Survivors of Ebola virus disease can develop health complications that persist after recovery. Now, a new study of an Ebola survivor describes how the virus remained live in the fluid within one of his eyes for more than 2 months after recovery.
The researchers behind the study note that while they found viable Ebola virus in the aqueous humor of the patient's affected eye, tests on tear fluid and conjunctiva samples tested negative for Ebola, suggesting casual contact with Ebola survivors does not pose a risk.
However, they warn that their findings do show a need for infection control when patients who have survived Ebola undergo any invasive procedures in their eyes.
They also note the study highlights the importance of follow-up care for people who have survived infection with Ebola virus.
The team reports the research in the New England Journal of Medicine and presented it at the 2015 Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Denver, Colorado.
Ebola survivors 'require ongoing medical care'
First author and infectious disease specialist Jay Varkey, an assistant professor of medicine at Emory University School of Medicine in Atlanta, GA, says the current Ebola outbreak in West Africa has resulted in the largest number of Ebola survivors in history.
He explains that Ebola survivors "require ongoing medical care to manage complications from the infection that may develop during recovery."
In their paper, Prof. Varkey and colleagues describe the case of 43-year-old Ian Crozier, a Zimbabwe-born doctor and American citizen who became infected with Ebola virus while working at an Ebola treatment center in Sierra Leone.
He was transported to the US and underwent 40 days of treatment in the Serious Communicable Disease Unit at Emory University Hospital.
During his recovery, it was clear that Dr. Crozier had acute uveitis and severe high pressure in one eye.
Uveitis is an inflammation of the middle layer of the eye, which includes the iris - the ring of muscle behind it - and a layer of tissue that supports the retina. It causes redness, blurred vision, eye pain, headaches and sensitivity to light.
Viable Ebola virus persisted in aqueous humor for more than 2 months
Two months after his discharge from the hospital, Dr. Crozier had a full eye exam at the Emory Eye Center. The exam included removal of fluid from inside the eye - a procedure known as "anterior chamber paracentesis."
The results showed he had viable Ebola virus in the aqueous humor of the inflamed eye. This was 9 weeks after the virus had cleared from his bloodstream.
Dr. Crozier was treated with topical corticosteroids and other medications to reduce the higher pressure in his eye. His eyesight has returned to normal following treatment for uveitis and he is continuing to have regular eye exams.
The authors conclude their findings have implications not only for Ebola virus disease (EVD) survivors but also for health care providers who have been sent home for ongoing care. They call for ongoing surveillance for the development of diseases in the eye and other parts of the body in the period following the Ebola outbreak, as Prof. Varkey explains:
"To safely evaluate and treat EVD survivors who develop complications in the eye and other 'immune-privileged' sites of the body, health care providers who perform invasive procedures should develop standard operating protocols for: 1. Safely donning and doffing PPE [personal protection equipment]; 2. Handling laboratory specimens, and 3. Managing medical waste."
Meanwhile, Medical News Today recently reported how leaders of the World Health Organization admitted to faults in their handling of the Ebola outbreak in West Africa. They say they have learned eight valuable lessons from the crisis, including the fact that current national and international capacities and systems cannot cope with large-scale outbreaks.