Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008

Abstract

A confirmed Ebola haemorrhagic fever (EHF) outbreak in Bundibugyo, Uganda, November 2007-February 2008, was caused by a putative new species (Bundibugyo ebolavirus). It included 93 putative cases, 56 laboratory-confirmed cases, and 37 deaths (CFR = 25%). Study objectives are to describe clinical manifestations and case management for 26 hospitalised laboratory-confirmed EHF patients. Clinical findings are congruous with previously reported EHF infections. The most frequently experienced symptoms were non-bloody diarrhoea (81%), severe headache (81%), and asthenia (77%). Seven patients reported or were observed with haemorrhagic symptoms, six of whom died. Ebola care remains difficult due to the resource-poor setting of outbreaks and the infection-control procedures required. However, quality data collection is essential to evaluate case definitions and therapeutic interventions, and needs improvement in future epidemics. Organizations usually involved in EHF case management have a particular responsibility in this respect.

Figure 1. Filovirus ward clinicians administering supportive treatment while concurrently recording clinical data during the Bundibugyo Uganda 2007–08 Ebola haemorrhagic fever outbreak.

Photo by Claude Mahoudeau.

Figure 2. Frequency of non-haemorrhagic symptoms from self-reported day of symptom onset to clinical outcome, as absolute numbers and percentages, among symptomatic (9 deceased and 12 surviving) laboratory-confirmed Ebola haemorrhagic fever patients, Bundibugyo District, Uganda, November 2007–February 2008.

Note changes in denominator between self-reported and clinically observed sections.

Figure 3. Median duration in days of symptoms from self-reported onset until clinical outcome among 26 symptomatic laboratory-confirmed Ebola haemorrhagic fever patients, Bundibugyo District, Uganda (November 2007–February 2008).

Blue and red bars indicate general and haemorrhagic symptoms, respectively. *Day 0 = presentation to the Ebola ward. ^‡Whiskers indicate maximum duration of the self-reported symptoms prior to presentation to the Ebola ward for patient observations >1. ^†Whiskers indicate maximum duration of the clinician-assessed symptoms at presentation to and during hospitalisation on the Ebola ward for patient observations >1. ^#Denominator contains female patients only (n = 9).

Figure 4. Frequency of haemorrhagic symptoms from self-reported day of symptom onset to clinical outcome, as absolute numbers and percentages, among symptomatic (9 deceased and 12 surviving) laboratory-confirmed Ebola haemorrhagic fever patients, Bundibugyo District, Uganda, November 2007–February 2008.

Note changes in denominator between self-reported and clinically observed sections.