EBOLA: The Virus

Dr Sandeep Dogra
MD, MNAMS

Assistant Professor
Dept. of Microbiology
Govt. Medical College, Jammu

Outbreak anywhere can be a risk everywhere

- Thomas R Frieden, CDC, Atlanta, USA

Overview

The agent
Taxonomy
Reservoir
Transmission
Pathogenesis

The agent
Enveloped, non-segmented,
negative-stranded RNA virus
Prototype Viral Hemorrhagic
Fever Pathogen
First appeared in 1976 in 2
outbreaks
Derived its name from a river
in Congo called Ebola
Caused more than 20 outbreaks
in Africa since than

Taxonomy

Order: Mononegavirales
Family: Filoviridae
Genus: Ebola like viruses
Species: Ebola
Subtypes:

Zaire Ebola virus - Democratic Republic of Congo (1976)

Sudan Ebola virus - Sudan (1976)
Reston Ebola virus - Philippines (1989)
Tai Forest Ebola virus - Ivory Coast (1994)
Bundibugyo Ebola virus - Uganda (2007)
C.M. Fauquet (2005). Virus taxonomy classification and nomenclature of viruses;
8th report of the International Committee on Taxonomy of Viruses

Reservoir of infection
Zoonotic virus
Fruit bats - most likely reservoir
Hypsignathus monstrosus
Epomops franqueti
Myonycteris torquata

Others - Chimpanzees, gorillas,

monkeys, forest antelope and
porcupines
Limited evidence that wild
dogs/cats become infected

Transmission
In Africa, Ebola may spread as a result of
hunting, processing, and consuming infected
animals (e.g., bush meat)
Human-to-human transmission of Ebola virus
via inhalation (aerosols) has NOT been
demonstrated
Remains from deceased infected persons are
highly infectious
Close contact and health care workers get
frequently infected while treating the patient

Human to human transmission

Virus present in high quantity in blood, body fluids,
and excreta of symptomatic patients
Opportunities for human-to-human transmission
Direct contact (through broken skin or unprotected
mucous membranes) with an EVD-infected patients
blood or body fluids
Direct contact with the corpse of a person who died
of EVD
Sharps injury (with EVD-contaminated needle or
other sharp)
Indirect contact with an EVD-infected patients
blood or body fluids via a contaminated object (soiled
linens or used utensils)

Pathogenesis

Incubation period ranges between 2-21 days

Onset of symptoms to death: 6-16 days
Mortality rates: 25-90% depends on Ebola strain
Zaire strain most virulent - mortality up to 90%
People are infectious as long as their blood and
secretions contain the virus

WHO. Ebola virus disease. Fact Sheet No. 103. Geneva: World Health Organisation, 2014.

Pathogenesis

Molecular basis of virulence not known

Direct infection of tissues
Immune dysregulation
Hypovolemia and vascular collapse
Electrolyte abnormalities
Multi-organ failure, septic shock

Disseminated intravascular coagulation (DIC)

and coagulopathy
Lancet. Mar 5, 2011; 377(9768): 849862.

Direct infection of tissues

Infects many cell, including monocytes,
macrophages, dendritic cells, endothelial cells,
fibroblasts, hepatocytes, adrenal cortical cells
and epithelial cells.
Virus migrates from the initial infection site to
regional lymph nodes and subsequently to the
liver, spleen and adrenal gland.

Immune dysregulation
High mortality rate believed to be the result of
virus proteins capability of defeating the
immune system by:
Complement mediated antibody-dependent
enhancement of infection
Inhibition of multiple interferon pathways
Infected macrophages inducing apoptosis in
lymphocytes

Hypovolemia and DIC

Adrenocortical necrosis also occurs and is
associated with hypotension and impaired
steroid synthesis
Hepatocellular necrosis leads to dysregulation of
clotting factors and subsequent coagulopathy
Virus appears to trigger a release of proinflammatory cytokines with subsequent
vascular leak and impairment of clotting
ultimately resulting in multi-organ failure and
shock .

Philippe Calain
Chief Epidemiologist
CDC Special Pathogens Branch

"At the end of the disease the patient does not look, from
the outside, as horrible as you can read in some books.
They are not melting. They are not full of blood. They're
in shock, muscular shock. They are not unconscious, but
you would say 'obtunded', dull, quiet, very tired. Very
few were hemorrhaging. Hemorrhage is not the main
symptom. Less than half of the patients had some kind
of hemorrhage. But the ones that had bled, died"

Summary
Humans are actually just an accidental host
Human-to-human transmission by direct
contact

No human-to-human transmission via inhalation

(aerosols)
No transmission before symptom onset

Greater risk for India because of the number of

Indians working in West African nations
Constantly changing genetic makeup of the
Ebola virus means it will spread at a much
greater speed.

More information

www.cdc.gov

www.who.int

Thank you Ebola

For making us realize that how much we interfere with nature and
how much we are prepared for any eventuality.