Post-Ebola virus syndrome

Post-Ebola virus syndrome (or post-Ebola syndrome) is a post-viral syndrome affecting those who have recovered from infection with Ebola.[1] Symptoms include joint and muscle pain, eye problems, including blindness, various neurological problems, and other ailments, sometimes so severe that the person is unable to work.[2] Although similar symptoms had been reported following previous outbreaks in the last 20 years, health professionals began using the term in 2014 when referring to a constellation of symptoms seen in people who had recovered from an acute attack of Ebola disease.

Post-Ebola virus syndrome
Other namesPost Ebola syndrome
Ebola virus particles (blue) attacking a cell (yellow)
SpecialtyInfectious disease

Signs and symptoms
Articles related to the
West African
Ebola virus epidemic
Overview
Nations with widespread cases
Other affected nations
Other outbreaks

Researchers have been aware of a group of symptoms that frequently followed Ebola virus disease for 20 years, but it became more widely reported with the large number of survivors of the deadly epidemic in 2014.[1][3][4][5][6] Post Ebola syndrome may manifest as joint pain, muscle pain, chest pain, fatigue, hearing loss, hair loss, cessation of menstruation, and poor long term health. Some survivors report neurological issues including memory problems and anxiety attacks. Vision loss is also frequently reported, along with eye pain, inflammation, and blurred vision.[7] Two papers published in the New England Journal of Medicine in 2015 report that symptoms include lethargy, joint pains, hair loss, and vision loss, frequently to the point of near blindness, and uveitis.[8][9]

Cause
Doctors put on protective gear before entering an Ebola treatment ward in Liberia, August 2014.

Although there is some progress that may potentially help Ebola survivors, adequate funding and further research is required to help provide more answers about post-Ebola syndrome.[10] Studies from previous outbreaks reveal that the virus is able to survive for months after recovery in some parts of the body such as the eyes and testes, where the immune system cannot reach. It is not known if the neurologic symptoms seen in survivors are a direct result of the virus or, instead, triggered by the immune system’s response to the infection. It is known that Ebola can trigger a massive cytokine storm that can cause bleeding throughout the body, including the brain, which may explain various neurological symptoms that have been reported.[11]

Viral persistence

According to a review by Brainard, et al., Ebola virus was identified in almost 3 out of 4 seminal fluid samples (18 survivors) almost 4 months after initial infection, with the last positive samples being more than 6 months (203 days) after infection had occurred.[12] Another aspect of survivors of the Ebola virus, is that it could become sexually transmitted, as the virus is present in semen nine months after the individuals are declared free of Ebola.[13] A 2017 study found the virus in the semen of some men after more than two years following the recovery from the acute infection.[14]

Diagnosis

In terms of diagnosis the individual may show sensitivity to light or eye redness when ocular problems are suspected. Neurologically the individual's coordination, gait and frontal release signs should be observed.[6]

Management

Management depends on the symptoms displayed, for example, if the individual indicates muscular-skeletal pain then paracetamol may be administered. If the individual presents with ocular problems, then prednisone and cyclopentolate may be used for treatment, according to the WHO.[6]

Follow-up

Researchers from the National Institute of Neurological Disorders and Stroke (NINDS) and Liberian research partners are doing a 5-year follow-up study of 1500 Ebola survivors in Liberia. Survivors will be evaluated every 6 months; as of October 2017 two follow-ups have been performed. Researchers will track relapses and viral persistence, characterize sequelae in various bodily systems, and do clinical studies on pharmacologic interventions and vaccines.[15]

PREVAIL III (Partnership for Research on Ebola Vaccines in Liberia III), a study of survivors and their contacts, a collaboration between NINDS and Liberia, was planned in late 2014.[16]

See also

References
  1. Scott, Janet T.; Sesay, Foday R.; Massaquoi, Thomas A.; Idriss, Baimba R.; Sahr, Foday; Semple, Malcolm G. (2016). "Post-Ebola Syndrome, Sierra Leone - Volume 22, Number 4—April 2016 - Emerging Infectious Disease journal - CDC". Emerging Infectious Diseases. 22 (4): 641–646. doi:10.3201/eid2204.151302. PMC 4806950. PMID 26983037.
  2. Burki, Talha Khan (July 2016). "Post-Ebola syndrome". The Lancet Infectious Diseases. 16 (7): 780–781. doi:10.1016/S1473-3099(15)00259-5. ISSN 1474-4457. PMID 27352759.
  3. Neporent, Liz (2014-09-03). "'Post-Ebola Syndrome' Persists After Virus Is Cured, Doctor Says". ABC news. Retrieved 12 May 2015.
  4. Farge, Emma; Giahyue, James Harding (2015-02-04). "Free from Ebola, survivors complain of new syndrome". Dakar, Monrovia. Reuters. Retrieved 12 May 2015.
  5. Grady, Denise (2015-05-07). "After Nearly Claiming His Life, Ebola Lurked in a Doctor's Eye". The New York Times. Retrieved 12 May 2015.
  6. "Clinical care for survivors of Ebola virus disease" (PDF). WHO. World Health Organization. Retrieved 5 August 2016.
  7. Carod-Artal, Francisco Javier (3 October 2015). "Post-Ebolavirus disease syndrome: what do we know?". Expert Review of Anti-infective Therapy. 13 (10): 1185–1187. doi:10.1586/14787210.2015.1079128. ISSN 1478-7210. PMID 26293407.
  8. Varkey, Jay B.; Shantha, Jessica G.; Crozier, Ian; Kraft, Colleen S.; Lyon, G. Marshall; Mehta, Aneesh K.; Kumar, Gokul; Smith, Justine R.; Kainulainen, Markus H.; Whitmer, Shannon; Ströher, Ute; Uyeki, Timothy M.; Ribner, Bruce S.; Yeh, Steven (7 May 2015). "Persistence of Ebola Virus in Ocular Fluid during Convalescence". New England Journal of Medicine. 372 (25): 2423–7. doi:10.1056/NEJMoa1500306. hdl:2328/35704. PMC 4547451. PMID 25950269.
  9. Epstein, Lauren; Wong, Karen K.; Kallen, Alexander J.; Uyeki, Timothy M. (17 December 2015). "Post-Ebola Signs and Symptoms in U.S. Survivors". New England Journal of Medicine. 373 (25): 2484–2486. doi:10.1056/NEJMc1506576. ISSN 0028-4793. PMID 26672870.
  10. "Ebola survivors: What happens next?". Foundation for Biomedical Research. Retrieved 8 July 2015.
  11. Clark, Danielle V; Kibuuka, Hannah; Millard, Monica; Wakabi, Salim; Lukwago, Luswa; Taylor, Alison; Eller, Michael A; Eller, Leigh Anne; Michael, Nelson L; Honko, Anna N; Olinger, Gene G; Schoepp, Randal J; Hepburn, Matthew J; Hensley, Lisa E; Robb, Merlin L (August 2015). "Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study". The Lancet Infectious Diseases. 15 (8): 905–912. doi:10.1016/S1473-3099(15)70152-0. PMID 25910637. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
  12. Brainard, Julii; Pond, Katherine; Hooper, Lee; Edmunds, Kelly; Hunter, Paul (2016-02-29). "Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review". PLOS Negl Trop Dis. 10 (2): e0004475. doi:10.1371/journal.pntd.0004475. ISSN 1935-2735. PMC 4771830. PMID 26927697.
  13. "Preliminary study finds that Ebola virus fragments can persist in the semen of some survivors for at least nine months". WHO. World Health Organization. Retrieved 5 August 2016.
  14. Fischer, William A.; Brown, Jerry; Wohl, David Alain; Loftis, Amy James; Tozay, Sam; Reeves, Edwina; Pewu, Korto; Gorvego, Galapaki; Quellie, Saturday; Cunningham, Coleen K.; Merenbloom, Carson; Napravnik, Sonia; Dube, Karine; Adjasoo, David; Jones, Erin; Bonarwolo, Korlia; Hoover, David (2017). "Ebola Virus RNA Detection in Semen More than Two Years After Resolution of Acute Ebola Virus Infection". Open Forum Infectious Diseases. 4 (3): ofx155. doi:10.1093/ofid/ofx155. PMC 5897835. PMID 29670927.
  15. Jagadesh, Soushieta; Sevalie, Stephen; Fatoma, Richard; Sesay, Foday; Sahr, Foday; Faragher, Brian; Semple, Malcolm G.; Fletcher, Tom E.; Weigel, Ralf; Scott, Janet T. (2018). "Disability among Ebola survivors and their close contacts in Sierra Leone: a retrospective case-controlled cohort study". Clinical Infectious Diseases. 66 (1): 131–133. doi:10.1093/cid/cix705. PMC 5833946. PMID 29020205.
  16. Massaquoi, Moses B F; Kennedy, Stephen B; Tegli, Jemee K; Bolay, Fatorma K; Kateh, Francis N (2016-04-01). "Fostering collaboration on post-Ebola clinical research in Liberia". The Lancet Global Health. 4 (4): e239. doi:10.1016/S2214-109X(15)00323-X. ISSN 2214-109X. PMID 27013310.

Further reading
Classification
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