Pharmacotherapy/Treatment Of Ebola-infected Patients

Ebola is a disease caused by a virus. It was first discovered in 1976. It takes its name from a village near the river Ebola in DR Congo where it began.

The largest outbreak of Ebola virus was in 2014 through 2016. It spread across Guinea Bissau, Sierra Leone and Liberia killing both old and young.

Ebola genus have several species with various degrees of fatality. They are Zaire, Bundibugyo, Sudan, Tai forest, Reston and bombali. The Zaire is thought to be more fatal. They affect both humans and primate animals.

Mode Of Transmission

It is believed that the primordial (natural) host of Ebola virus is the bats of the pteropodidae family. Close contact with infected blood, secretion or bodily fluid gave it the chance in the human population. Human-to-human transmission via direct contact through broken skin or mucous membranes (eyes, nose and mouth) became the major means of transmission.

Read Also: Why Ebola did not spread like Covid-19

Direct contact with the fluid (blood, sweat, breast milk or others fluids) of Ebola infected persons or dead bodies can cause infection. And people remain infectious as long as the virus is still in their system. However, people who recover confer natural immunity for up to 10 years. A person can only spread Ebola to other people after they develop signs and symptoms of Ebola.

People who are free of Ebola virus can still spread the disease. Because the virus can stay in some parts of the body for a long time. An example is semen. It can be spread through semen of a recovered man from some months. Scientists are currently working to find out how long these persistent viruses remain in these hidden places away from the body's immune system.

The properties of Ebola infected persons can hold on to their body fluids. And the virus can survive for days in dry atmosphere in places like door knobs. These are means of spreading the virus when a person opens the door using the knob.

Symptoms

It takes between 8-10 days for symptoms to manifest. Some are shorter or longer between 2-20 days. Initial symptoms include fever, headache, muscle pain and chills. Later, a person may experience internal bleeding resulting in vomiting or coughing blood.

People may experience:

Pain areas: in the abdomen, chest, joints, or muscles

Whole body: chills, dehydration, fatigue, fever, loss of appetite, malaise, or sweating

Gastrointestinal: diarrhoea, nausea, vomiting, or vomiting blood

Also common: coughing up blood, eye redness, headache, mental confusion, petechiae, or sore throat

Diagnosis/Test

The world health organisation (WHO) recommended specimen is whole blood collected in EDTA from live patients exhibiting symptoms. However, dead disease patients under autopsy can be screened with oral fluid specimens stored in universal transport medium and this can also be done on live patients when blood collection is not possible.

The diagnosis recommended by WHO is an automated or semi-automated nucleic acid test (NAT) and rapid antigen detection test for use in remote settings where NAT is not readily available.

Other tests include electron microscope, virus isolated reverse transcriptase polymerase chain reaction (RT-PCR) assay, antibody capture ELISA, antigen capture detection test and serum neutralisation test.

Prevention Of Ebola Virus

Social distancing is still the best way to avoid coming in contact with those with Ebola and their properties. This includes their clothes, cutlery, door knob, etc. Personal hygiene goes a long way too. Those who are infected should be treated in special hospitals where medical personnel wear personal protective equipment (PPE).

Pharmacotherapy of Ebola patients

Treatment/Pharmacotherapy

There are two approaches to treatment. In some places, vaccines are either approved or underway. In other places, drugs are the target source of treatment.

Vaccines

The U.S. The Food and Drug Administration (FDA) approved the Ebola vaccine rVSV-ZEBOV (trade name “Vebo”) on December 19, 2019. The rVSV-ZEBOV vaccine is a single dose vaccine regimen that has been found to be safe and protective against only the Zaire ebolavirus species of ebolavirus. This is the first FDA approval of a vaccine for Ebola.

Another investigational vaccine was developed and introduced under a research protocol in 2019 to combat an Ebola outbreak in the Democratic Republic of the Congo. This vaccine leverages two different vaccine components (Ad26.ZEBOV and MVA-BN-Filo) and requires two doses with an initial dose followed by a second “booster” dose 56 days later. The second vaccine is also designed to protect against only the Zaire ebolavirus species of Ebola (Source: CDC).

Drugs

Supportive care including providing fluids and electrolytes (body salts) and treating specific symptoms. Some drugs are under investigation with two being used on Ebola patients. There are some marked improvements in fatality rate as compared to those not in the drug. They are regeneron (REGN-EB3) and mAb114. They are antiviral. They are not approved by the FDA.

Drugs for supportive treatment are meant to treat symptoms. Since Ebola patients suffer dehydration from vomiting and diarrhea, zinc and oral rehydration therapy is a gold mine. It can be oral or intravenous administration depending on the level of corporation and degree of disease progression. To stop vomiting, ondansetron or chlorpromazine can do.

Most ebola patients feel pain and anxiety. Use paracetamol for fever and pain. Tramadol or morphine (under strict observation due to respiratory distress) will be better for severe pain. Avoid non steroidal antiinflammatory drugs (NSAIDS) because of platelet effect in ebola patients.

Read Also: Difference between vaccines and drugs

Treating other infections in ebola patients should begin after diagnosis. However, in cases diagnosis is not available or will delay, it is better to start treatment. For example, electrolyte tests may be needed to confirm potassium level before IV doses.

When malaria is suspected or confirmed, artesunate injection is preferred rather than oral artemisinin combination therapy (ACT).

Antibiotics that can be given to ebola patients include oral or injectable amoxicillin and clavulanic acid, ceftriaxone, ciprofloxacin and cefixime when bacteria is suspected. Metronidazole can be used for bloody diarrhea or worsening abdominal pain.

People with chronic disease such as tuberculosis and human immunodeficiency virus (HIV) on medication should continue their treatment. When the ebola is severe leading to the suspension of those drugs, they should be started immediately after recovery.

Oral or injectable vitamin K is valuable when there is bleeding. Tranexamic acid may be recommended.

Heartburn, stomach,  duodenal ulcer and those in that category can be managed with omeprazole and magnesium trisilicate such as gaviscon.

Seizures can be handled with diazepam. Phenobarbital loading dose and haloperidol for non cooperative patients.

Thiamine or vitamin B1 can be used for unexplained neurological conditions. Oxygen is necessary for severe cases.

Note: All doses are standard dose based on weight and or age. For example, cilrofloxacin should not be given to children including children with Ebola virus disease.

For more information about Ebola virus disease (EVD), visit WHO website.

Share On Social Media With Family And Friends To Show You Care!