r/infectiousdisease

A young girl washing her hands at an Ebola prevention checkpoint supported by UK aid at a Ugandan border crossing point with the Democratic Republic of the Congo, August 2019. Photo: DFID/Anna Dubuis via Wikimedia Commons, CC BY 2.0.

The ongoing Ebola outbreak in eastern Democratic Republic of the Congo and Uganda is a regional emergency with public number still catching up to the real picture in the field. The WHO has declared the outbreak a “Public Health Emergency of International Concern” and Africa’s CDC declared a similar public health emergency. Despite both of those declarations, we still are likely well behind the curve in terms of confirmed case counts.

The US CDC’s May 17^(th) update had listed 10 confirmed cases in the DRC, 336 confirmed cases, with 88 deaths and two imported cases confirmed in Uganda. Today’s update from Africa’s CDC had increased the death count to 106 and 395 suspected cases across the affected areas of the DRC like Bunia, Goma, Mongwalu, Butembo, and Nyakunde and Kampala, Uganda. The Associated Press reports that one of the infected is an American doctor and medical missionary in Bunia. The numbers are likely to be higher by morning (I’ll be keeping this post up to date with important new information on the outbreak). None of this is to say this should be treated like a COVID-level threat with the WHO noting it does not yet meet the definition of a pandemic emergency. The threat to the average person outside of the region is low. Heightened risk currently sits with the families, health workers, burial teams, patients, drivers, contact tracers, and whoever else can be pulled into the chain of transmission.

What’s causing the outbreak?

Before getting further into the current outbreak, it is worth remembering how and when Ebola entered the official record in the first place. WHO describes Ebola disease as first appearing in 1976 in two near-simultaneous outbreaks, one of the Sudan virus disease in Nzara, in what is now South Sudan, and the other of Ebola virus disease in Yambuku, in what is now the Democratic Republic of the Congo. The Yambuku outbreak, near the Ebola River, is the one that gave the disease its name. CDC’s outbreak history lists the 1976 DRC outbreak at 318 cases and 280 deaths (a fatality rate of 88%). The index case was treated at Yambuku Mission Hospital with an injection for possible malaria, and subsequent transmission followed through contaminated needles and syringes at the hospital and nearby clinics, as well as close personal contact.

This is Bundibugyo ebolavirus, as opposed to the better-known Zaire ebolavirus. Species is important here; I say that because when most people hear about Ebola, they’re likely to think of the West Africa outbreak or the 2018-2020 outbreak in North Kivu and Ituri. Those were Zaire ebolavirus outbreaks, and thankfully our modern response toolkit to combat Zaire ebolavirus now has a vaccine. Bundibugyo is different, most importantly in that there is no vaccine and no treatment beyond supportive care such as fluids, electrolytes, oxygen, constant monitoring, watching for secondary infections, and clinical hygiene. That puts an added strain on the already lean control machinery like isolation of cases, tracing contacts for 21 days, protecting health care workers with adequate PPE, and crucially, handling burials safely.

Why tracing an outbreak early is difficult

In an early epidemic, we often end up with a denominator problem in that counts of cases often lag behind the actual epidemic curve. This happens for a variety of reasons: people get sick before being tested, families bury someone before samples can be collected, healthcare workers get exposed before a disease even has a name, patients move closer to hospitals, contacts move around before tracing is even known to be needed, and any other reason imaginable for why a case may be missed. With Africa CDC already describing hundreds of suspected cases and over 100 deaths into the public phase of the outbreak, it seems that the response is working to reconstruct something that may have been moving around for quite some time, with late April being thought to be a decent starting point with a healthcare worker being identified as an early case. So while the confirmed numbers are useful, they’re almost always going to be underestimates the day they’re released.

How does this compare to 2014?

The 2014 comparison is useful, but it is not perfect. Seven days after announcement is not the same thing as seven days after spillover. One outbreak can burn quietly for weeks before being recognized, while another can be identified faster because the surveillance system is already primed. So the comparison should not be treated as a clean clock-to-clock match. What we can compare is the early public surveillance snapshot: what officials knew, what they were still chasing, and what kinds of warning signs were already visible.

WHO’s first public notice on March 23, 2014, described 49 cases and 29 deaths in Guinea, a 59% case fatality ratio. By March 27, WHO was reporting 103 suspected and confirmed cases, 66 deaths, four laboratory-confirmed cases in Conakry, four health-worker deaths, and suspected cases with deaths in Liberia and Sierra Leone among people who had traveled from Guinea. ECDC’s March 27 update described the outbreak as rapidly evolving and noted that supplies and logistics were still being mobilized.

So while the variant is different, the early shape of the current epidemic is not exactly more reassuring than previous outbreaks as we see high deaths relative to reported cases, health-worker deaths, funeral exposure, city involvement, border risk, and contact tracing trying to catch up to events that have already happened. That along with the fact that the current outbreak is Bundibugyo, with no licensed vaccine or treatment, makes me more concerned for those in the region.

Politics are not irrelevant

In 2014, the outbreak occurred while USAID and the CDC were still at a working capacity with regards to combating infectious diseases like Ebola. Even then, the response was late, messy, and inadequate. This outbreak is happening after DOGE spent most of 2025 cutting into USAID and US international health response capacity. Obviously that didn’t cause the outbreak, but it certainly changed the response environment for the worse. Especially having nerfed our Ebola research capacity. High-containment labs have incredibly harsh safety standards, and with Bundibugyo having no licensed vaccine and no specific therapeutic, shutting down one of the rare labs capable of doing safe work on Ebola is working in the wrong direction to say the least.

Where the outbreak could be going.

I had seen a story on twitter regarding a case in Kinshasa but I haven’t been able to confirm anything other than a person who tested negative. Goma and Kampala likely matter more at the moment. Goma is a large, mobile city on the Rwandan border, and it is currently under the control of the Rwanda-backed paramilitary group M23 movement. AFP-linked reporting says a confirmed case in Goma involved the wife of a man who died of Ebola in Bunia. She traveled to Goma after his death while already infected leading to the closure of some Goma-Gisenyi border crossings after the case was reported.

Uganda has reported two imported confirmed cases among people who traveled from the DRC, with no local transmission identified at the time of WHO’s report. One imported case is a warning. Two imported cases that do not obviously sit in one neat chain make me wonder what the DRC side has not reconstructed yet.

CDC is now trying to put some of its machinery back in motion as their May 18 briefing, confirmed the American case linked to work in the DRC, evacuation of other American and high-risk contacts to a quarantine facility Germany, enhanced screening and traveler monitoring for arrivals from DRC, Uganda, and South Sudan, and entry restrictions for non-U.S. passport holders who had been in those countries during the previous 21 days. The risk to the American public remains low.

What to watch out for

Over the next few days, I’ll be watching whether cases keep appearing in Goma, Butembo, Bunia, or other cities. Isolated introductions are one thing. Multiple urban chains are different. There’s also a need to keep an eye on Uganda for local transmission. Some imported cases are expected when people move across borders for care, work, or family reasons but any local spread in Kampala would change the story for the worse.

I’ll also be watching out for the gap between suspected cases, deaths, and confirmed cases to either widen or start to narrow depending on how much suspected cases outpace confirmatory testing. The count is supposed to move as testing catches up, but a widening gap would be a bad sign. I’ll be watching to see whether international support moves faster than the virus. Early signs are good with the ECDC having activated the EU Health Task Force, the IRC launched an emergency response in eastern DRC, and Africa CDC says it is working with partners to assess medical countermeasures and accelerate the necessary operational research.

Not sure if it’s a new trend or if my algorithm has started showing them to me more often, but I’ve been seeing a lot of posts that appear to be asking for medical advice.

There are several subs where this is appropriate (eg r/medical_advice and r/askdocs), but my understanding is that this sub is intended more for discussion on the topic of ID.

It also concerns me that a poster seeking advice might take what a commenter says at face value, when this sub has no vetting in place to ensure people who provide advice are qualified to do so. (No offence to the kind people who have been trying to offer help in these situations!)

Am I alone, or do others agree we should consider banning posts asking for medical advice? (Maybe adding a sticky with recommended subs for this?)

Me - back again - except this time I actually feel like I have had a genuine listeria exposure. I am 21 weeks pregnant and I want god honest truths here no sugar coating

Yesterday morning I had a glass of chocolate milk. After finishing a full glass I saw there was hardened old chocolate milk at the bottom. It was clear this glass was not clean.

Here’s my issue, and a habit we are changing. We soak all our dishes together and usually over night or even a day (pregnant, full time working, it happens). This includes cutting boards with raw chicken and produce, raw chicken knives etc.

I’m starting to think this glass somehow soaked in this sink then missed the dishwasher from how it looked honestly. Don’t ask me how.

Anyway I’m actually concerned about listeria from this as I’m sure the stagnant water with food, raw poultry & produce was a serious grounds for bacteria that has likely been flourishing in that chocolate milk gunk at the bottom.

Help me understand the legitimate risk here because I genuinely feel it’s high.

While walking outside, a tree branch scratched my skin. I’m worried there may have been saliva from a nearby dog/cat on the branch. Also, nearby there are a few cats live nearby inside a house (not homeless cat). I later touched the scratched area and then touched my tongue with the same finger. Could this pose any rabies risk, and would rabies vaccination be necessary?

Primary issue: Positive AFB sample ~36 hours out from excision/debridement of chest wound. Wound is located at site of old port; port was removed due to it causing a fungal bloodstream infection that almost killed me. Are these things possibly related?

I’m Day 1 post-surgical excision/debridement of a big fistula/wound on my chest, at the site of my previously-removed port.

Details on what was happening pre-surgery in a former post; I’ll link in comments.

It’s only ~36 hours since surgery and most of the tissue samples/cultures obviously haven’t resulted yet, BUT the Plastics resident just told me that a sample from the fistula is positive on an “acid fast” (?) test. She said “AFB positive,” and that ID is following/will come by tomorrow/soon.

Can anyone explain what that might mean for me? I know that TRUE answers will come from my team/ID/etc. after the cultures grow/show what’s in there… but those can take awhile and I’m so curious. This wound is over the site of my old port, which was removed after it got/gave me a fungal bloodstream infection (Candida parapsilosis) during a hospital stay in 2024. The fungus took up residence in a massive right atrial thrombus I had (thanks to Behçet’s) and the combo very nearly killed me.

Could this positive AFB situation be remnants of that same fungal infection? Or does AFB only show bacteria (not fungus)? Any idea what this will look like for me?

Of note, I have CVID, have taken a variety of biologic meds (currently Rinvoq, Otezla) over the past decade, and rely on high-dose steroids to keep my MAGIC Syndrome in check (aka keep me alive). So I’m essentially the poster child for both primary immunodeficiency and immunosuppression due to medications.

Thank you to anyone who can sketch out even a tiny bit of what this might mean!

- Age: 34 AFAB (NB)

- Height: 5’11”;

- Weight: 180kg

- Nonsmoker

- Complex medical history. MAGIC Syndrome (Behçet’s + Relapsing Polychondritis); CVID (on IgG replacement); HFpEF; CTEPH; steroid-induced DM2; VTE (right atrial thrombus, repeat PE’s).

- Rinvoq, IVIG, long-term/high-dose steroids (methylprednisolone), Warfarin, Azathioprine, Otezla, etc.

So I will say, before this ship, I honestly hadnt ever heard of the virus. I'm 42. Well in my 42 years I have been around mice, cleaned up after them a few times in my life etc. Fast forward to almost 2 wks ago and one got into our cabin in a Tn campground. It happens almost yearly when weather goes warm then we get that quick cold snap again. Never thought about it bc again, I hadnt heard about it. Well I cleaned up after this stupid mouse and of course not in the correct way as they are now saying. I swept and vacuumed. Now I am terrified. I have like til end of june to be out of that 8 wk window now. Then of course I had to come up on a tik tok of a girl in ky who got it last yr and was the first in the state after cleaning up a bunch in her basement the same way. I'm literally spiraling and have little children. I will never clean up after one again, someone else can! But I cant undo what is done😭😭😭😭

I have been suffering from a fungal infection for almost 4 years now. I’ve taken medicines from many doctors and whenever I continue treatment for 3–4 months, it gets better, but within 1 month it comes back again. I’m really frustrated and mentally tired of this cycle. Has anyone gone through something similar or found a long-term solution? What helped you prevent it from recurring? Any advice regarding hygiene, treatment, diet, clothes, or lifestyle would really help.

Whether the Hondius cluster becomes the next pandemic cannot yet be known. What is certain is that the capitalist ruling class has demonstrated, over six years and counting, that it is structurally incapable of preventing pandemics.

Read more: The MV Hondius hantavirus outbreak and the threat of another pandemic

Hi everyone

I had a 5 week old piercing that got infected. It’s healing up with antibiotics but I was wondering if it’s reset the healing entirely?

It’s my third lobe, titanium, has been upsized because of swelling, stud, cleaning twice a day

How likely am I to die of rabies several years post-exposure?

Hey folks!

I'm a 29-year old male from Australia. About 7.5 years ago I went to Vietnam with some friends and late one night, a banh mi stall owner's small dog ran up to my foot and lightly bit my toe.

We couldn't really see a clear bite mark or blood - despite this, I became riddled with anxiety and absolutely convinced that I'd just contracted rabies, especially given the prevalence of the disease in Vietnam. My friends thought I was being absolutely crazy for worrying about it so much, given we there was no clear bite mark or blood drawn - though I've heard the disease can enter our bodies through non-visible micro-punctures of the skin.

They also didn't think the dog had rabies to begin with, although we were all drunk, meaning no one could clearly remember every detail from that night, and I know dogs can have rabies days before showing symptoms. For whatever reason, I didn't see a doctor until about a week afterwards, and he basically just said: if you have it, you're dead, anyway. Super reassuring, right?

I also didn't bother with the vaccine, cause it was going to make the rest of our trip really difficult to navigate, as it requires 5 shots on specific days across the space of a month, and our itinerary meant that we weren't always going to be near a hospital. In retrospect, I really wish I'd just gotten it.

In the weeks following, I started spiraling and becoming increasingly convinced that I was experiencing intermittent tingling in my toe; I even developed a fever, which led me to go to hospital. But then nothing further happened from there, and my friends seemed to think I just stressed myself into those symptoms (possible).

I go very, very long periods without thinking about it. But every now and then, I come across articles or videos that talk about rabies, or show someone in their final days, and I go back down the rabbit hole.

You then read that rabies can have an extraordinarily long incubation period, with there being documented cases of 6, 8, even 25 years post-exposure! I know those are the exceptions to the role - but what if I'm one of them? Maybe the fact that it was my toe where I was bitten could make longer incubation period more probable?

So in short - am I being a hypochondriac or do I have reason to still be concerned?