patients have survived clinical Ebola disease following their use. The survival of these patients suggests that passive immunity may be of benefit in some patients.

No commercially available Ebola vaccines are available. However, a recombinant human monoclonal antibody directed against the envelope GP of Ebola has been demonstrated to possess neutralizing activity. This Ebola neutralizing antibody may be useful in vaccine development or as a passive prophylactic agent.

Another approach has been evaluated in the rhesus macaque model of Ebola hemorrhagic fever, which carries a mortality rate that approaches 100%. Geisbert et al administered recombinant nematode anticoagulant protein, a potent inhibitor of tissue factor-initiated coagulation.9 One third of the monkeys given the nematode anticoagulant protein survived a lethal dose of Ebola virus, whereas 16 of the 17 (94%) control animals died. This approach targeted the hemorrhagic disease component of the infection rather than the virus itself.

More on Ebola Virus

Overview: Ebola Virus
Differential Diagnoses & Workup: Ebola Virus
Treatment & Medication: Ebola Virus
Follow-up: Ebola Virus
Multimedia: Ebola Virus
References
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References

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Further Reading

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Keywords

Ebola virus, viral hemorrhagic fever syndrome, Arenaviridae, Bunyaviridae, Flaviviridae, Filoviridae, EBO-Z, Marburg virus, Ebola infection, Ebola virus Zaire, Ebola virus Sudan, EBO-S, African-derived Ebola virus, Ebola virus Côte-d'Ivoire, EBO-C, Ebola virus Reston, EBO-R

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Contributor Information and Disclosures

Author

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

Medical Editor

Martin J Wood, MD †, Former Consulting Staff, Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK
Martin J Wood, MD † is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, and Royal College of Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M Kerkering, MD, Professor of Medicine and Microbiology, Department of Internal Medicine, Division of Infectious Disease, Brody School of Medicine at East Carolina University
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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