Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection

Abstract

Aim: Although Ebola virus infection (EVI) clinically presents with common, prominent, gastroenterologic manifestations, this subject has not been previously reviewed. This work critically and comprehensively reviews this subject. Methods: This study is a comprehensive literature review generated by computerized search of literature, supplemented by review of monographs and textbooks in pathology, gastroenterology, infectious diseases, and virology. Results: Common gastrointestinal manifestations include diarrhea—70 %, nausea and vomiting—60 %, and abdominal pain—45 %. The diarrhea and nausea and vomiting frequently produce profound, life-threatening hypovolemia requiring intravenous administration of crystalloid solutions, and frequently produce electrolyte disorders requiring electrolyte supplementation. Although gastrointestinal hemorrhage was commonly reported in early epidemics, its frequency has decreased to 10 % with prevention of disseminated intravascular coagulation. Hyperamylasemia is commonly reported, but the frequency of pancreatitis is unknown. The mean serum AST and ALT levels are each about 200/UL, with an unusual pattern for viral hepatitis of AST > ALT. The serum alkaline phosphatase averages about 160 IU/L, whereas the total bilirubin averages about 0.8 mg/dL. Risks of contracting infection during endoscopy performed on infected patients are unknown, but may be significant, as indicated by hundreds of healthcare workers contracting EVI during epidemics before instituting strict infectious control measures and anecdotal evidence of one endoscopist contracting EVI from performing endoscopy on an infected patient. Conclusions: Physicians must be vigilant for gastroenterologic manifestations of EVI for appropriate diagnosis and therapy. This work should stimulate clinicopathologic studies to improve the current understanding of the gastroenterologic pathophysiology. Endoscopy is currently not standardly recommended to evaluate diarrhea, nausea and vomiting, or abdominal pain associated with EVI due to potential risks, but may be considered for endoscopic therapy for active, life-threatening, GI hemorrhage.