Neuro complications cited in UK nurse's Ebola case

Post-Ebola complications that recently hospitalized a Scottish nurse who had initially recovered from her infection in January include a severe central nervous system (CNS) disorder, and her spinal fluid has tested positive for the virus, an official said.

Scottish health officials said last week that Pauline Cafferkey, sickened by Ebola last December while working in Sierra Leone, was hospitalized and is critical condition after suffering an unusual late complication from the disease. Developments such as the tracing of her contacts, vaccination of those though to have had contact with her body fluids, her treatment in a high-containment unit, and her deteriorating condition, however, have raised concerns about whether her illness involved a full-blown Ebola relapse.

The closely watched case has infection control implications and promises to shed more light on the clinical spectrum of complications in survivors.

Survivor medical issues

Even after Ebola patients clear the virus from their bloodstreams, it can persist in immune-protected areas such as they eyes and testes. Long-term complications can be debilitating, such as eye inflammation, joint pain, and severe headaches.

Little is known about the long-term consequences of the disease, because earlier outbreaks occurred on a much smaller scale, with only sporadic case studies to guide clinicians. With more than 17,000 survivors in West Africa's outbreak, howeer, researchers are ramping up investigations on complications.

Also, clinical problems among healthcare worker survivors in developed nations with more advanced medical systems are adding to the knowledge base. For example, clinicians found live Ebola virus in the aqueous humor of Ian Crozier, MD, a US physician who survived his infection last fall. His uveitis and vision problems persisted weeks after his recovery, according to a case study published early online in a May 7 issue of the New England Journal of Medicine.

International health experts on the disease met in Sierra Leone in August to tackle survivor medical issues, which one expert called "an emergency within an emergency."

Neurologic complications noted

Experts told the New York Times that Cafferkey's Ebola complication involves a severe CNS disorder. Also, the woman's spinal fluid has tested positive for traces of the Ebola virus, according to the report yesterday, which cited Bruce Aylward, MD, MPH, assistant director-general in charge of Ebola outbreak response for the World Health Organization.

Stuart Nichol, MD, who heads the viral pathogens branch at the Centers for Disease Control and Prevention, told the Times that Cafferkey's complications are consistent with a meningitis-like syndrome, which isn't an Ebola infection recurrence, but an apparently extremely rare complication.

Several experts noted that neurologic complications have been seen, but they also noted that it's difficult to sort out whether they are related to Ebola. Some also speculated that complications might be more likely in survivors who had been critically ill or possibly be an unintended result of experimental treatment.

See also:

Oct 14 Times story

May 7 N Engl J Med brief report

Aug 7 CIDRAP News story "Ebola survivor meeting explores research priorities, 'biobanking'"

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