Clinical Virology of Ebola Hemorrhagic Fever (EHF): Virus, Virus Antigen, and IgG and IgM Antibody Findings among EHF Patients in Kikwit, Democratic Republic of the Congo, 1995

Abstract

Ebola hemorrhagic fever (EHF) patients treated at Kikwit General Hospital during the 1995 outbreak were tested for viral antigen, IgG and IgM antibody, and infectious virus. Viral antigen could be detected in virtually all patients during the acute phase of illness, while antibody was not always detectable before death. Virus was also isolated from patients during the course of their febrile illness, but attempts to quantify virus in Vero E6 cells by standard plaque assay were often unsuccessful. IgG and IgM antibody appeared at approximately the same time after disease onset (8-10 days), but IgM persisted for a much shorter period among the surviving convalescent patients. IgG antibody was detectable in surviving patients through about 2 years after onset, the latest time that samples were obtained. Detection of Ebola virus antigens or virus isolation appears to be the most reliable means of diagnosis for patients with suspected acute EHF, since patients with this often-fatal disease (80% mortality) may not develop detectable antibodies before death.

Detection of Ebola Viral Antigen by Enzyme-Linked Immunosorbent Assay Using a Novel Monoclonal Antibody to Nucleoprotein

“…The first three subtypes cause severe clinical symptoms in both humans and monkeys, while subtype Reston has caused disease only in monkeys (4,10,11). Ebola virus infection has an acute onset, and frequently, no antibody production is observed at the onset of clinical symptoms (1,7). On the other hand, the virus load in patients' blood and tissues such as liver is extremely high (7).…”

“…Ebola virus infection has an acute onset, and frequently, no antibody production is observed at the onset of clinical symptoms (1,7). On the other hand, the virus load in patients' blood and tissues such as liver is extremely high (7). Therefore, quick and accurate primary screening for Ebola virus infection can be achieved by detection of the viral antigens rather than by detection of specific antibodies (14).…”

Ebola virus – from neglected threat to global emergency state

“…Patients who survive usually improve in the second week after onset of the disease, 39 while fatal cases are characterized by more severe early symptoms and signs that progress to multiple organ failure, typically dying in the second week. 59,60 It has been shown that survivors of the infection had an IgM response 2 days after the appearance of symptoms and an IgG response 5 to 8 days after onset of symptoms. On the other hand, in fatal cases there seemed to be a lack of IgG response and only 30% of these patients developed IgM response.…”

“…On the other hand, in fatal cases there seemed to be a lack of IgG response and only 30% of these patients developed IgM response. 59,61 therapeutic Measures…”

Status and challenges of filovirus vaccines

“…Within 6-8 days of fever, hemorrhagic complications can develop, and patients develop increasingly severe symptoms including severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction. For ZEBOV, clinical signs include elevated liver enzymes, pronounced decreases in peripheral blood lymphocyte counts, especially CD8 T cells, and elevations in inflammatory cytokines [31][32][33][34]. Thrombocytopenia is reported as well as decreases in platelet counts and development of disseminated intravascular coagulation in some but not all fatal cases.…”