{"id":36862,"date":"2026-05-24T14:23:11","date_gmt":"2026-05-24T08:53:11","guid":{"rendered":"https:\/\/atsixty.com\/?p=36862"},"modified":"2026-05-26T13:49:33","modified_gmt":"2026-05-26T08:19:33","slug":"ebola-virus-disease","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/24\/ebola-virus-disease\/","title":{"rendered":"Ebola Virus Disease"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* All styles namespaced to #ebov01 -- no bleed into WordPress theme *\/\n#ebov01 *,#ebov01 *::before,#ebov01 *::after{box-sizing:border-box;margin:0;padding:0}\n#ebov01{\n  --ter:#8B3D20;--ter-light:#B85A38;--ter-pale:#FDF0EB;--ter-dark:#6B2D14;\n  --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n  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.mr-stem{font-size:0.9rem}#ebov01 .mr-opt-text{font-size:0.86rem}}\n<\/style>\n\n<div id=\"ebov01\">\n\n  <div class=\"mr-header\">\n    <div class=\"mr-eyebrow\">Morning Rounds &middot; Daily Clinical Quiz<\/div>\n    <div class=\"mr-title\">\n      Ebola Virus Disease<br><em>Virology, Pathogenesis &amp; Management<\/em>\n    <\/div>\n    <div class=\"mr-subtitle\">Five cases &middot; Read carefully &middot; Trust your instinct<\/div>\n    <div class=\"mr-chips\">\n      <span class=\"mr-chip\">5 Cases<\/span>\n      <span class=\"mr-chip\">+4 \/ &minus;1 scoring<\/span>\n      <span class=\"mr-chip\">Options reshuffled<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-sentinel\" id=\"ebov01-sentinel\"><\/div>\n\n  <div class=\"mr-progress\" id=\"ebov01-progress\">\n    <div class=\"mr-prog-inner\">\n      <div class=\"mr-pips\" id=\"ebov01-pips\"><\/div>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-body\">\n    <div id=\"ebov01-cases\"><\/div>\n\n    <div class=\"mr-submit-wrap\">\n      <button class=\"mr-btn\" id=\"ebov01-submit\">Submit for Debrief<\/button>\n    <\/div>\n\n    <div class=\"mr-score\" id=\"ebov01-score\">\n      <div class=\"mr-score-in\">\n        <div class=\"mr-score-ey\">Round Complete<\/div>\n        <div class=\"mr-ring\" id=\"ebov01-ring\">\n          <div class=\"mr-ring-in\">\n            <span class=\"mr-ring-pct\" id=\"ebov01-pct\">0%<\/span>\n            <span class=\"mr-ring-sub\">net<\/span>\n          <\/div>\n        <\/div>\n        <div class=\"mr-score-title\">Your Debrief<\/div>\n        <div class=\"mr-score-net\" id=\"ebov01-net\"><\/div>\n        <div class=\"mr-verdict\" id=\"ebov01-verdict\"><\/div>\n        <div class=\"mr-bands\">\n          <span class=\"mr-band mr-band-c\" id=\"ebov01-ct-c\"><\/span>\n          <span class=\"mr-band mr-band-w\" id=\"ebov01-ct-w\"><\/span>\n          <span class=\"mr-band mr-band-s\" id=\"ebov01-ct-s\"><\/span>\n        <\/div>\n        <button class=\"mr-retry\" id=\"ebov01-retry\">&#8635; New Round<\/button>\n      <\/div>\n    <\/div>\n  <\/div>\n<\/div>\n\n<script>\n(function () {\n  'use strict';\n\n  var NS    = 'ebov01';\n  var TOTAL = 5;\n  var MAX   = 20;\n  var LTRS  = ['A','B','C','D'];\n\n  \/* ================================================================\n     QUESTION BANK -- Ebola Virus Disease\n     ================================================================\n\n     Q1  MORPHOLOGY & CLASSIFICATION (Easy)\n         Filamentous virion; shepherd's crook on EM; family Filoviridae;\n         negative-sense ssRNA; 7 structural proteins.\n         Answer: Filoviridae; negative-sense single-stranded RNA\n\n     Q2  PATHOGENESIS -- PRIMARY TARGET CELLS (Medium)\n         Primary targets are monocytes, macrophages, dendritic cells.\n         Lymphocytes die by bystander apoptosis -- not directly infected.\n         VP35 blocks IFN-alpha\/beta production; VP24 blocks STAT1\n         nuclear import. Intracellular receptor: NPC1 (Niemann-Pick C1).\n         Answer: Monocytes, macrophages, and dendritic cells\n\n     Q3  CLINICAL FEATURES -- CAUSE OF DEATH (Medium)\n         Contrary to popular belief, massive fluid loss (vomiting +\n         diarrhoea) causing hypovolaemia and multi-organ failure is the\n         primary cause of death -- NOT haemorrhage. Overt bleeding\n         occurs in only ~50% of cases. Hiccups = poor prognostic sign.\n         Incubation: 2-21 days (WHO quarantine period).\n         Answer: Hypovolaemia and multi-organ failure from massive\n                 gastrointestinal fluid losses, not haemorrhage\n\n     Q4  LABORATORY DIAGNOSIS (Easy-Medium)\n         RT-PCR: gold standard; reliably positive from day 3 of symptoms.\n         Before day 3: may be false-negative even in true infection.\n         ELISA IgM\/IgG: appear later in illness.\n         Virus isolation: BSL-4 only, reference labs.\n         Antigen detection ELISA: used in field settings.\n         Answer: RT-PCR on blood or serum; becomes reliably positive\n                 3 or more days after symptom onset\n\n     Q5  TREATMENT -- FDA-APPROVED MONOCLONAL ANTIBODIES (Hard)\n         PALM RCT (NEJM 2019): compared ZMapp, remdesivir, mAb114\n         (ansuvimab), and REGN-EB3 (Inmazeb) in DRC outbreak.\n         mAb114 and REGN-EB3 were superior -- trial stopped early.\n         FDA approvals 2020:\n           Inmazeb (atoltivimab + maftivimab + odesivimab): Oct 2020\n           Ebanga (ansuvimab-zykl): Dec 2020\n         Both target the Ebola glycoprotein (GP).\n         Vaccine: rVSV-ZEBOV (Ervebo) -- VSV vector, ring vaccination.\n         Remdesivir was ORIGINALLY developed for Ebola; failed in PALM.\n         Answer: Inmazeb (atoltivimab\/maftivimab\/odesivimab) --\n                 triple monoclonal antibody cocktail targeting GP\n     ================================================================ *\/\n\n  var QS = [\n\n    \/* ---- Q1 : Morphology & Classification ---- *\/\n    {\n      id:      1,\n      tag:     'Ebola Virus &mdash; Classification',\n      stem:    'On electron microscopy, <strong>Ebola virus<\/strong> displays a characteristic elongated, filamentous morphology with a distinctive <em>shepherd\\'s crook<\/em> or U-shaped configuration. Which of the following correctly identifies the viral family and genome type?',\n      correct: 'Filoviridae; negative-sense single-stranded RNA',\n      opts: [\n        'Filoviridae; negative-sense single-stranded RNA',\n        'Arenaviridae; ambisense single-stranded RNA',\n        'Paramyxoviridae; negative-sense single-stranded RNA',\n        'Bunyaviridae; negative-sense segmented single-stranded RNA'\n      ],\n      exp:     '<strong>Ebola virus<\/strong> belongs to the family <strong>Filoviridae<\/strong> (Latin: <em>filo<\/em> = thread), reflecting its characteristic filamentous morphology. It carries a <strong>negative-sense single-stranded RNA<\/strong> genome of approximately 19&nbsp;kb &mdash; one of the largest non-segmented RNA genomes. The genome encodes <strong>7 structural proteins<\/strong>: NP (nucleoprotein), VP35, VP40 (matrix protein), GP (glycoprotein &mdash; the surface attachment protein), VP30, VP24, and L (RNA-dependent RNA polymerase). There are six recognised <em>Ebolavirus<\/em> species; <strong>Zaire ebolavirus<\/strong> (EBOV) is the most lethal, with case fatality rates of 25&ndash;90% in historical outbreaks. <strong>Extra point:<\/strong> Marburg virus is the only other member of Filoviridae; its genome organisation is similar but it is antigenically distinct. Filoviruses are <strong>BSL-4<\/strong> pathogens &mdash; the highest containment level.'\n    },\n\n    \/* ---- Q2 : Pathogenesis -- Primary Target Cells ---- *\/\n    {\n      id:      2,\n      tag:     'Ebola Virus &mdash; Pathogenesis',\n      stem:    'A <strong>32-year-old healthcare worker<\/strong> returning from an Ebola-affected region develops fever, severe myalgia, and profuse watery diarrhoea. Regarding the early pathogenesis of Ebola virus disease, which cells are the <em>primary<\/em> targets of viral replication following initial infection?',\n      correct: 'Monocytes, macrophages, and dendritic cells',\n      opts: [\n        'Monocytes, macrophages, and dendritic cells',\n        'CD4+ T lymphocytes and CD8+ T lymphocytes',\n        'Hepatocytes and adrenal cortical cells',\n        'Vascular endothelial cells and platelets'\n      ],\n      exp:     'Ebola virus initially infects <strong>monocytes, macrophages, and dendritic cells<\/strong> at the site of entry. These infected antigen-presenting cells then disseminate the virus via the lymphatics and bloodstream to the liver, spleen, and adrenal glands. <strong>Lymphocytes are notably NOT directly infected<\/strong> &mdash; they undergo massive <em>bystander apoptosis<\/em> triggered by soluble factors, causing the profound lymphopenia characteristic of severe EVD. Viral immune evasion is mediated by <strong>VP35<\/strong> (blocks IFN-&alpha;\/&beta; production) and <strong>VP24<\/strong> (blocks STAT1 nuclear translocation, preventing IFN signalling). The intracellular entry receptor is <strong>NPC1 (Niemann-Pick C1)<\/strong>, a cholesterol transporter in late endosomes\/lysosomes. <strong>Extra point:<\/strong> the massive cytokine storm released by infected macrophages (&ldquo;cytokine shock&rdquo;) drives endothelial activation, coagulopathy, and DIC &mdash; not direct viral endothelial infection, which is a later phenomenon.'\n    },\n\n    \/* ---- Q3 : Clinical Features -- Cause of Death ---- *\/\n    {\n      id:      3,\n      tag:     'Ebola Virus &mdash; Clinical Features',\n      stem:    'A <strong>28-year-old nurse<\/strong> with confirmed Ebola virus disease is admitted on day 6 of illness with profuse vomiting, watery diarrhoea (10&ndash;12 litres\/day), hypotension, and oliguria. She has no overt bleeding. Which of the following statements about the cause of death in Ebola virus disease is most accurate?',\n      correct: 'Death occurs primarily from hypovolaemia and multi-organ failure due to massive gastrointestinal fluid losses; overt haemorrhage is present in fewer than half of fatal cases',\n      opts: [\n        'Death occurs primarily from hypovolaemia and multi-organ failure due to massive gastrointestinal fluid losses; overt haemorrhage is present in fewer than half of fatal cases',\n        'Haemorrhage from all mucosal surfaces is the invariable terminal event in all fatal cases',\n        'Respiratory failure from direct Ebola pneumonitis is the leading cause of death',\n        'Encephalitis from neurotropic spread of Ebola virus causes fatal cerebral oedema in most cases'\n      ],\n      exp:     'Contrary to popular depiction, <strong>massive haemorrhage is not the primary cause of death<\/strong> in EVD. Overt bleeding occurs in only approximately <strong>30&ndash;50%<\/strong> of cases, predominantly from venepuncture sites and the GI tract, and is a late manifestation. The dominant mechanism of death is <strong>hypovolaemic shock and multi-organ failure<\/strong> from enormous gastrointestinal fluid losses (up to 10&nbsp;L\/day of diarrhoea) combined with cytokine-driven vascular leak. Aggressive fluid and electrolyte replacement is therefore the cornerstone of supportive care. <strong>Important clinical features:<\/strong> the illness begins with a <em>dry phase<\/em> (fever, myalgia, headache &mdash; days 1&ndash;5) followed by a <em>wet phase<\/em> (vomiting, diarrhoea, possible haemorrhage &mdash; days 5 onwards). <strong>Extra point:<\/strong> <em>hiccups<\/em> are a recognised poor prognostic sign in EVD, indicating severe gastrointestinal and diaphragmatic involvement. The WHO quarantine period is <strong>21 days<\/strong> (maximum incubation period); average incubation is 8&ndash;10 days.'\n    },\n\n    \/* ---- Q4 : Laboratory Diagnosis ---- *\/\n    {\n      id:      4,\n      tag:     'Ebola Virus &mdash; Diagnosis',\n      stem:    'A <strong>40-year-old man<\/strong> with travel history from an Ebola-endemic region presents with fever and malaise for <strong>2 days<\/strong>. He is suspected to have Ebola virus disease and is placed in isolation. An initial RT-PCR test returns <strong>negative<\/strong>. What is the most appropriate interpretation and next step?',\n      correct: 'A negative RT-PCR within the first 3 days of symptom onset does not exclude EVD; repeat testing at 72 hours or later after symptom onset is required',\n      opts: [\n        'A negative RT-PCR within the first 3 days of symptom onset does not exclude EVD; repeat testing at 72 hours or later after symptom onset is required',\n        'A negative RT-PCR at any point reliably excludes Ebola virus disease and the patient can be discharged from isolation',\n        'Serum IgM ELISA should be performed immediately as it is more sensitive than RT-PCR in the first 48 hours',\n        'Virus isolation in a BSL-2 laboratory should be attempted as the definitive diagnostic method'\n      ],\n      exp:     '<strong>RT-PCR<\/strong> (real-time reverse transcriptase PCR) is the gold-standard confirmatory test for EVD. However, viraemia is low in the first 1&ndash;3 days of illness, making RT-PCR <strong>unreliable before 72 hours of symptom onset<\/strong> &mdash; a negative result in this window does not exclude infection. <strong>WHO guidance:<\/strong> if the first test is negative and clinical suspicion remains high, repeat RT-PCR at &ge;72 hours after symptom onset. If the repeat is also negative, EVD is effectively excluded. <strong>Serological tests<\/strong> (IgM\/IgG ELISA) appear later (IgM from day 2&ndash;9, IgG from day 5&ndash;8) and are not useful for early diagnosis. <strong>Virus isolation<\/strong> requires <strong>BSL-4 containment<\/strong> and is restricted to reference laboratories. <strong>Extra point:<\/strong> rapid antigen detection tests (RDTs) such as the OraQuick Ebola Rapid Antigen Test have been deployed in field settings; they offer results in 15 minutes but have lower sensitivity than RT-PCR. All Ebola diagnostics must be performed under <strong>strict PPE protocols<\/strong> &mdash; blood is highly infectious even in small volumes.'\n    },\n\n    \/* ---- Q5 : FDA-Approved Treatment ---- *\/\n    {\n      id:      5,\n      tag:     'Ebola Virus &mdash; Specific Treatment',\n      stem:    'During the 2018&ndash;2020 <strong>Democratic Republic of Congo<\/strong> Ebola outbreak, the PALM randomised controlled trial compared four investigational treatments. Two agents demonstrated significantly superior survival compared with the others, leading to early trial termination. Which of the following was subsequently granted <strong>FDA approval<\/strong> in October 2020 for Zaire ebolavirus infection?',\n      correct: 'Inmazeb (atoltivimab + maftivimab + odesivimab) &mdash; a triple monoclonal antibody cocktail targeting the viral glycoprotein',\n      opts: [\n        'Inmazeb (atoltivimab + maftivimab + odesivimab) &mdash; a triple monoclonal antibody cocktail targeting the viral glycoprotein',\n        'ZMapp &mdash; a plant-derived triple monoclonal antibody cocktail that demonstrated superiority in the PALM trial',\n        'Remdesivir &mdash; a nucleotide analogue originally developed for Ebola that proved highly effective in the PALM trial',\n        'Favipiravir &mdash; a broad-spectrum RNA polymerase inhibitor approved after demonstrating survival benefit in the PALM trial'\n      ],\n      exp:     'The <strong>PALM RCT<\/strong> (<em>NEJM<\/em> 2019) compared four agents in the DRC outbreak: ZMapp, remdesivir, <strong>mAb114 (ansuvimab)<\/strong>, and <strong>REGN-EB3 (Inmazeb)<\/strong>. mAb114 and REGN-EB3 demonstrated significantly lower mortality (approximately 34% and 29% respectively vs. 49% for ZMapp and 53% for remdesivir) &mdash; the trial was stopped early. <strong>Two FDA approvals followed in 2020:<\/strong> (1) <strong>Inmazeb<\/strong> (atoltivimab + maftivimab + odesivimab-ebgn) &mdash; a <em>triple<\/em> monoclonal antibody cocktail, October 2020; (2) <strong>Ebanga<\/strong> (ansuvimab-zykl, i.e. mAb114) &mdash; a <em>single<\/em> monoclonal antibody, December 2020. Both target the <strong>viral glycoprotein (GP)<\/strong>, blocking host cell entry. <strong>Extra point &mdash; important trap:<\/strong> remdesivir was originally <em>developed for Ebola<\/em> but <em>failed<\/em> in the PALM trial; it later found its clinical role in COVID-19 (ACTT-1 trial). ZMapp, despite being widely used in the 2014 West Africa outbreak, was never formally approved. The <strong>rVSV-ZEBOV vaccine (Ervebo)<\/strong>, using a ring vaccination strategy, was pivotal in containing the DRC outbreak and received FDA approval in December 2019. <strong>Current outbreak &mdash; May 2026:<\/strong> a new Ebola outbreak confirmed in <strong>Ituri Province, DRC<\/strong> and Uganda is caused by <strong>Bundibugyo virus<\/strong> (species <em>Orthoebolavirus bundibugyoense<\/em>) &mdash; the 17th Ebola outbreak in DRC since 1976. WHO declared it a <strong>PHEIC on 16 May 2026<\/strong>. Critically, <strong>neither Inmazeb, Ebanga, nor the rVSV-ZEBOV vaccine (Ervebo) cover Bundibugyo virus<\/strong> &mdash; all approved therapeutics and the licensed vaccine are specific to <em>Zaire ebolavirus<\/em>. Management of the current outbreak relies entirely on supportive care, IPC, and contact tracing. 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Ebola holds no surprises for you.'],\n      [4, 'Strong \\u2014 one nuance to revisit before exam day.'],\n      [3, 'Solid base \\u2014 consolidate the harder mechanisms.'],\n      [2, 'Halfway there \\u2014 the debrief panels repay careful reading.'],\n      [0, 'These cases reward a second look. 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