Anti-diarrheal medication use in the treatment of Ebola virus-induced diarrhea.

We would like to comment on the use of anti-diarrheal medication in the treatment of Ebola virus-induced diarrhea. Early symptoms of Ebola virus disease (EVD) are nonspecific and may include fever, chills, myalgias, malaise, and anorexia. Approximately five days after symptom onset, 62 percent of patients develop gastrointestinal (GI) illness including abdominal pain, nausea, vomiting, and watery diarrhea [1]. The often voluminous diarrhea may lead to significant hypovolemia, ultimately resulting in shock and/or death. Supportive, symptom-based treatment is recommended; the use of anti-diarrheal medications to reduce GI output may be considered. Patient outcomes attributed to EVD-induced diarrhea treatment choice are not known. In general, non-antibiotic anti-diarrheal medications are not recommended for diarrhea associated with fever or for mucous-containing diarrhea marked by inflammation, ulceration, or bleeding of the GI tract [2]. However, this general recommendation is based largely upon expert opinion or extrapolation from small series limited to a few causes of infectious diarrhea. A key question for an assessment of the role of anti-diarrhea therapy in EVD is: In the pathophysiology of EVD, does diarrhea play a protective role through elimination of the infectious agent? Equating the treatment of EVD-induced diarrhea to that of diarrhea associated with severe bacterial GI infections or self-limiting community-acquired viral gastrointestinal infections is problematic. EVD-induced diarrhea has been described in recent reports as watery and voluminous (5 or more liters per day) [3]. Profuse and watery diarrhea is known to occur as a result of small bowel hypersecretion