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Sequelae of Ebola Virus Disease

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Ebola Virus Disease
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Abstract

The long-term effects of the Ebola virus and the care needed by survivors is an evolving area and in the coming years we have much opportunity to learn about the late complications of the disease. In this chapter, we will first outline some of the proposed pathways for sequalae of EVD, then focus on the body systems in which some of these problems occur, and structure these around the time-frame in which they happen. Within the broad range of complications, the most common and potentially manageable relate to the psychosocial and ophthalmological sequelae, and viral persistence in semen with the accompanying risk of disease transmission—greatest attention is paid to these areas. Finally, we provide an approach to the Ebola survivor and outline future direction for care and research.

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References

  1. Purpura LJ, Rogers E, Baller A, White S, Soka M, Choi MJ, Mahmoud N, et al. Ebola virus RNA in semen from an HIV-positive survivor of Ebola. Emerg Infect Dis. 2017;23(4):714–5. https://doi.org/10.3201/eid2304.161743.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mate SE, Kugelman JR, Nyenswah TG, Ladner JT, Wiley MR, Cordier-Lassalle T, Christie A, et al. Molecular evidence of sexual transmission of Ebola virus. N Engl J Med. 2015;373(25):2448–54. https://doi.org/10.1056/NEJMoa1509773.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sissoko D, Duraffour S, Kerber R, Kolie JS, Beavogui AH, Camara AM, Graldine C, et al. Persistence and clearance of Ebola virus RNA from seminal fluid of Ebola virus disease survivors: a longitudinal analysis and modelling study. Lancet Glob Health. 2017;5(1):e80–8. https://doi.org/10.1016/S2214-109X(16)30243-1.

    Article  PubMed  Google Scholar 

  4. World Health Organization. Clinical care for survivors of Ebola virus disease. 2016, no, January 1–31.

    Google Scholar 

  5. Vetter P, Kaiser L, Schibler M, Ciglenecki I, Bausch DG. Sequelae of Ebola virus disease: the emergency within the emergency. Lancet Infect Dis. 2016a;3099(16). https://doi.org/10.1016/S1473-3099(16)00077-3 (World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved).

    Article  Google Scholar 

  6. Howlett P, Brown C, Helderman T, Brooks T, Lisk D, Deen G, Solbrig M, Lado M. Ebola virus disease complicated by late-onset encephalitis and polyarthritis, Sierra Leone. Emerg Infect Dis. 2016;22(1):150–2. https://doi.org/10.3201/eid2201.151212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tiffany A, Vetter P, Mattia J. Ebola virus disease complications as experienced by survivors in Sierra Leone. Clin Infect. 2016. https://cid.oxfordjournals.org/content/62/11/1360.full

  8. Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, Sow A, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014, October, 141022140021004. https://doi.org/10.1056/NEJMoa1411677.

    Article  CAS  Google Scholar 

  9. Ksiazek TG, Rollin PE, Williams AJ, Bressler DS, Martin ML, Swanepoel R, Burt FJ, et al. Clinical virology of Ebola hemorrhagic fever (EHF): virus, virus antigen, and IgG and IgM antibody findings among EHF patients in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999;179(Suppl 1):S177–87. https://doi.org/10.1086/514321.

    Article  PubMed  Google Scholar 

  10. Rowe AK, Bertolli J, Khan AS, Mukunu R, Bressler D, Williams AJ, Peters CJ, et al. Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. J Infect Dis. 1995;3:28–35.

    Google Scholar 

  11. Vetter P, Li AF, Schibler M, Jacobs M, Bausch DG, Kaiser L. Ebola virus shedding and transmission: review of current evidence. J Infect Dis. 2016b; 214(Suppl 3):177–84. https://doi.org/10.1093/infdis/jiw254.

    Article  CAS  Google Scholar 

  12. McElroy AK, Akondy RS, Davis CW, Ellebedy AH, Mehta AK, Kraft CS, Marshall Lyon G, et al. Human Ebola virus infection results in substantial immune activation. Proc Natl Acad Sci USA. 2015;112(15):4719–24. https://doi.org/10.1073/pnas.1502619112.

    Article  CAS  PubMed  Google Scholar 

  13. Kibuuka H, Berkowitz NM, Millard M, Enama ME, Tindikahwa A, Sekiziyivu AB, Costner P, et al. Safety and immunogenicity of Ebola virus and marburg virus glycoprotein DNA vaccines assessed separately and concomitantly in healthy Ugandan adults: a phase 1b, randomised, double-blind, placebo-controlled clinical trial. Lancet. 2015a;385(9977):1545–54. https://doi.org/10.1016/S0140-6736(14)62385-0.

    Article  CAS  PubMed  Google Scholar 

  14. Mattia JG, Vandy MJ, Chang JC, Platt DE, Dierberg K, Bausch DG, Brooks T, et al. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2016;16(3):331–8. https://doi.org/10.1016/S1473-3099(15)00489-2.

    Article  PubMed  Google Scholar 

  15. Etard J-F, Sow MS, Leroy S, Touré A, Taverne B, Keita AK, Msellati P, et al. Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study. Lancet Infect Dis. 2017;17:545–52. https://doi.org/10.1016/S1473-3099(16)30516-3.

    Article  PubMed  Google Scholar 

  16. Zeng X, Blancett CD, Koistinen KA, Schellhase CW, Bearss JJ, Radoshitzky SR, Honnold SP, et al. 2017. Persistent asymptomatic Ebola virus infection in Rhesus Monkeys. Nat Microbiol 17113: 1–11. doi:https://doi.org/10.1038/nmicrobiol.2017.113.

  17. Carpenter A, Cox AT, Marion D, Phillips A, Ewington A. A case of a chlorine inhalation injury in an Ebola Treatment Unit. J R Army Med Corps. 2015;1–3. https://doi.org/10.1136/jramc-2015-000501. (Epub ahead of print).

    Article  Google Scholar 

  18. Rosenke K, Adjemian J, Munster VJ, Marzi A, Falzarano D, Onyango CO, Ochieng M, et al. Plasmodium parasitemia associated with increased survival in Ebola virus–infected patients. Clin Infect Dis. 2016;63(8):1026–33. https://doi.org/10.1093/CID/CIW452.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Who Meeting on Survivors of Ebola Virus Disease: Clinical Care of Survivors Meeting Report. 2015, no. August: 3–4.

    Google Scholar 

  20. Deen GF, Knust B, Broutet N, Sesay FR, Formenty P, Ross C, Thorson AE, et al. Ebola RNA persistence in Semen of Ebola virus disease survivors—preliminary report. N Engl J Med. 2015;151014140118009. https://doi.org/10.1056/NEJMoa1511410.

    Article  CAS  Google Scholar 

  21. Sterk E. Filovirus haemorrhagic fever. Filovirus haemorrhagic fever guideline 2008; 2008.

    Google Scholar 

  22. Kibuuka H, Berkowitz NM, Millard M, Enama ME, Tindikahwa A, Sekiziyivu AB, Costner P, et al. The merits of malaria diagnostics during an Ebola virus disease outbreak. Emerg Infect Dis. 2015b;22(2):2448–54. https://doi.org/10.3201/eid2202.151656.

    Article  CAS  Google Scholar 

  23. Kerber R, Krumkamp R, DIallo B, Jaeger A, Rudolf M, Lanini S, Bore JA, et al. Analysis of diagnostic findings from the European mobile laboratory in Guéckédou, Guinea, March 2014 through March 2015. J Infect Dis. 2016;214:S250–7. https://doi.org/10.1093/infdis/jiw269.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Waxman M, Aluisio AR, Rege S, Levine AC. Characteristics and survival of patients with Ebola virus infection, malaria, or both in Sierra Leone: a retrospective cohort study. Lancet Infect Dis. 2017;17(6):654–60. https://doi.org/10.1016/S1473-3099(17)30112-3.

    Article  PubMed  Google Scholar 

  25. Uyeki TM, Mehta AK, Davey RT Jr, Liddell AM, Wolf T, Vetter P, Schmiedel S, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016;374(7):636–46. https://doi.org/10.1056/NEJMoa1504874.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Calain P, Bwaka MA, Colebunders R, De Roo A, Guimard Y, Katwiki KR, Kibadi K, et al. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo : clinical observations in 103 patients. J infect Dis. 1999;179(Suppl 1):1–7.

    Google Scholar 

  27. Qureshi AI, Chughtai M, Loua TO, Kolie JP, Camara HFS, Ishfaq MF, N’Dour CT, Beavogui K. Study of Ebola virus disease survivors in Guinea. Clin Infect Dis. 2015;61(7):1035–42. https://doi.org/10.1093/cid/civ453.

    Article  PubMed  Google Scholar 

  28. Lötsch F, Schnyder J, Goorhuis A, Grobusch MP. Neuropsychological long-term sequelae of Ebola virus disease survivors – a systematic review. Travel Med Infect Dis. 2017;18:18–23. https://doi.org/10.1016/j.tmaid.2017.05.001.

    Article  PubMed  Google Scholar 

  29. Clark DV, Kibuuka H, Millard M, Wakabi S, Lukwago L, Taylor A, Eller MA, et al. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet Infect Dis. 2015;15(8):905–12. https://doi.org/10.1016/S1473-3099(15)70152-0.

    Article  PubMed  Google Scholar 

  30. Jagadesh S, Sevalie S, Fatoma R, Sesay F, Sahr F, Faragher B, Semple MG, Fletcher TE, Weigel R, Scott JT. Disability among ebola survivors and their close contacts in Sierra Leone: a retrospective case-controlled cohort study. Clin Infect Dis. 2018;66(1):131–3. https://doi.org/10.1093/cid/cix705.

    Article  PubMed  Google Scholar 

  31. Bowen L, Smith B, Steinbach S, Billioux B, Summers A, Azodi S, Ohayon J, Schindler M, Nath A. Survivors of Ebola virus disease have persistent neurologic deficits. n.d.

    Google Scholar 

  32. Howlett PJ, Walder AR, Lisk DR, Fitzgerald F, Sevalie S, Lado M, et al. Case series of severe neurologic sequelae of Ebola virus disease during epidemic, Sierra Leone. Emerg Infect Dis. 2018;24(8):1412–21. https://doi.org/10.3201/eid2408.171367.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dhillon P, McCarthy S, Gibbs M. Surviving stroke in an Ebola treatment centre. BMJ Case Rep. 2015;3–4. https://doi.org/10.1136/bcr-2015-211062.

  34. Wilson AJ, Martin DS, Maddox V, Rattenbury S, Bland D, Bhagani S, Cropley I, et al. Thromboelastography in the management of coagulopathy associated with Ebola virus disease. Clin Infect Dis. 2016;62(5):610–2. https://doi.org/10.1093/cid/civ977.

    Article  PubMed  Google Scholar 

  35. Bower H, Smout E, Bangura MS, Kamara O, Turay C, Johnson S, Oza S, Checchi F, Glynn JR. Deaths, late deaths, and role of infecting dose in Ebola virus disease in Sierra Leone: retrospective cohort study. BMJ. 2016;i2403. https://doi.org/10.1136/bmj.i2403

  36. De Roo A, Ado B, Rose B, Guimard Y, Fonck K, Colebunders R. Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Trop Med Int Health. 1998;3(11):883–5. https://doi.org/10.1046/j.1365-3156.1998.00322.x.

    Article  PubMed  Google Scholar 

  37. Rabelo I, Lee V, Fallah MP, Massaquoi M, Evlampidou I, Crestani R, Decroo T, Van den Bergh R, Severy N. Psychological distress among Ebola survivors discharged from an Ebola treatment unit in Monrovia, Liberia – a qualitative study. Front Public Health. 2016;4:142. https://doi.org/10.3389/fpubh.2016.00142.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gidado S, Oladimeji AM, Roberts AA, Nguku P, Nwangwu IG, Waziri NE, Shuaib F, et al. Public knowledge, perception and source of information on Ebola virus disease – Lagos, Nigeria; September, 2014. PLoS Curr. 2015;7 (OUTBREAKS). Public Library of Science. https://doi.org/10.1371/currents.outbreaks.0b805cac244d700a47d6a3713ef2d6db.

  39. Nakiyingi L, Nankabirwa H, Lamorde M. Tuberculosis diagnosis in resource-limited settings: clinical use of GeneXpert in the diagnosis of smear-negative PTB: a case report. Afr Health Sci. 2013;13(2):522–4. https://doi.org/10.4314/ahs.v13i2.46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Nanyonga M, Saidu J, Ramsay A, Shindo N, Bausch DG. Sequelae of Ebola virus disease, Kenema District, Sierra Leone. Clin Infect Dis. 2016;62(1):125–6. https://doi.org/10.1093/cid/civ795.

    Article  PubMed  Google Scholar 

  41. Keita MM, Taverne B, Savané SS, March L, Doukoure M, Sow MS, Touré A, Etard JF, Barry M, Delaporte E. Depressive symptoms among survivors of Ebola virus disease in Conakry (Guinea): preliminary results of the PostEboGui Cohort. BMC Psychiatry. 2017;17(1):127. https://doi.org/10.1186/s12888-017-1280-8.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gillespie DK. Psychological first aid. 1963;33(9):391–95. https://doi.org/10.1111/j.1746-1561.1963.tb00427.x.

    Article  CAS  Google Scholar 

  43. Valle C. Accepting and supporting Ebola survivors, orphans and families of Ebola patients in the community a toolkit for social mobilizers and communicators. 2014. http://another-option.com/wp-content/uploads/2014/07/AO_EBOLA_Stigma_Toolkit_Final_4.pdf

  44. Kibadi K, Mupapa K, Kuvula K, Massamba M, Ndaberey D, Bwaka MA, De Roo A, Colebunders R. Late ophthalmologic manifestations in survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 2000;179(Suppl 1):13–4.

    Google Scholar 

  45. Varkey JB, Shantha JG, Crozier I, Kraft CS, Marshall Lyon G, Mehta AK, Kumar G, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med. 2015;372(25):2423–7. https://doi.org/10.1056/NEJMoa1500306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Steptoe PJ, Scott JT, Baxter JM, Parkes CK, Dwivedi R, Czanner G, Vandy MJ, et al. Novel retinal lesion in Ebola survivors, Sierra Leone, 2016. Emerg Infect Dis J. 2017;23(7):1102–9. https://doi.org/10.3201/eid2307.161608.

    Article  Google Scholar 

  47. Baggi FM, Taybi A, Kurth A, Van Herp M, Di Caro A, Wölfel R, Günther S, Decroo T, Declerck H, Jonckheere S. Management of pregnant women infected with ebola virus in a treatment centre in Guinea. June 2014. Euro Surveill. 2014;19.

    Google Scholar 

  48. Caluwaerts S, Fautsch T, Lagrou D, Moreau M, Camara AM, Gnther S, Di Caro A, et al. Dilemmas in managing pregnant women with Ebola: 2 case reports. Clin Infect Dis. 2016;62(7):903–5. https://doi.org/10.1093/cid/civ1024.

    Article  PubMed  Google Scholar 

  49. Fallah MP, Skrip LA, Dahn BT, Nyenswah TG, Flumo H, Glayweon M, Lorseh TL, Kaler SG, Higgs ES, Galvani AP. Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. Lancet Glob Health. 2016;4(10):e678–9. https://doi.org/10.1016/S2214-109X(16)30147-4. (This is an Open Access article under the CC BY license)

    Article  PubMed  Google Scholar 

  50. Nicastri E, Balestra P, Ricottini M, Petrosillo N, Di Caro A, Capobianchi MR, Giancola ML, Ippolito G. Temporary neurocognitive impairment with Ebola virus: Table 1. J Neurol Neurosurg Psychiatry. 2016;0(0):jnnp-2016-313695. https://doi.org/10.1136/jnnp-2016-313695.

    Article  Google Scholar 

  51. Chertow D, Nath A, Suffredini A, Danner R. Severe meningoencephalitis in a case of Ebola virus disease: a case report. Ann Intern Med. 2016;165(4):301–4.

    Article  Google Scholar 

  52. Jacobs M, Rodger A, Bell DJ, Bhagani S, Cropley I, Filipe A, Gifford RJ, et al. Late Ebola virus relapse causing Meningoencephalitis: a case report. Lancet (Lond). 2016;6736(16):1–6. https://doi.org/10.1016/S0140-6736(16)30386-5.

    Article  Google Scholar 

  53. Billioux BJ. Neurological complications of Ebola virus infection. Neurotherapeutics. 2016;13(3):461–70. https://doi.org/10.1007/s13311-016-0457-z.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Wendo C. Caring for the survivors of Uganda’s Ebola epidemic one year on TT. Lancet. 2001;358(9290):1350. https://doi.org/10.1016/S0140-6736(01)06467-4.

    Article  CAS  PubMed  Google Scholar 

  55. Epstein L, Wong K, Kallen KJ, Ukeyi TM. Post-Ebola signs and symptoms in U.S. survivors. N Engl J Med. 2015;373(25):2484. https://doi.org/10.1056/NEJMc1511801.

    Article  CAS  PubMed  Google Scholar 

  56. Kibadi K, Mupapa K, Kuvula K, Massamba M, Ndaberey D, Muyembe-Tamfum JJ, Bwaka MA, De Roo A, Colebunders R. Late ophthalmologic manifestations in survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999;179(Suppl 1):S13–4. https://doi.org/10.1086/514288.

    Article  PubMed  Google Scholar 

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Howlett, P., Lado, M. (2018). Sequelae of Ebola Virus Disease. In: Lado, M. (eds) Ebola Virus Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-94854-6_6

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