Depression, headaches, and insomnia are just some of the often debilitating symptoms Ebola survivors may experience, according to a clinically based survey of post-Ebola syndrome (PES) published today in Emerging Infectious Diseases.
The case series involved 35 Ebola survivors from the 2014-2016 outbreak in West Africa. All survivors were seen in Sierra Leone, and had obtained an Ebola survivor discharge certificate from the Military Hospital (34MH) Ebola Survivors Clinic in Freetown. During the outbreak, Sierra Leone confirmed 3,956 deaths and 10,168 survivors.
Patients were referred to a joint neuro-psychiatric clinic in 2016 where they underwent a full neurologic examination, psychiatric screening, and specialist investigations, including brain scan imaging, if they exhibited more than one major neurologic or psychological symptom. None of the participants reported any neurologic or psychiatric illness prior to their Ebola infection.
Headache was the most common symptom of PES, reported by 30 study participants (75.0%). Of those with headache, 14 (46.6%) had undifferentiated headache, 13 (43.3%) migraine, and 3 (10.0%) tension-type headaches. Headaches were described as pounding and throbbing, and associated with sensitivity to light and sound.
Two survivors suffered stroke (confirmed via computed tomography), and two each reported peripheral sensory neuropathy and peripheral nerve lesions.
Insomnia, eye pain also common
Among the 35 survivors, 21 (52.5%) described new insomnia; 12 (30.0%) described depressive symptoms, and 11 (27.5%) had anxiety symptoms.
Other symptoms were eye pain (12 patients, or 30%), and 8 patients described vision loss. Nine of the patients who were assessed were described as having severe disabilities.
"I think the most surprising thing was that we found a small group of survivors with significant symptoms and associated disability," said Patrick Howlett, MD, lead author of the study and a researcher at King's College London. Howlett told CIDRAP News that most subjects reported improvement during follow-up.
The West Africa outbreak has yielded by far the most information about Ebola survivors compared with previous outbreaks. Earlier studies have shown central nervous system viral invasion following Ebola virus exposure, and this study confirmed the presence of central and peripheral nervous system disorders associated with a broad range of disability.
"I think the message from this, and for the DRC [Democratic Republic of the Congo, whose outbreak is now winding down], is that we need to make sure health systems are able to respond to epidemics, and provide a high quality of care to survivors. To do this we should support investment in training healthcare workers," Howlett said.
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