Ebola Virus Disease Complicated by Late-Onset Encephalitis and Polyarthritis, Sierra Leone

Howlett, Patrick; Brown, Colin S; Helderman, Trina; Brooks, Tim; Lisk, Durodamil; Deen, Gibrilla F.; Solbrig, Marylou V.; Lado, Marta

doi:10.3201/eid2201.151212

Cited by 71 publications

(83 citation statements)

References 7 publications

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“…EBOV RNA was detected in CSF 7 days after onset of symptoms in a patient who presented with acute encephalopathy [19] and up to day 41 days (13 days after blood tested negative) in a patient who experienced a biphasic course of disease characterized by the development of encephalitis after a period of improvement [34]. Recently, viral RNA and infectious virus were detected in CSF from an EVD survivor with recrudescent meningoencephalitis 9 months after resolution of disease [41].…”

Section: Body Fluidsmentioning

confidence: 97%

“…EBOV RNA has been detected in a skin swab up to 23 days after clearance of viremia [31], but results of cell culture performed at the same time were negative. The maximal reported duration of EBOV RNA detection in an axillary swab was 44 days after onset of symptoms, in a patient who experienced a prolonged course of disease [34]. Whether this reflects the presence of infectious virus, remnant RNA, or external contamination from other body fluids remains unknown.…”

Section: Body Fluidsmentioning

confidence: 99%

“…While EBOV RNA and viable virus are typically detected in saliva early in the course of disease, viral shedding does not seem to persist after resolution of symptoms [18,23,33]. From urine specimens, EBOV was isolated up to 9 days after clearance of viral RNA from blood in a male patient with severe disease [31], and RNA was recovered up to 36 days (64 days after disease onset) after blood tested negative by RT-PCR from a young woman who presented with EVD complicated by severe encephalopathy [34]. In a severely ill patient who needed renal replacement therapy, EBOV could not be detected in effluent waste [35].…”

Section: Body Fluidsmentioning

confidence: 99%

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Ebola Virus Shedding and Transmission: Review of Current Evidence

et al. 2016

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Background. The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community.Methods. We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission.Findings. Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [ preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission.

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Section: Body Fluidsmentioning

confidence: 97%

Section: Body Fluidsmentioning

confidence: 99%

Section: Body Fluidsmentioning

confidence: 99%

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Ebola Virus Shedding and Transmission: Review of Current Evidence

et al. 2016

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“…In severe cases, coma may occur [18]. Meningitis and encephalitis related to EVD have also been reported in the recent outbreak, as well as in prior outbreaks, although the incidence is not well documented [22][23][24]. During acute EVD, seizures have also been reported, although these are not well characterized [11].…”

Section: Acute Neurologic Manifestationsmentioning

confidence: 99%

“…In the first case, a lumbar puncture was performed early in the course of disease, revealing a viral load of 1 × 10 6 viral copies/ml and a normal cell count and glucose in the CSF [23]. In the second case, a lumbar puncture was performed at day 41 after EVD onset; Ebola virus was detected at a cycle threshold (CT) value of 37.6, but further CSF analysis was not available [24]. Although not typical laboratory analyses, cytokine analyses on patients with Ebola have in the past revealed a Bcytokine storm^, with increased proinflammatory cytokine and chemokine production in patients with Ebola, particularly in those with more severe disease [28].…”

Section: Laboratory Findingsmentioning

confidence: 99%

Neurological Complications of Ebola Virus Infection

2016

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Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.

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