EBOLA HEMORRHAGIC FEVER – A NEW SCARE TO WORLD HOMOEOPATHIC PROPHYLAXIS AND MANAGEMENT

Now the word EBOLA become very familiar to us  due to news reports of its spread in Africa and a scare that the virus may have spread to our nation, but by god grace till now no case has been reported. Ebola hemorrhagic fever has made worldwide news because of its destructive potential.  Now this disease may seem far away from us and with the ease of travel, it would not be difficult for a disease like Ebola to spread. Knowledge of how to handle these types of more exotic illness is always worth learning. According to WHO, Ebola virus disease first appeared in 1976 in two simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River from which the disease takes its name

Ebola hemorrhagic fever is a severe viral infection that is often fatal, sometimes within days. Symptoms include severe fever accompanied by muscle pain, weakness, vomiting and diarrhea, and in severe cases, unstoppable bleeding and shutdown of vital organs. In the case of Ebola, no conventional treatment or vaccine is available. Fortunately for us, homoeopathy has great renowned for its healing ability in epidemics.

The disease typically occurs in outbreaks in tropical regions of Sub- Saharan Africa. From 1976 (when it was first identified) through 2013, fewer than 1,000 people per year have been infected. The largest outbreak to date is the ongoing 2014 West Africa Ebola virus outbreak, which is affecting Guinea, Sierra Leone, and Liberia. As of August 2014, it is also affecting Nigeria. As of the end of July 2014 more than 1440 cases have been identified. By 31 July 2014, they reported that the death toll had reached 826 people from 1440 cases. On 8 August, the WHO declared the epidemic to be an international public health emergency. Urging the world to offer aid to the affected regions.

Causes

Ebola virus disease (EVD) is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. While there are five identified sub-species of Ebolavirus, four viruses cause disease in humans. They are Bundibugyo virus (BDBV), Ebola virus (EBOV), Sudan virus (SUDV), Tai Forest virus (TAFV).

The fifth virus, Reston virus (RESTV), is not considered to be disease-causing in humans.

Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers illnesses marked by severe bleeding, organ failure and, in many cases, death. Both viruses are native to Africa, where sporadic outbreaks have occurred for decades. Ebola virus and Marburg virus live in animal hosts, and humans can contract the viruses from infected animals. Ebola virus has been found in African monkeys, chimps and other nonhuman primates. A milder strain of Ebola has been discovered in monkeys and pigs in the Philippines. Marburg virus has been found in monkeys, chimps and fruit bats in Africa.

Spread of Disease

The WHO says it is believed that fruit bats may be the natural host of the Ebola virus in Africa, passing on the virus to other animals.

Humans contract Ebola through contact with the bodily fluids of infected animals or the bodily fluids of infected humans.

Transmission from animals to humans - Experts suspect that both viruses are transmitted to humans through an infected animal's bodily fluids like Blood. Butchering or eating infected animals can spread the viruses. Scientists who have operated on infected animals as part of their research have also contracted the virus.

Tourists in certain African caves and some underground mine workers have been infected with the Marburg virus, possibly through contact with the feces or urine of infected bats.

Transmission from person to person - Infected people typically don't become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial.

Medical personnel can be infected if they don't use protective gear, such as surgical masks and gloves. Medical centers in Africa are often so poor that they must reuse needles and syringes. Some of the worst Ebola epidemics have occurred because contaminated injection equipment wasn't sterilized between uses. There's no evidence that Ebola virus or Marburg virus can be spread via insect bites.

MSF (Médecins Sans Frontières USA) says that while the virus is believed to be able to survive for some days in liquid outside an infected organism, chlorine disinfection, heat, direct sunlight, soaps and detergents can kill it. MSF epidemiologist said outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water.

Can plane passengers become infected? Is it an air borne disease?

While the CDC (Center for disease control USA) acknowledges its possible a person infected with Ebola in West Africa could get on a plane and arrive in another country, the chances of the virus spreading during the journey are low.

It’s very unlikely that they would be able to spread the disease to fellow passengers, said Stephen Monroe, deputy director of CDCs National Center for Emerging Zoonotic and Infectious Diseases. He added that most people who have become infected with Ebola lived with or cared for an ill patient.

This is not an airborne transmission, said Dr. Marty Cetron, director of CDCs Division of Global Migration and Quarantine. There needs to be direct contact frequently with body fluids or blood.

Clinical Manifestations

Signs and symptoms typically begin abruptly within five to 10 days of infection with Ebola or Marburg virus. Early symptoms of EVD may be similar to those of malaria, dengue fever, or other tropical fevers, before the disease progresses to the bleeding phase.

Signs and symptoms usually begin suddenly with a flu-like stage characterized by fatigue, fever, headaches, and joint, muscle, and abdominal pain. Vomiting, diarrhea and loss of appetite are also common. Less common symptoms include the following: sore throat, chest pain, hiccups, shortness of breath and trouble swallowing.

The average time between contracting the infection and the start of symptoms is 8 to 10 days, but it can vary between 2 and 21 days.

Skin manifestations may include a maculopapular rash (in about 50% of cases).

In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g. gastrointestinal tract, nose, vagina, and gums) has been reported. In the bleeding phase, which typically starts 5 to 7 days after first symptoms internal and subcutaneous bleeding may present itself through reddening of the eyes and bloody vomit. Bleeding into the skin may create petechiae, purpura, ecchymoses, and hematomas (especially around needle injection sites). Types of bleeding known to occur with Ebola virus disease include vomiting blood, coughing it up or blood in the stool.

Heavy bleeding is rare and is usually confined to the gastrointestinal tract. In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death.  

All people infected show some symptoms of circulatory system involvement, including impaired blood clotting. If the infected person does not recover, death due to multiple organ dysfunction syndromes occurs within 7 to 16 days (usually between days 8 and 9) after first symptoms.

Diagnosis

Ebola and Marburg hemorrhagic fevers are difficult to diagnose because early signs and symptoms resemble those of other diseases, such as typhoid and malaria.

The medical history, especially travel and work history along with exposure to wildlife are important to suspect the diagnosis of EVD. The diagnosis is confirmed by isolating the virus, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture, detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) is effective early and in those who have died from the disease. During an outbreak, virus isolation is often not feasible. The most common diagnostic methods are therefore real time PCR and ELISA detection of proteins, which can be performed in field or mobile hospitals. Filovirions can be seen and identified in cell culture by electron microscopy due to their unique filamentous shapes, but electron microscopy cannot tell the difference between the various filoviruses despite there being some length differences.

Prevention of Disease

Prevention focuses on avoiding contact with the viruses. The following precautions can help prevent infection and spread of Ebola and Marburg.

Avoid areas of known outbreaks - Before traveling to Africa, find out about current epidemics by checking the Centers for Disease Control and Prevention website.

Wash your hands frequently - As with other infectious diseases, one of the most important preventive measures is frequent hand-washing. Use soap and water, or use alcohol based hand rubs containing at least 60 percent alcohol when soap and water aren't available.

Avoid bush meat - In developing countries, avoid buying or eating the wild animals, including nonhuman primates, sold in local markets.

Avoid contact with infected people - In particular, caregivers should avoid contact with the person's body fluids and tissues, including blood, semen, vaginal secretions and saliva. People with Ebola or Marburg are most contagious in the later stages of the disease.

Follow infection-control procedures - If you're a health care worker, wear protective clothing, such as gloves, masks, gowns and eye shields. Keep infected people isolated from others. Dispose of needles and sterilize other instruments.

Don't handle remains - The bodies of people who have died of Ebola or Marburg disease are still contagious. Specially organized and trained teams should bury the remains, using appropriate safety equipment.

Outlook (Prognosis)

As many as 90% of patients die from the disease. Patients usually die from low blood pressure (shock) rather than from blood loss.

General Management

In Modern system of medicine, No antiviral medications have proved effective in treating infection with either virus till now.

Supportive hospital care includes:

·        Providing fluids

·        Maintaining blood pressure

·        Providing oxygen as needed

·        Replacing lost blood

·        Treating other infections that develop

Homoeopathic management

Homoeopaths have found that their medicines can prevent and treat various infections. There is not much research demonstrating the efficacy of the homoeopathic medicines in preventing viral conditions, though there is some evidence that the medicines can be used to prevent other infectious diseases. In the 1800s homoeopaths commonly used medicines to prevent or cure what later came to be understood as bacterial or viral infections. Homoeopaths commonly find that successful treatment of acute or chronic disease with homeopathic medicines often leads to stronger and healthier people who do not get severely or recurrently ill. One of the additional advantages of using homoeopathy in treating viral conditions is that homoeopathic medicines can be prescribed even before a definitive diagnosis has been made. This is because homoeopaths prescribe based on the totality of symptoms, and laboratory work is not always necessary to find the correct medicine. Since some viral conditions are difficult to diagnose even after laboratory tests, one is often able to cure people with homoeopathy before a conventional medical diagnosis can be made.

The symptoms of Ebola and other hemorrhagic fevers resemble those of malaria, dengue fever, yellow fever and viral hepatitis. Homoeopathy may not have a medicine that kills the virus, but can definitely help the body fight back. In homoeopathy, remedies are often chosen based on the symptom picture, so the remedies most often used for Ebola will be the same as for these other diseases. The following remedies would be considered by a homoeopath for any of the viral hemorrhagic fevers that match this symptom picture.

Crotalus horridus 30C – Is to be considered for when there is difficulty swallowing due to spasms and constriction of the throat, dark purplish blood, edema with purplish, mottled skin. It has been found successful application in this disease ,as well as reportedly a prophylactic action when in low material dose. A mental and physical prostration that is almost paralytic in character. Scarlet fever when it becomes putrid; typhoid when it becomes putrid, diphtheria with much bleeding and putridity. The body appears mottled, blue intermingled with yellow jaundice comes on with astonishing quickness, and the eyes become yellow, and the skin becomes yellow and mottled. Blue in spots. Black and blue spots as if bruised, intermingled with yellow. After hemorrhages the skin becomes extremely anemic.

It is yellow, pale, bloodless. The body looks like wax. Hemorrhage from the ears, eyes, nose, lungs, from the mucous membranes everywhere, from the bowels, from the uterus, A haemorrhagic constitution.

Crotalus is indicated in disease of the very lowest, the most putrid type, coming on with unusual rapidity, reaching that putrid state in an unusually short time. One who has been poisoned rapidly sinks into, this besotted, benumbed. putrid, semi-conscious state. There is a feeling as if death were coming over him. As the blood oozes out it becomes black, It is sometimes fluid. An awful state of nervousness prevails. Trembling of the limbs, tremulous weakness. On protruding the tongue it comes out quivering. Tired by the slightest exertion. Sudden prostration of the vital powers. A paralytic weakness prevails throughout. Twitching of the muscles, trembling of the limbs. Sliding down in bed occurs in the typhoid conditions where this remedy has proved of benefit, the forms of yellow fever with great prostration. This species of yellow fever has been cured by this remedy. Convulsions and paralysis. It has twitching of muscles something like chorea, trembling, localized spasms, hysterical manifestations.

Bothrops 30C – Is the remedy to think of when nervous trembling, difficulty articulating speech, sluggishness, swollen puffy face, black vomiting are present

Lachesis mutus 30C – when there’s delirium with trembling and confusion, hemorrhaging in any area, consider this remedy. Often, the person cannot bear tight or constricting clothing or bandages and feels better from heat and worse on the left side.

Mercurius corrosivus 30C, – For copious bleeding, better when lying on the back with the knees bent up, delirium, headache with burning cheeks, photophobia, black swollen lip, metallic, bitter or salt taste in mouth.

Secale cornutum 30c,– For thin, slow, painless oozing dark hemorrhage with offensive odor, cold skin and tingling in the limbs. The individual wants to be uncovered and feels WORSE from motion.

Echinacea 30C – For when there’s sepsis or blood poisoning, fetid smelling discharges and enlarged lymph nodes.