Ebola Virus Disease Outbreak in Isiro, Democratic Republic of the Congo, 2012: Signs and Symptoms, Management and Outcomes

Abstract

Data collected during the 2012 Ebola virus disease (EVD) epidemic in the Democratic Republic of the Congo were analysed for clinical signs, symptoms and case fatality of EVD caused by Bundibugyo virus (BDBV), establishment of differential diagnoses, description of medical treatment and evaluation of the quality of clinical documentation. In a quantitative observational prospective study, global epidemiological data from 52 patients (34 patients within the community, 18 patients treated in the Ebola Treatment Centre) were entered anonymously into a database, subsequently matched and analysed. Relevant findings include an over-representation of females among community EVD cases (85.3%) and of community EVD cases in the age group of 15-54 years (82.4%). All ETC patients had fever (55.6% of all 18 ETC patients during their hospital stay) or self-reported fever (88.2% upon admission) at some point of time during their illness. Major symptoms of ETC patients during hospital stay included asthenia (82.4%), anorexia (82.4%), myalgia (70.6%), sore throat/difficulty swallowing (70.6%), arthralgia (76.5%) and nausea (70.6%). Gastrointestinal signs and symptoms (nausea, diarrhoea, vomiting) (76.4%) as well as general pain (94.1%) were frequent in ETC patients. The median duration of EVD was 18 days, while the mean incubation period was 11.3 days. Differential diagnosis of EVD included malaria (28.3%), intestinal parasitosis (10.9%), and infectious syndrome (10.9%). There was also an important variation in clinical evolvement. Quality of documentation was adversely affected by the way patient file contents were transferred from inside to outside the high-risk zone, entailing a mean mismatch value of 27.3% between patient file contents inside vs. outside the high-risk zone. This study adds further description of EVD (frequently non-specific signs and symptoms, non frequent bleeding, a long incubation period, long duration of disease) and emphasizes the need for improving clinical monitoring and documentation in EVD outbreak settings.

Fig 1. Map of the Democratic Republic of the Congo.

Isiro, capital of the Haut-Uele District, is situated in north-eastern DRC.

Fig 2. Case numbers of the 2012 Isiro Epidemic.

The Isiro Epidemic yielded 62 cases (5 suspect, 21 probable and 36 confirmed). Clinical documentation of 52 cases (16 probable, 36 confirmed) could be retrieved and analysed. Out of these, there were 16 probable and 18 confirmed community cases, which never reached the Ebola Treatment Centre (ETC). The 18 patients who reached the ETC were all confirmed cases.

Fig 3. Evolvement of body temperature in patients treated in the Ebola Treatment Centre (ETC).

In five inpatients of the ETC body temperature could be followed up from the second or third day of disease onwards. Four of those patients had fever at least on one day. Three patients showed a pattern with fever during the beginning of disease, which lasted no longer than until the 12^th day of disease. Three patients had high fever ≥ 38.5°C.

Fig 4. Evolvement of body temperature in patients treated in the Ebola Treatment Centre (ETC).

In five inpatients of the ETC body temperature could be followed up from the second or third day of disease onwards. Four of those patients had fever at least on one day. Three patients showed a pattern with fever during the beginning of disease, which lasted no longer than until the 12^th day of disease. Three patients had high fever ≥ 38.5°C.

Fig 5. Evolvement of body temperature in patients treated in the Ebola Treatment Centre (ETC).

In five inpatients of the ETC body temperature could be followed up from the second or third day of disease onwards. Four of those patients had fever at least on one day. Three patients showed a pattern with fever during the beginning of disease, which lasted no longer than until the 12^th day of disease. Three patients had high fever ≥ 38.5°C.

Fig 6. Evolvement of body temperature in patients treated in the Ebola Treatment Centre (ETC).

In five inpatients of the ETC body temperature could be followed up from the second or third day of disease onwards. Four of those patients had fever at least on one day. Three patients showed a pattern with fever during the beginning of disease, which lasted no longer than until the 12^th day of disease. Three patients had high fever ≥ 38.5°C.

Fig 7. Evolvement of body temperature in patients treated in the Ebola Treatment Centre (ETC).

In five inpatients of the ETC body temperature could be followed up from the second or third day of disease onwards. Four of those patients had fever at least on one day. Three patients showed a pattern with fever during the beginning of disease, which lasted no longer than until the 12^th day of disease. Three patients had high fever ≥ 38.5°C.

Fig 8. Time from sign or symptom onset until admission to hospital (Ebola Treatment Centre or other).

61% of the n = 18 confirmed EVD cases who were hospitalized in the ETC later showed up to a healthcare facility on their first until third day of disease. 22% of the cases did so between the 4^th and 6^th day, 5% from the 7^th until 9^th day, and 6 cases on the 10^th day of disease or beyond. One case was not applicable (n/a), because it was a baby born in the ETC.

Fig 9. Evolvement of EVD of particularly informative inpatients in the Ebola Treatment Centre (ETC).

The figure shows the evolvement of disease of two patients who succumbed due to EVD and two patients who survived it. All four patients are identical to patients No. 1 to 4 in Figs 3–7. The presence or absence of fever, gastrointestinal signs or symptoms, haemorrhagic signs, asthenia and a bad state of health (severe disease, threat to life) were documented on a daily basis, as well as admission to and discharge from the ETC.