Ebola

==Signs and symptoms==
[[File:Symptoms of ebola.png|thumb|upright=1.3|Signs and symptoms of Ebola<ref name="CDC2014S" />]]

===Onset===
<!-- Incubation -->
The length of time between exposure to the virus and the development of symptoms ([[incubation period]]) is between 2 and 21 days,<ref name=WHO2014/><ref name="CDC2014S">{{Cite web |date=28 January 2014 |title=Ebola Hemorrhagic Fever Signs and Symptoms |url=https://www.cdc.gov/vhf/ebola/symptoms/index.html |url-status=live |archive-url=https://web.archive.org/web/20140801015854/https://www.cdc.gov/vhf/ebola/symptoms/index.html |archive-date=1 August 2014 |access-date=2 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC) }}</ref> and usually between 4 and 10 days.<ref name="Goeijenbier2014">{{Cite journal |vauthors=Goeijenbier M, van Kampen JJ, Reusken CB, Koopmans MP, van Gorp EC |date=November 2014 |title=Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis |url=http://www.njmonline.nl/getpdf.php?t=a&id=10001148 |url-status=live |journal=Neth J Med |volume=72 |issue=9 |pages=442–448 |pmid=25387613 |archive-url=https://web.archive.org/web/20141129144852/http://www.njmonline.nl/getpdf.php?t=a&id=10001148 |archive-date=29 November 2014}}</ref> However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.<ref>{{Cite journal |vauthors=Haas CN |date=14 October 2014 |title=On the Quarantine Period for Ebola Virus |journal=PLOS Currents Outbreaks |volume=6 |doi=10.1371/currents.outbreaks.2ab4b76ba7263ff0f084766e43abbd89 |pmc=4205154 |pmid=25642371 |doi-access=free }}</ref>

<!-- Early -->
Symptoms usually begin with a sudden [[influenza]]-like stage characterised by [[fatigue (medical)|fatigue]], [[fever]], [[asthenia|weakness]], [[anorexia (symptom)|decreased appetite]], [[myalgia|muscular pain]], [[arthralgia|joint pain]], headache, and sore throat.<ref name=WHO2014/><ref name="Goeijenbier2014" /><ref name="Gatherer 2014">{{Cite journal |vauthors=Gatherer D |date=August 2014 |title=The 2014 Ebola virus disease outbreak in West Africa |journal=J Gen Virol |volume=95 |issue=Pt 8 |pages=1619–1624 |doi=10.1099/vir.0.067199-0 |pmid=24795448 |doi-access=free}}</ref><ref name="Hun2012">{{Cite book | vauthors = Magill A |url= https://books.google.com/books?id=UgvdM8WRld4C&pg=PA332 |title=Hunter's tropical medicine and emerging infectious diseases |date=2013 |publisher=Saunders |isbn=978-1416043904 |edition=9th |location=New York |page=332 |author-link=Alan Magill |archive-url=https://web.archive.org/web/20160320072816/https://books.google.com/books?id=UgvdM8WRld4C&pg=PA332 |archive-date=20 March 2016 |url-status=live |name-list-style=vanc}}</ref> The fever is usually higher than {{convert|38.3|°C|°F|0}}.<ref name="Hoenen2006">{{Cite journal |vauthors=Hoenen T, Groseth A, Falzarano D, Feldmann H |date=May 2006 |title=Ebola virus: unravelling pathogenesis to combat a deadly disease |journal=Trends in Molecular Medicine |volume=12 |issue=5 |pages=206–215 |doi=10.1016/j.molmed.2006.03.006 |pmid=16616875}}</ref> This is often followed by nausea, vomiting, [[diarrhoea]], abdominal pain, and sometimes [[hiccups]].<ref name=Hun2012/><ref name="Brown2017">{{Cite journal |vauthors=Brown CS, Mepham S, Shorten RJ |date=June 2017 |title=Ebola Virus Disease: An Update on Epidemiology, Symptoms, Laboratory Findings, Diagnostic Issues, and Infection Prevention and Control Issues for Laboratory Professionals |journal=Clinical Laboratory Medicine |type=Review |volume=37 |issue=2 |pages=269–284 |doi=10.1016/j.cll.2017.01.003 |pmid=28457350}}</ref> The combination of severe vomiting and diarrhoea often leads to severe [[dehydration]].<ref name="Sharma2015">{{Cite journal |vauthors=Sharma N, Cappell MS |date=September 2015 |title=Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection |journal=Digestive Diseases and Sciences |type=Review |volume=60 |issue=9 |pages=2590–2603 |doi=10.1007/s10620-015-3691-z |pmid=25972150 |s2cid=5674317|doi-access=free }}</ref> Next, [[shortness of breath]] and [[chest pain]] may occur, along with [[oedema|swelling]], [[headaches]], and [[decreased level of consciousness|confusion]].<ref name=Hun2012/> In about half of the cases, the skin may develop a [[maculopapular rash]], a flat red area covered with small bumps, five to seven days after symptoms begin.<ref name="Goeijenbier2014" /><ref name="Hoenen2006" />

===Bleeding===
In some cases, internal and external bleeding may occur.<ref name="WHO2014" /> This typically begins five to seven days after the first symptoms.<ref name="urlwhqlibdoc.who.int">{{Cite book |title=Marburg and Ebola virus infections: a guide for their diagnosis, management, and control |vauthors=Simpson DI |publisher=World Health Organization |year=1977 |isbn=924170036X |page=10f |hdl=10665/37138 |id=WHO offset publication; no. 36 |hdl-access=free}}</ref> All infected people show some [[bleeding disorder|decreased blood clotting]].<ref name="Hoenen2006" /> Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases.<ref>{{Cite web | vauthors = King JW, Rafeek H | date =  14 January 2021 | veditors = Chandrasekar PH |title=Ebola Virus, Clinical Presentation |url=http://emedicine.medscape.com/article/216288-clinical#showall |url-status=live |archive-url=https://web.archive.org/web/20120101205843/http://emedicine.medscape.com/article/216288-clinical#showall |archive-date=1 January 2012 |access-date=30 July 2012 |publisher=Medscape }}</ref> This may cause [[haematemesis|vomiting blood]], [[haemoptysis|coughing up of blood]], or [[blood in stool]].<ref>{{Cite web |title=Appendix A: Disease-Specific Chapters – Chapter: Hemorrhagic fevers caused by: i) Ebola virus and ii) Marburg virus and iii) Other viral causes including bunyaviruses, arenaviruses, and flaviviruses |url=http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/hemorrhagic_fevers_chapter.pdf |url-status=live |archive-url=https://web.archive.org/web/20141015081924/http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/hemorrhagic_fevers_chapter.pdf |archive-date=15 October 2014 |access-date=9 October 2014 |publisher=[[Ministry of Health and Long-Term Care]]}}</ref> Bleeding into the skin may create [[petechia]]e, [[purpura]], [[Ecchymosis|ecchymoses]] or [[haematoma]]s (especially around needle injection sites).<ref name="Feldmann2011" /> [[Subconjunctival haemorrhage|Bleeding into the whites of the eyes]] may also occur.<ref name="ShanthaEye2016">{{cite journal | vauthors = Shantha JG, Yeh S, Nguyen QD | title = Ebola virus disease and the eye | journal = Current Opinion in Ophthalmology | volume = 27 | issue = 6 | pages = 538–544 | date = November 2016 | pmid = 27585217 | doi = 10.1097/ICU.0000000000000313 | type = Review | s2cid = 34367099 }}</ref> Heavy bleeding is uncommon; if it occurs, it is usually in the [[gastrointestinal tract]].<ref name="West2014">{{cite journal | vauthors = West TE, von Saint André-von Arnim A | title = Clinical presentation and management of severe Ebola virus disease | journal = Annals of the American Thoracic Society | volume = 11 | issue = 9 | pages = 1341–1350 | date = November 2014 | pmid = 25369317 | doi = 10.1513/AnnalsATS.201410-481PS | type = Review }}</ref> The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon,<ref>{{cite journal | vauthors = Sharma N, Cappell MS | title = Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection | journal = Digestive Diseases and Sciences | volume = 60 | issue = 9 | pages = 2590–2603 | date = September 2015 | pmid = 25972150 | doi = 10.1007/s10620-015-3691-z | s2cid = 5674317 | doi-access = free }}</ref> but in the 2014–15 outbreak in the US it was ~18%,<ref>{{Cite web |date=6 January 2020 |title=Ebola virus disease Information for Clinicians in U.S. Healthcare Settings {{!}} For Clinicians {{!}} Ebola (Ebola Virus Disease) {{!}} Ebola Hemorrhagic Fever {{!}} CDC |url=https://www.cdc.gov/vhf/ebola/clinicians/evd/clinicians.html |access-date=22 March 2020 |website=www.cdc.gov |language=en-us}}</ref> possibly due to improved prevention of [[disseminated intravascular coagulation]].<ref name="Sharma2015" />

===Recovery or death===
Recovery may begin between seven and 14&nbsp;days after first symptoms.<ref name=Hun2012/> Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to [[hypovolemic shock|shock from fluid loss]].<ref name=Ruz2014/> In general, bleeding often indicates a worse outcome, and blood loss may result in death.<ref name="Gatherer 2014" /> People are often in a [[coma]] near the end of life.<ref name=Hun2012/>

Those who survive often have ongoing muscular and joint pain, [[hepatitis|liver inflammation]], and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.<ref name="Hun2012" /><ref name="Tosh2014" /> Problems with vision may develop.<ref>{{Cite web |date=7 August 2015 |title=An emergency within an emergency: caring for Ebola survivors |url=https://www.afro.who.int/news/emergency-within-emergency-caring-ebola-survivors |url-status=live |archive-url=https://web.archive.org/web/20150813163313/https://www.afro.who.int/en/sierra-leone/press-materials/item/7908-an-emergency-within-an-emergency-caring-for-ebola-survivors.html |archive-date=13 August 2015 |access-date=12 August 2015 |publisher=[[World Health Organization]] (WHO)}}</ref> It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebola virus on two separate occasions.<ref>{{Cite web |title=Ebola Virus Disease |url=https://srhd.org/health-topics/diseases-conditions/ebola |access-date=15 September 2020 |website=SRHD |language=en-US}}</ref>

Survivors develop [[antibodies]] against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections.<ref name="CDC2014QAT" />