Differential Diagnosis
- Single most likely diagnosis
- Ebola virus disease: The patient's symptoms, including fever, weakness, headache, loose stools, epistaxis, and petechial rash, are consistent with Ebola virus disease. His occupation as a nurse in a hospital in Guinea, where he was exposed to patients with similar symptoms, further supports this diagnosis. The acute onset of illness, severe weakness, and hemorrhagic manifestations are also characteristic of Ebola.
- Other Likely diagnoses
- Congo Crimean hemorrhagic fever: This disease, caused by a tick-borne virus, can present with similar symptoms, including fever, headache, and hemorrhage. However, the patient's exposure history and the presence of loose stools and epistaxis make Ebola a more likely diagnosis.
- Lassa fever: Although not listed among the options, Lassa fever is another viral hemorrhagic fever common in West Africa, which could present with similar symptoms. However, the specific combination of symptoms and exposure history points more towards Ebola.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hemorrhagic fever with renal syndrome (HFRS): While less likely given the patient's symptoms and exposure history, HFRS can cause severe illness and renal failure. It is essential to consider this diagnosis due to its potential severity, even if it is less likely than Ebola.
- Yellow fever: Although the patient's symptoms could partially align with yellow fever, the absence of a clear history of mosquito exposure and the specific constellation of symptoms make it less likely. However, given the severity and potential for hemorrhage, it should not be entirely ruled out without further investigation.
- Rare diagnoses
- Dengue fever: While dengue can cause severe illness, including hemorrhagic manifestations, the patient's symptoms and exposure history make it a less likely diagnosis compared to Ebola or other viral hemorrhagic fevers. Dengue typically presents with a more pronounced rash and severe thrombocytopenia, which, although possible, is not the primary concern given the patient's other symptoms.