Clinical Scenario:
A 10-year-old boy presents with 5 days of fever, severe fatigue, myalgia and headache, followed by repeated vomiting, profuse watery diarrhea and abdominal pain. Ten days earlier, he had returned from an area experiencing an Ebola outbreak.
He is lethargic, tachycardic and moderately dehydrated. There is no active bleeding. Laboratory tests show thrombocytopenia, leukopenia and elevated transaminases. A rapid malaria test is negative.
While Ebola testing is being arranged, which of the following is the most appropriate approach?
A. Wait for bleeding before initiating isolation
B. Isolate, use appropriate PPE and arrange Ebola RT-PCR
C. Perform lumbar puncture to exclude meningitis
D. Start corticosteroids while awaiting serology
E. Exclude Ebola because the malaria test is negative
Correct answer & Explanation:
Correct answer: B. Isolate, use appropriate PPE and arrange Ebola RT-PCR
Explanation
The combination of a compatible clinical illness and relevant epidemiological exposure should raise immediate suspicion of Ebola virus disease.
Ebola typically begins with nonspecific systemic symptoms such as fever, profound fatigue, myalgia and headache, followed after several days by gastrointestinal manifestations including vomiting, diarrhea and abdominal pain. Importantly, bleeding is not universal and should not be required before considering the diagnosis.
The appropriate approach is immediate infection-control precautions and diagnostic testing. Ebola can only be confirmed by laboratory testing; RT-PCR is an important diagnostic method during acute illness. Specimens from suspected patients are a significant biohazard and must be collected, transported and processed using appropriate biosafety procedures.
At the same time, other causes of acute febrile illness must not be neglected. Malaria, typhoid fever, meningococcal disease and other infections can resemble early Ebola, and testing/treatment for more likely alternative diagnoses should continue when clinically appropriate.
Why not the other options?
- A. Bleeding is not necessary for Ebola diagnosis and may occur later.
- C. Lumbar puncture is an invasive procedure and should not be performed before appropriate infection-control assessment in a patient potentially infected with a high-consequence pathogen.
- D. Corticosteroids have no established role as routine empirical treatment for suspected Ebola.
- E. A negative malaria test does not establish Ebola; laboratory confirmation is still required.
Postgraduate pearl
Ebola should be suspected from the combination of epidemiological exposure + compatible illness, not from hemorrhage alone.
The key sequence is:
Suspect → isolate/use PPE → notify appropriate public-health authorities → collect appropriate specimens safely → perform diagnostic testing → continue evaluation for alternative diagnoses.
References
- World Health Organization. Diagnostic testing for Ebola disease and Marburg virus disease: interim guidance. 9 July 2026.
- World Health Organization. WHO guidelines for the clinical management of filovirus disease. 11 June 2026.
- Centers for Disease Control and Prevention. Clinical Features of Ebola Disease. Updated May 27, 2026.
- Centers for Disease Control and Prevention. Clinical Guidance for Ebola Disease. Updated May 27, 2026.
