Pathology and Diagnosis

Very few specimens were obtained for histological study. In three adequately preserved liver specimens available, fatty changes and necrosis of hepatocytes and Kupffer cells were noted, necrosis being of the focal type, distributed throughout the liver lobules. Intact cells with hyalinized cytoplasm and ghostlike nuclei (Councilman bodies of yellow fever fame) were seen, as were large amounts of karyorrhectic debris. Inflammatory changes were minimal in the liver and other organs.

Comparisons were made with Marburg disease, for which there was a large amount of pathological material available, both from human beings and from experimental animals. Here, in addition to the focal necrotic centers in the liver, was evidence of hemorrhagic diathesis in many organs and of panencephalitis in the brain, with glial nodule formation, perivascular lymphocyte cuffing, and interstitial edema.

Several pathologists deemed the differential diagnosis of Ebola infection to be extremely difficult in settings where there might be malaria, Lassa fever, Marburg disease, yellow fever, Congo-Crimean hemorrhagic fever, typhoid fever, infectious hepatitis, leptospirosis, brucellosis, and other fevers. Some other pathologists felt the lesions observed to be adequately specific to permit an Ebola diagnosis.

Clinical pathological data are extremely limited. A few white blood cell counts were normal to slightly elevated. No differential counts were made. Proteinuria occurred frequently.

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