Ebola virus disease (EVD), often referred to simply as Ebola, is a severe and frequently fatal illness impacting humans and other primates. The disease is caused by ebolaviruses, first identified in 1976 in Zaire, now the Democratic Republic of Congo. It is characterized by a sudden onset of symptoms and has a high case fatality rate, historically ranging from 25% to 90%, with an average around 50%.
Understanding “Ebola Face”
“Ebola face” is not a recognized medical term but rather a colloquial description used to describe the severe facial appearance of individuals suffering from advanced Ebola virus disease. It’s not a single symptom, but a collection of visible signs stemming from the body’s overwhelming response to the infection. It reflects the profound systemic impact of the virus, including severe dehydration, inflammation, and potential bleeding. The term describes a general look of extreme illness and distress that becomes more pronounced as the disease progresses.
This generalized appearance can result from a combination of factors, such as sunken eyes due to fluid loss, changes in skin color, or the development of rashes. While not a precise diagnostic indicator, the phrase captures the visible deterioration of a patient’s health, underscoring EVD’s severity and how its effects become evident on the face.
Common Symptoms Affecting the Head and Face
Ebola virus disease causes several symptoms affecting the head and face. Early in the illness, a severe headache is a common complaint, often with fatigue and muscle pain. As the disease progresses, a diffuse red rash may appear on the skin, sometimes starting on the face and spreading downwards to the trunk. This rash can sometimes involve skin ulceration.
Patients also develop conjunctivitis (red or bloodshot eyes). Facial swelling (edema) can occur due to fluid shifts. Later stages may show hemorrhagic manifestations like petechiae (small red or purple spots) or purpura (larger bruised areas) on the skin, indicating bleeding from small blood vessels. Frank hemorrhages, such as bleeding from the nose, eyes, or gums, are also possible in the terminal phase, further altering facial appearance.
Systemic Impact of Ebola Leading to Facial Manifestations
Facial manifestations of Ebola virus disease result from the virus’s widespread systemic impact. The Ebola virus primarily targets immune cells, such as macrophages and dendritic cells, leading to a dysregulated inflammatory response. This triggers a “cytokine storm,” an excessive release of pro-inflammatory molecules that can cause extensive tissue damage throughout the body.
The virus also causes vascular damage to endothelial cells lining blood vessels. This damage leads to increased vascular permeability, causing blood vessels to leak fluid and, in severe cases, blood into surrounding tissues. Significant fluid loss from severe vomiting and diarrhea, which can amount to 20 liters per day, contributes to severe dehydration, resulting in sunken facial features. The coagulation cascade can also be triggered, leading to blood clotting issues and contributing to internal and external bleeding, which may appear as bruising or oozing from mucosal surfaces on the face. Organ dysfunction, including liver and kidney failure, further exacerbates the patient’s condition, contributing to the overall appearance of severe illness.