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In the wake of caring for four patients with active Ebola virus in 2014, Emory clinicians have taken stock of lessons learned in infectious disease prevention, therapeutic care, and health aftereffects and are sharing that information broadly with other health care professionals and first responders.
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Text
Clinical Infectious Diseases
BRIEF REPORT
Ebola Virus Persistence in Semen
of Male Survivors
Timothy M. Uyeki,1,a Bobbie Rae Erickson,1,a Shelley Brown,1 Anita K. McElroy,1,2
Deborah Cannon,1 Aridth Gibbons,1 Tara Sealy,1 Markus H. Kainulainen,1
Amy J. Schuh,1 Colleen S. Kraft,2 Aneesh K. Mehta,2 G. Marshall Lyon III,2
Jay B. Varkey,2 Bruce S. Ribner,2 Richard T. Ellison III,3 Ellie Carmody,4 Gerard J. Nau,5
Christina Spiropoulou,1 Stuart T. Nichol,1 and Ute Ströher1
1
Centers for Disease Control and Prevention, and 2Emory University Hospital, Atlanta, Georgia;
Division of Infectious Diseases, University of Massachusetts Medical School, Worcester;
4
Division of Infectious Diseases, NYU School of Medicine, Bellevue Hospital Center, New York;
and 5Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, and the
Warren Alpert Medical School of Brown University, Providence
3
We investigated the duration of Ebola virus (EBOV) RNA and
infectious EBOV in semen specimens of 5 Ebola virus disease
(EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and
70 days, respectively, after EVD onset.
Keywords. Ebola virus; semen; sexual transmission.
Recently, molecular evidence of sexual transmission of Ebola
virus (EBOV) from a male survivor of Ebola virus disease
(EVD) to a female partner that occurred 179 days after EVD
illness onset was reported in Liberia [1]. A semen specimen
from the survivor collected 199 days after illness onset had
detectable EBOV (Zaire ebolavirus species) RNA, and the
virus isolation attempt was negative [1]. This case highlights
the urgency of understanding EBOV persistence in semen
and assessing potential infectiousness to inform the risk of
transmission of EBOV from male survivors to their sexual
partners.
Limited data from testing of semen specimens collected from
a small number of male survivors of previous EBOV associated
EVD outbreaks indicated that EBOV RNA can be detected up
to 101 days after illness onset [2–4]. Recently, detection of
EBOV RNA in semen was reported up to 284 days after illness
onset [5]. However, the longest period from illness onset that
infectious EBOV has been recovered by viral culture of semen
was from a male survivor at 82 days after EVD symptoms began
[2–4]. Given these data, it was important to investigate the duration and infectiousness of EBOV in available semen specimens
Received 8 February 2016; accepted 24 March 2016; published online 3 April 2016.
a
T. M. U. and B. R. E. contributed equally to this work.
Correspondence: T. M. Uyeki, Centers for Disease Control and Prevention, Mailstop A-20,
1600 Clifton Rd, NE, Atlanta, GA 30329 (tuyeki@cdc.gov).
®
2016;62(12):1552–5
Clinical Infectious Diseases
Published by Oxford University Press for the Infectious Diseases Society of America 2016.
This work is written by (a) US Government employee(s) and is in the public domain in the
US. DOI: 10.1093/cid/ciw202
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voluntarily submitted by a small number of adult male survivors
of EVD in the United States.
METHODS
Semen specimens from 5 survivors who had experienced moderately severe to critical illness with EVD, all of whom received
different investigational therapeutics in addition to supportive
clinical management during their hospitalization [6], were tested after recovery during 2014–2015. These survivors submitted
semen specimens at different times when convenient after recovery from EVD for virologic testing at the Centers for Disease
Control and Prevention (CDC) as part of their follow-up clinical management during the post-EVD convalescent period.
Survivors were counseled by their physicians to abstain from
sex or to use condoms until there was no evidence of EBOV
RNA detected. Semen specimens were collected and transported as soon as possible or maintained at 4 degrees Celsius and
shipped overnight on frozen cold packs to CDC. The majority of
the specimens were processed within 0–3 days; however a few
were processed 5–8 days after collection. Only one specimen
that was collected 290 days post symptom onset was frozen
prior to virus culture. Semen specimens were processed at CDC
under biosafety level 4 (BSL4) conditions. Nucleic acid was extracted and tested by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) for EBOV nucleoprotein (NP) as
well as an internal cellular control gene (beta 2-microglobulin
(b2m) (Thermo Fisher Scientific, #4326319E) [7]. The NP
assay has an estimated limit of detection of 400 TCID50/mL
based on several unpublished studies and from a similar performance profile of the NP EUA assay (http://www.fda.gov/
EmergencyPreparedness/Counterterrorism/MedicalCounter
measures/MCMLegalRegulatoryandPolicyFramework/ucm
182568.htm#ebola). Copies per mL that correspond with virus
load cannot be calculated because the assay detects genomic,
antigenomic, and mRNA; therefore, positive and negative controls are performed for each qRT-PCR run, but no standard
curve is generated. Cycle threshold (Ct) values <40 were considered positive. Interpretation of qRT-PCR results includes
analysis of the Ct values, curves, and the b2m results for each
specimen. Given the specimen type, studies are ongoing to determine the distribution of the internal control to provide information on specimen quality. To detect infectious virus, cell culture
virus isolation was attempted as previously described [2].
RESULTS
The results of EBOV RNA detection in available semen specimens over time from illness onset are shown in Figure 1. EBOV
RNA was detected in semen out to 290 days after symptom
�Figure 1. Ebola virus nucleoprotein (NP) quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and virus isolation results on semen specimens. Each
diamond represents an independent semen specimen. NP qRT-PCR results are included inside the diamonds and rectangles as either the cycle threshold value or neg for
negative results. Red and black diamonds represent positive and negative virus isolation, respectively. The rectangles denote no virus isolation was attempted. The red dashed
diamond indicates a contaminated isolation attempt and infectious Ebola virus could not be confirmed. The black dashed line signifies the last day post onset of symptoms
when virus was isolated.
onset (272 days after the first negative blood specimen result)
(Supplementary Table 1). The first negative EBOV RNA result
in semen ranged from 222 to 393 days after illness onset. EBOV
was isolated from semen specimens collected from 3 survivors
and out to 70 days after illness onset (34 days after the first negative blood specimen result). The NP Ct values for semen specimens from which EBOV was isolated by viral culture ranged
from 26 to 30 (Supplementary Table 1). (Higher Ct values indicate lower concentration of the target sequence).
DISCUSSION
We describe the detection of EBOV RNA and infectious virus in
semen specimens collected from 5 male patients who were hospitalized for EVD in the United States during 2014 and recovered. EBOV RNA was detected out to 290 days after illness
onset, whereas infectious EBOV was isolated from semen collected out to 70 days after illness onset. This is similar to the
reported timeframe of 82 days for isolating infectious virus
from semen after illness onset in a previous EVD outbreak [2].
BRIEF REPORT
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�Infection of the testes by EBOV likely occurs through viremia
during acute EVD. EBOV antigens were identified in seminiferous tubules from one fatal EVD case [8], and inflammation was
reported with identification of EBOV particles in interstitial
cells, endothelium, and monocytes of testicular tissue of experimentally infected nonhuman primates [9]. EBOV in the testes
may be shielded from the immune response, and therefore active viral replication can continue for prolonged periods. Much
more research is needed to understand the pathogenesis and
maintenance of EBOV in immune-privileged organs. The impact of any investigational therapeutics administered during
clinical management of EVD upon EBOV persistence in the testes during the post-EVD recovery period is unknown, although
the half-life of these experimental therapies is likely far shorter
than the period for which EBOV could be detected in semen
specimens.
Until recently, the World Health Organization (WHO) and
CDC recommended abstinence or condom use for at least
3 months after recovery from EVD [1]. Based upon uncertainty
about the duration of infectious EBOV in semen and concern of
EBOV sexual transmission through exposure to semen of a recovered male EVD survivor, WHO now recommends that male
EVD survivors should abstain from sex or practice safe sex with
correct condom use until semen has tested negative twice with at
least a 1-week interval by RT-PCR [10]. Information about the
limitations of the tests should also be discussed when providing
results. WHO also recommends that if semen has not been tested, safe sex should be practiced for at least 12 months after onset
of EVD. CDC recommends that until more information is
known about the persistence of EBOV in semen, contact with
semen from a recovered EVD patient should be avoided [1, 11].
Our findings are limited by the overall small number of
semen specimens that were submitted for Ebola virus testing
at different time intervals from illness onset. The longevity of
EBOV RNA detection in semen of male EVD survivors requires
further investigation to determine if there is a correlation between viral RNA detection and infectious virus. It may be
that higher viral loads during the acute phase of the illness
leads to increased seeding of these immune privileged sites
and therefore prolonged presence of both infectious and noninfectious EBOV. The sensitivity of virus isolation from semen
specimens could be affected by several factors such as storage
time and temperature, host factors, fungal or bacterial contaminants, or presence of unknown inhibitors. Efforts were made to
minimize the time from specimen collection to cell culture inoculation. Processing of a few specimens were delayed because of
transportation issues, but even at day 5 post collection, a positive
isolate was obtained. The case of suspected EBOV sexual transmission 179 days from symptom onset has raised some questions
about the sensitivity of virus isolation [1], but because the specimen that tested positive by qRT-PCR and negative by virus
culture was collected 20 days after the suspected transmission
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BRIEF REPORT
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event, it is possible that infectious virus was no longer present
in semen by the time of sampling.
In conclusion, the reported results support previous data suggesting the potential for sexual transmission of EBOV through
semen exposure to a susceptible sexual partner from a recovered
adolescent or adult male EVD survivor out to at least 82 days
after EVD illness onset. Given the case report of suspected
EBOV sexual transmission 179 days after EVD onset [1], the detection of EBOV RNA in semen for 4–6 months after EVD
onset in 43% of survivors in a cross-sectional study [5], and
our findings, it seems prudent to adhere to the WHO recommendation for male survivors to practice abstinence or safe sex with
condom use for up to 6 months after EVD onset if semen cannot
be tested. Counseling of all adolescent and adult male survivors
and their sexual partners about the potential for sexual transmission of EBOV through semen exposure is essential. Broader epidemiological and scientific studies are needed to assess the risk
of sexual transmission of EBOV from semen as well as vaginal
fluid of EVD survivors to their partners, compliance with
WHO and CDC recommendations, and effectiveness of condoms to reduce sexual transmission of EBOV.
Supplementary Data
Supplementary materials are available at http://cid.oxfordjournals.org.
Consisting of data provided by the author to benefit the reader, the posted
materials are not copyedited and are the sole responsibility of the author, so
questions or comments should be addressed to the author.
Notes
Acknowledgments. We thank the following individuals for their contributions: David Gilchrist MD, Thomas Greenough MD (University of
Massachusetts Medical School, Worcester, Massachusetts); Cynthia Condon, Michael Pentella PhD, Tanya Swanson (William A. Hinton State Laboratory Institute, Jamaica Plain, MA), Larry Madoff, MD, Cheryl Gauthier
MA (Massachusetts Department of Public Health, Boston, MA); Patricia
Costa (The Miriam Hospital, Providence, Rhode Island); Cynthia Vanner,
Toby Bennett, Utpala Bandy MD, MPH (Rhode Island Department of
Health, Providence, RI); Jennifer Rakeman PhD (New York City Public
Health Laboratory, Department of Health and Mental Hygiene,
New York, NY); Sean Cloonan MD (NYU School of Medicine, Bellevue
Hospital Center, New York, NY); and the Ebola virus disease survivors
who submitted clinical specimens for this work.
Disclaimer. The views expressed are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control
and Prevention.
Potential conflicts of interest. All authors: No reported conflicts. All
authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content
of the manuscript have been disclosed.
References
1. Mate SE, Kugelman JR, Nyenswah TG, et al. Molecular evidence of sexual transmission of Ebola virus. N Engl J Med 2015; 373:2448–54.
2. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of
Ebola virus during the outbreak in Kikwit, democratic republic of the Congo,
1995. J Infect Dis 1999; 179(Suppl 1):S170–6.
3. Emond RT, Evans B, Bowen ET, Lloyd G. A case of Ebola virus infection. Br Med J
1977; 2:541–4.
4. Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic followup of convalescent Ebola hemorrhagic fever patients and their household contacts,
�Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis 1999; 179(Suppl 1):S28–35.
5. Deen GF, Knust B, Broutet N, et al. Ebola RNA persistence in semen of Ebola virus
disease survivors: preliminary report. N Engl J Med 2015. PMID: 26465681.
6. Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med 2016; 374:636–46.
7. Southern TR, Racsa LD, Albariño CG, et al. Comparison of FilmArray
and quantitative real-time reverse transcriptase PCR for detection of Zaire
Ebola virus from contrived and clinical specimens. J Clin Microbiol 2015;
53:2956–60.
8. Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism,
pathology and pathogenesis of Ebola and Marburg viruses. J Pathol 2015;
235:153–74.
9. Baskerville A, Fisher-Hoch SP, Neild GH, Dowsett AB. The pathology of experimental Ebola virus infection in monkeys. J Pathol 1985; 147:199–209.
10. World Health Organization. Interim Guidance, Clinical care for survivors of Ebola
virus disease. 2016. Available at: http://www.who.int/csr/resources/publications/
ebola/guidance-survivors/en/.
11. Centers for Disease Control and Prevention. Ebola (Ebola virus disease). Q&As on
Transmission. Available at: http://www.cdc.gov/vhf/ebola/transmission/qas.html.
BRIEF REPORT
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�
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Ebola Virus Persistence in Semen of Male Survivors
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Uyeki, T. M., B. R. Erickson, S. Brown, A. K. McElroy, D. Cannon, A. Gibbons, T. Sealy, M. H. Kainulainen, A. J. Schuh, C. S. Kraft, A. K. Mehta, G. M. Lyon, 3rd, J. B. Varkey, B. S. Ribner, R. T. Ellison, 3rd, E. Carmody, G. J. Nau, C. Spiropoulou, S. T. Nichol and U. Stroher (2016). "Ebola Virus Persistence in Semen of Male Survivors." Clin Infect Dis 62(12): 1552-1555.
Abstract
We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and 70 days, respectively, after EVD onset.
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free online - Oxford Academic
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Title
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Ebola Virus Persistence in Semen of Male Survivors
Creator
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Uyeki, T. M., B. R. Erickson, S. Brown, A. K. McElroy, D. Cannon, A. Gibbons, T. Sealy, M. H. Kainulainen, A. J. Schuh, C. S. Kraft, A. K. Mehta, G. M. Lyon, 3rd, J. B. Varkey, B. S. Ribner, R. T. Ellison, 3rd, E. Carmody, G. J. Nau, C. Spiropoulou, S. T. Nichol and U. Stroher
Subject
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Description
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We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors.
Date
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2016-06-15
Type
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Publication
Ebola
Follow up
Laboratory Testing
Public Health
R-Res&Pub
Specimen Collection
Specimen Handling
Survivors
Viral Hemorrhagic Fever
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https://www.nytimes.com/2017/10/19/health/ebola-survivors-cataracts.html
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Ebola's Legacy: Children with Cataracts
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New York Times
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Treatment & Care
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Grady, Denise. 2017. "Ebola's Legacy: Children with Cataracts." New York Times [October 19, 2017].
Date
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2017-10-19
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2025-09-27
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2022-09-27 - general asset review - Treatment & Care group
2022-12-07 general asset review - IPC (change to R-T&C)
Ebola
Eye/Ocular Health
Follow up
Infection Prevention and Control
Patient Care
Public Health
R-T&C
Survivors
-
https://repository.netecweb.org/files/original/b4b91e09d2c8bbe44553e79ad1d68d36.pdf
f6709c9377c098057c3c619907dc2cbc
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Ophthalmology. Author manuscript; available in PMC 2017 December 01.
Published in final edited form as:
Ophthalmology. 2016 December ; 123(12): 2626–2628.e2. doi:10.1016/j.ophtha.2016.07.013.
Long-term management of panuveitis and iris heterochromia in
an Ebola survivor
Jessica G. Shantha, M.D.1, Ian Crozier, M.D.2, Jay B. Varkey, M.D.3, Colleen S. Kraft, M.D.3,4,
G. Marshall Lyon III, M.D., M.M.Sc.3, Aneesh K. Mehta, M.D.3, Renee Donahue Carlson, M.D.
3, Charles E. Hill, M.D., PhD.,
Author Manuscript
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta,
GA
Gokul Kumar, M.D.1, Matthew R. Debiec, M.D.1, Purnima S. Patel, M.D.1, Timothy W. Olsen,
M.D.1, Robert B. Nussenblatt, M.D., M.P.H.5, Daniel F. Martin, M.D.6, Ute Ströher, Ph.D.7,
Timothy M. Uyeki, M.D., M.P.H., M.P.P7, Bruce S. Ribner, M.D., M.P.H.3, Justine R. Smith,
FRANZCO, PhD8, and Steven Yeh, M.D.1
1Emory
Author Manuscript
Eye Center, Department of Ophthalmology, Emory University School of Medicine, Atlanta,
GA 2Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda 3Division of
Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, GA
4Department of Pathology and Laboratory Medicine, Emory University School of Medicine,
Atlanta, GA 5National Eye Institute, National Institutes of Health, Bethesda, MD 6Cole Eye
Institute, The Cleveland Clinic, Cleveland, OH 7Centers for Disease Control and Prevention,
Atlanta, GA 8Flinders University, Adelaide, Australia
Introduction
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in
history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra
Leone, Guinea, and Liberia.1 Reports of uveitis have emerged in EVD survivors.2-3 Herein
Author Manuscript
Corresponding Author Steven Yeh, M.D., 1365B Clifton Road NE, Atlanta, GA 30322, Phone: 404-778-5070 Fax: 404-778-4380,
steven.yeh@emory.edu.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of
the resulting proof before it is published in its final citable form. Please note that during the production process errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Disclaimer: The views expressed are those of the authors and do not necessarily represent the official position of the Centers for
Disease Control and Prevention.
Meeting Presentations
American Academy of Ophthalmology Annual Meeting, “Ophthalmic manifestations of Ebola virus disease”, AAO Symposium
“Ebola and the Eye: A Story of Survivors”, November 15, 2015, Las Vegas, NV
American Society of Retina Specialists Annual Meeting, “Clinical Features and Multimodality Diagnostic Imaging in Ebola VirusAssociated Panuveitis: Insights into Pathogenesis”, July 12, 2015, Vienna, Austria
American Society of Retina Specialists Annual Meeting, “Panuveitis associated with Ebola Virus Disease: Clinical Management”,
July 12, 2015, Vienna, Austria
ARVO Keynote Series Closing Session: “Ebola and the Eye: A Story of Discovery and Uncertainty”, May 7, 2015, Denver, Colorado
�Shantha et al.
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Author Manuscript
Case Report
Author Manuscript
we discuss clinical features, multimodality imaging, and long-term management of
aggressive, sight-threatening panuveitis, in an EVD survivor, providing insight into the
pathogenesis of this condition.
Acute hypertensive anterior uveitis
Acute Ebola virus disease and early post-Ebola syndrome
A 43-year-old physician developed EVD in Kenema, Sierra Leone. After 40 days of
hospitalization at Emory University, he was discharged with serum and urine testing
negative by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay
for EBOV RNA.4 One month after discharge, he experienced blurred vision, sacroilitis,
enthesitis, and word-finding difficulties. Ophthalmic evaluation showed visual acuities of
20/15 in both eyes and multiple peripheral chorioretinal scars with hypopigmented haloes
bilaterally, consistent with inactive chorioretinitis requiring no intervention (Supplemental
Figure 1).
Fourteen weeks after EVD diagnosis, the patient presented with acute, left hypertensive
anterior uveitis with visual acuity of 20/20 and intraocular pressure (IOP) of 44 mmHg in
the left eye.2 Treatment was initiated with topical prednisolone acetate 1% (Pred Forte 1%) 4
times daily, brimonidine 0.2% and dorzolamide 2%/timolol 0.5%, and acetazolamide.
Serologies for syphilis, cytomegalovirus, herpes simplex virus-1 and -2, and Toxoplasma
gondii. HLA-B27 was negative.
Author Manuscript
Left anterior chamber paracentesis yielded aqueous humor positive for EBOV by qRT-PCR
with a cycling threshold of 18.7 and a positive EBOV culture. Pre- and 24-hours postprocedure, conjunctival swab and tear film tested negative for EBOV RNA.2
Anterior scleritis, and intermediate uveitis
On day 5 of the acute ocular illness, left visual acuity declined to 20/60 and the IOP was 15
mmHg. Diffuse anterior scleritis and intermediate uveitis prompted addition of oral
prednisone 80 mg, with the topical Pred Forte 1% every 2 hours, timolol 0.5%, and atropine
1% (Supplemental Figure 2).
Left visual acuity declined to 20/150 at day 6 of illness, and examination revealed grade 2+
AC cell, a 0.5 mm hypopyon, and grade 1-2+ vitreous haze. OCT scan showed mild left
retinal thickening (Supplemental Figure 2).
Author Manuscript
Despite symptomatic improvement, left visual acuity worsened to 20/250 at day 9, and IOP
declined to 6 mmHg. Corneal edema followed hypotony, with grade 2+ AC cell and grade
3+ vitreous haze (Supplemental Figure 2). Difluprednate 0.05% every 2 hours was
initiated.
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
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Optic neuropathy, and panuveitis
Author Manuscript
Left visual acuity deteriorated to 20/500 and IOP decreased to 2 mmHg at day 10. A left
relative afferent pupillary defect (RAPD) developed, indicating optic neuropathy. Iris
heterochromia developed at day 11, with a change from blue to green (Figure 1). Left
anterior segment OCT (AS-OCT) revealed iris stromal thickening (502 μm) when compared
to the right (376 μ m). Ultrasound biomicroscopy (UBM) showed ciliary body edema. A
dense grade 3+ vitreous haze persisted, prompting B-scan ultrasound, which revealed
shallow peripheral, choroidal effusions and optic nerve head edema (Figure 1).
Antiviral therapy with favipiravir
Author Manuscript
Due to clinical worsening, a 21-day course of oral favipiravir (T-705, Toyoma Chemical,
Japan) was initiated. After two loading doses of 2000 mg, favipiravir was administered 1200
mg twice daily. Three days after starting favipiravir (day 18 of illness), visual acuity had
declined to finger counting at 2 feet and IOP was 3 mmHg. A periocular triaminolone
acetonide injection (40 mg/1 ml) was administered in the Emory University Hospital Serious
Communicable Diseases Unit (SCDU). A post-procedure conjunctival swab tested negative
for EBOV RNA.
One day after the injection, left visual acuity was hand motions, but IOP increased to 9
mmHg. The patient was discharged on a course of favipiravir, and oral prednisone was
tapered, decreasing by 10 mg/day every two weeks. Topical difluprednate 0.05% and
atropine 1% were continued.
Long-term follow-up
Author Manuscript
Forty-five days after initial onset of acute ocular illness, the patient completed favipiravir
and remained on oral prednisone 15 mg daily and topical difluprednate 0.05%. Visual acuity
had improved to 20/15 with resolution of RAPD and IOP of 10 mmHg. Slit lamp
examination showed resolved corneal edema, endothelial pigment without KP, and trace AC
pigment. Posterior segment examination showed grade 0.5+ vitreous haze. The iris thickness
had decreased to 452 μm by day 32, with resolution of heterochromia (Figure 1)
At one-year follow-up, left visual acuity returned to 20/20 with IOP of 11 mmHg. After 18
months, visual acuity had declined to 20/60 with development of diffuse posterior capsular
cataract. Anterior uveitis was observed with diffuse stellate KP, 1+ AC cell and stable
posterior segment. Repeat AC paracentesis tested negative for Ebola virus by qRT-PCR.
PCR testing was also negative for CMV, HSV, and VZV DNA. Topical prednisolone acetate
taper was given over four weeks with resolution of anterior uveitis.
Author Manuscript
Discussion
The clinical and multimodal imaging features of this aggressive spectrum of ophthalmic
pathology highlight the mechanisms of inflammation and infection, which improved
following the administration of corticosteroids and antiviral medication.
Iris heterochromia coincided with iris and ciliary body edema by AS-OCT and UBM; this
was suggestive of heavy leukocyte infiltration and/or massive protein exudation related to an
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
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extreme inflammatory response associated with active EBOV replication. Immediate
improvement of IOP and recovery of ciliary body anatomy following the corticosteroid
injection supported the key role of appropriately timed anti-inflammatory therapy.
Although the precise role of favipiravir – a pyrazinecarboxamide derivative that inhibits viral
RNA replicase5 – was unclear, our patient’s disease process worsened initially on topical
and systemic corticosteroid. Following the initiation of favipiravir, a periocular
corticosteroid injection was administered because of concerns for recalcitrant hypotony,
ciliary body shutdown, and irreversible vision loss. The patient’s clinical improvement
paralleled the anatomic reduction in iris thickening by AS-OCT.
Author Manuscript
In summary, diagnostic ophthalmic imaging highlighted the anatomic and pathologic
changes that occurred during our patient’s sight-threatening panuveitis. The imaging
findings suggested severe reactive inflammation in the presence of EBOV viral replication,
emphasizing the need for consideration of management strategies that target infectious and
inflammatory processes in post-Ebola uveitis. Potential for uveitis recurrence mandates
long-term monitoring.
Supplementary Material
Refer to Web version on PubMed Central for supplementary material.
Acknowledgments
Financial Support
Author Manuscript
This project was supported by the National Center for Advancing Translational Sciences of the National Institutes
of Health Award Number UL1TR000454 (Atlanta Clinical and Translational Science Institute), an unrestricted
departmental grant from Research to Prevent Blindness, Inc. (New York, NY) and by NIH/NEI core grant P30EY06360 (Department of Ophthalmology, Emory University School of Medicine), an Alcon Research Institute
Young Investigator Grant (Dr. Yeh), a Heed Ophthalmic Fellowship Foundation Grant, Cleveland, OH (Dr.
Shantha), and a fellowship grant from the Australian Research Council (FT130101648, to Dr. Smith). Favipiravir
was provided by the Department of Defense Joint Project Manager Medical Countermeasure Systems.
References
Author Manuscript
1. Ebola situation report - 10 June 2016. World Health Organization; Geneva: 2016. http://
apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
2. Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola Virus in Ocular Fluid during
Convalescence. The New England journal of medicine. 2015; 372(25):2423–2427. [PubMed:
25950269]
3. Mattia JG, Vandy MJ, Chang JC, et al. Early clinical sequelae of Ebola virus disease in Sierra
Leone: a cross-sectional study. The Lancet. Infectious diseases. 2015
4. Kraft CS, Hewlett AL, Koepsell S, et al. The Use of TKM-100802 and Convalescent Plasma in 2
Patients With Ebola Virus Disease in the United States. Clinical infectious diseases : an official
publication of the Infectious Diseases Society of America. 2015; 61(4):496–502. [PubMed:
25904375]
5. Oestereich L, Ludtke A, Wurr S, Rieger T, Munoz-Fontela C, Gunther S. Successful treatment of
advanced Ebola virus infection with T-705 (favipiravir) in a small animal model. Antiviral research.
2014; 105:17–21. [PubMed: 24583123]
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�Shantha et al.
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Figure 1. Anterior segment photographs and digital imaging
Author Manuscript
(A) Slit lamp photograph of right eye with corresponding anterior segment OCT at baseline
shows iris thickness of 377 μm. (B) Slit lamp photograph and anterior segment OCT at day
11 show a green iris color with iris thickening at 502 μm. (C) By day 32, slit lamp
photograph shows reversal of iris color to original blue color and corresponding decrease in
iris edema to 452 μm. (D) Ultrasound biomicroscopy (UBM) show normal ciliary body
anatomy of the right eye. (E) UBM of left eye shows ciliary body swelling (green triangles)
and supraciliary/choroidal effusion (yellow areas) consistent with progressive panuveitis,
choroiditis and evolving hypotony at day 12. (F) Repeat UBM shows decreased ciliary body
swelling and resolution of supraciliary/choroidal effusion (yellow arrows) by day 32. (G) Bscan ultrasound shows choroidal thickening at day 11 and repeat at day 32. (H) shows
resolution of choroidal thickening.
Author Manuscript
Ophthalmology. Author manuscript; available in PMC 2017 December 01.
�
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Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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https://www.ncbi.nlm.nih.gov/pubmed/27594198
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121070/
Citation
Citation information for the publication itself.
Shantha, J. G., I. Crozier, J. B. Varkey, C. S. Kraft, G. M. Lyon, 3rd, A. K. Mehta, R. D. Carlson, C. E. Hill, G. Kumar, M. R. Debiec, P. S. Patel, T. W. Olsen, R. B. Nussenblatt, D. F. Martin, U. Stroher, T. M. Uyeki, B. S. Ribner, J. R. Smith and S. Yeh (2016). "Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor." Ophthalmology 123(12): 2626-2628 e2622.
Abstract
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra Leone, Guinea, and Liberia. Reports of uveitis have emerged in EVD survivors. Herein we discuss clinical features, multimodality imaging, and long-term management of aggressive, sight-threatening panuveitis, in an EVD survivor, providing insight into the pathogenesis of this condition.
Accessibility
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free online - Pubmed Central
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor
Creator
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Shantha, J. G., I. Crozier, J. B. Varkey, C. S. Kraft, G. M. Lyon, 3rd, A. K. Mehta, R. D. Carlson, C. E. Hill, G. Kumar, M. R. Debiec, P. S. Patel, T. W. Olsen, R. B. Nussenblatt, D. F. Martin, U. Stroher, T. M. Uyeki, B. S. Ribner, J. R. Smith and S. Yeh
Subject
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Treatment & Care
Description
An account of the resource
The 2013-2016 West African Ebola virus disease (EVD) outbreak has been the largest in history with 28,616 cases and 11,310 deaths in the highest transmission countries of Sierra Leone, Guinea, and Liberia.
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-12-01
Type
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Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
Ebola
Example
Eye/Ocular Health
Follow up
Public Health
R-Res&Pub
R-T&C
Specimen Collection
Survivors
-
https://repository.netecweb.org/files/original/7946b4a9d7253b996b7b691654a6538b.pdf
93f57a9f76b1fce5f52a44b65d7be936
PDF Text
Text
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Author manuscript
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
Published in final edited form as:
N Engl J Med. 2015 June 18; 372(25): 2423–2427. doi:10.1056/NEJMoa1500306.
Persistence of Ebola Virus in Ocular Fluid during Convalescence
Author Manuscript
Jay B. Varkey, M.D., Jessica G. Shantha, M.D., Ian Crozier, M.D., Colleen S. Kraft, M.D., G.
Marshall Lyon, M.D., Aneesh K. Mehta, M.D., Gokul Kumar, M.D., Justine R. Smith, M.B.,
B.S., Ph.D., Markus H. Kainulainen, Ph.D., Shannon Whitmer, Ph.D., Ute Ströher, Ph.D.,
Timothy M. Uyeki, M.D., M.P.H., M.P.P., Bruce S. Ribner, M.D., M.P.H., and Steven Yeh, M.D.
Department of Medicine, Division of Infectious Diseases (J.B.V., C.S.K., G.M.L., A.K.M., B.S.R.),
the Department of Ophthalmology (J.G.S., G.K., S.Y.), and the Department of Pathology and
Laboratory Medicine (C.S.K.), Emory University School of Medicine, and the Centers for Disease
Control and Prevention (M.H.K., S.W., U.S., T.M.U.) — both in Atlanta; the Infectious Diseases
Institute, Mulago Hospital Complex, Kampala, Uganda (I.C.); and Flinders University, Adelaide,
SA, Australia (J.R.S.)
SUMMARY
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop
during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are
unknown. We describe a patient who recovered from EVD and was subsequently found to have
severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in
aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
Author Manuscript
The current outbreak of EVD is believed to have begun in December 2013.1 As of April 26,
2015, a total of 26,312 cases of EVD (including 10,899 deaths) had been reported in six
countries in West Africa (i.e., Sierra Leone, Liberia, Guinea, Mali, Nigeria, and Senegal),
the United States, the United Kingdom, and Spain.2 The outbreak has also resulted in the
largest number of EVD survivors in history.
Author Manuscript
Among survivors of EVD, late complications that include ocular disease can develop during
convalescence.3,4 However, few systematic studies have been conducted on post-EVD
sequelae, so the incidence and clinical manifestations of post-EVD ocular complications are
unclear. Here, we report the clinical course of a man in whom severe, acute, unilateral
uveitis developed during the convalescent phase of EVD. We also report the detection of
viable EBOV in aqueous humor obtained from the inflamed eye 14 weeks after the onset of
the initial symptoms of EVD and 9 weeks after the clearance of viremia.
CASE REPORT
A previously healthy 43-year-old male physician received a diagnosis of EVD on September
6, 2014, while he was working in an Ebola treatment unit in Kenema, Sierra Leone. He was
Address reprint requests to Dr. Yeh at the Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd.
NE, Atlanta, GA 30322, or at steven.yeh@emory.edu.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
�Varkey et al.
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transferred to Emory University Hospital in Atlanta and arrived 4 days after the onset of
symptoms. He was treated with an experimental small interfering RNA antiviral agent
(TKM-100802, Tekmira Pharmaceuticals), convalescent plasma, and aggressive supportive
care.5
Author Manuscript
The hospital course was complicated by multiorgan system failure requiring mechanical
ventilation for 12 days and hemodialysis for 24 days.6 After extubation, the patient had
altered mental status, difficulty walking related to severe proximal weakness and
deconditioning, and extreme fatigue. On day 44 of the illness, hemodialysis was no longer
required and his mental status had markedly improved, with some residual mild wordfinding difficulty. Ambulation was limited to short distances because of exertional fatigue.
Blood and urine tested negative for EBOV on quantitative reverse-transcriptase–
polymerasechain-reaction (RT-PCR) assay on serial specimens, and he was discharged
home. A semen sample obtained on the day of discharge was positive for EBOV RNA on
quantitative RT-PCR assay, and EBOV was isolated from semen by means of culture at the
Centers for Disease Control and Prevention (CDC).7 The patient was advised to abstain
from sex or to use condoms for at least 3 months.8 Longitudinal monitoring of semen
specimens for EBOV is ongoing.
Author Manuscript
After discharge, 10 weeks after the onset of EVD symptoms, the patient’s word-finding
difficulty and exercise tolerance were markedly improved, but he had new symptoms,
including low back pain involving the right lumbar and sacroiliac region, bilateral enthesitis
of the Achilles’ tendon, and paresthesias involving the distal lower limbs. Ophthalmic
symptoms, which began shortly after discharge from the hospital, included occasional
bilateral ocular burning, foreign-body sensation, and photophobia. He required an
adjustment in his prescription for reading glasses, which suggested an accommodative
change. His ocular history was clinically significant only for myopia. He was referred to the
Emory Eye Center for further evaluation.
On initial evaluation in November 2014, the patient’s visual acuity was 20/15 bilaterally
while wearing eyeglasses. Intraocular pressure, pupils, ocular motility, and confrontational
visual fields were normal. The examination of the anterior eye by means of slit lamp was
normal. The examination of the dilated posterior eye revealed previously undocumented
multiple, peripheral chorioretinal scars with hypopigmented halos in both eyes and a small
intraretinal hemorrhage adjacent to one scar in the left eye (Fig. 1). He received the
diagnosis of posterior uveitis (i.e., chorioretinitis), a likely sequela of EVD. Close clinical
follow-up was planned.
Author Manuscript
One month later, 14 weeks after the diagnosis of EVD, he presented with an acute onset of
redness, blurred vision with halos, pain, and photophobia in the left eye. Visual acuity was
measured at 20/15 in the right eye and 20/20 in the left eye. The left intraocular pressure was
highly elevated at 44 mm Hg (normal value, 10 to 21). Slit-lamp examination of the left eye
showed conjunctival injection, mild corneal edema, rare nongranulomatous keratic
precipitates, and grade 1+ leukocytes and protein (flare) in the anterior chamber (Fig. 2).
Examination of the anterior chamber with gonioscopy indicated no signs of angle closure.
Dilated funduscopic examination showed stable chorioretinal scars in both eyes with no
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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other signs of ocular inflammation. He received a diagnosis of anterior uveitis and ocular
hypertension in the left eye. Treatment was started with eyedrops containing 1%
prednisolone acetate four times daily and with ocular hypotensive agents including
acetazolamide (at a dose of 500 mg orally twice daily), eyedrops containing 0.2%
brimonidine twice daily, and eyedrops containing 2% dorzolamide and 0.5% timolol twice
daily. Results of laboratory testing, including measurement of the erythrocyte sedimentation
rate and C-reactive protein, were normal; rapid plasma reagin testing and serologic analysis
for Toxoplasma gondii were negative.
Author Manuscript
Author Manuscript
Because of escalating anterior-chamber inflammation and worsening symptoms during the
subsequent 48 hours, the frequency of administration of prednisolone acetate was increased
to every 2 hours, and eyedrops containing 1% atropine twice daily were added. After
another 24 hours of increasing inflammation and concern about an infectious cause,
paracentesis of the anterior chamber was performed, with aspiration of 170 µl of aqueous
humor through a sterile 30-gauge needle while the practitioner was wearing gloves and a
surgical mask. The specimen was double-bagged and delivered to a dedicated laboratory at
Emory University Hospital for testing samples from patients with EVD. Testing was
performed by clinical laboratory technologists who were trained in the safe handling of
infectious pathogens and with the use of the standard institutional operating protocols.9 The
aqueous humor tested positive for EBOV RNA on quantitative RT-PCR assay, with a cycle
threshold value of 18.7. EBOV was isolated from this specimen by means of a viral culture
performed at the CDC.7 A conjunctival swab obtained before the procedure and tear-film
specimens collected before the procedure and 24 hours after the procedure tested negative
for EBOV RNA on quantitative RT-PCR assay. In addition, a specimen of peripheral blood
tested negative for EBOV RNA on quantitative RT-PCR assay. Preliminary analyses of
EBOV sequenced from blood during the patient’s hospitalization for symptomatic EVD, as
compared with EBOV sequenced from ocular fluid, identified a single nonsynonymous
mutation, as well as two silent mutations and two mutations in noncoding regions. The
significance of these mutations is unknown. However, these findings are in contrast to
results that showed no changes in viral consensus sequences acquired over several days from
a single patient.10 All personal protective equipment and materials that were used during
paracentesis and laboratory testing were sterilized by means of autoclaving before
disposal.11
Author Manuscript
The uveitis continued to progress; by 5 days after the onset of symptoms, visual acuity in the
left eye was decreased to 20/60. Anterior-segment examination revealed scleritis and
persistent anterior uveitis. Intermediate uveitis (i.e., vitritis, with grade 0.5+ haze) was noted
on examination of the dilated posterior segment. Oral prednisone (at a dose of 1 mg per
kilogram of body weight per day) was started. Ophthalmic drops of 1% prednisolone acetate
every 2 hours, 0.5% timolol twice daily, and 1% atropine twice daily were continued in the
left eye.
During the subsequent 72 hours, the patient’s condition improved, with resolution of the
scleritis and a decrease in the anterior uveitis. Despite this improvement in the anteriorsegment inflammation, the vitritis worsened, resulting in a decrease in visual acuity to
20/400 in the left eye at 1 week (Fig. 3). Continued clinical deterioration of the patient’s left
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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eye prompted the initiation of treatment with topical difluprednate (Alcon Laboratories), a
21-day course of oral favipiravir (MediVector), a periocular injection of oral prednisone. On
examination 3 months after presentation with uveitis, the vitritis was resolving and left
visual acuity had recovered to 20/15. Follow-up ophthalmic evaluations are ongoing.
DISCUSSION
Author Manuscript
We describe the detection of viable EBOV in the aqueous humor of the eye in a patient in
recovery from EVD with acute panuveitis (a combination of anterior, intermediate, and
posterior uveitis). In a previous EVD outbreak, EBOV RNA was detected on RT-PCR assay
in a conjunctival sample obtained from a 25-year-old patient 22 days after the onset of
symptoms and 10 days after viremia had cleared. In that patient, 45 days after the onset of
EVD symptoms, posterior uveitis developed; the patient did not undergo any additional
testing of ocular tissue.4 Marburg virus, a filovirus like EBOV, has also been associated
with uveitis during convalescence. In 1975, Marburg virus was cultured from the aqueous
humor of a patient with acute anterior uveitis that developed nearly 3 months after the onset
of acute illness.12 Viral culture of the patient’s aqueous humor that was sampled 2 weeks
later was negative.13
Author Manuscript
Although the pathogenesis of EVD-associated uveitis is unknown, we believe that the
severe, acute panuveitis that developed in our patient was a direct cytopathic effect of active
replication of EBOV persisting in an immune-privileged organ. The acute onset of
symptoms, unilateral location, and extreme elevation of intraocular pressure that were seen
in our patient are clinical findings similar to infectious uveitis syndromes caused by
herpesviruses, in which the pathogenesis is known to be a direct consequence of active viral
replication.14,15 Although the relative contribution of lytic viral infection, as compared with
immunologic reaction to EBOV, in the pathogenesis of our patient’s aggressive panuveitis is
unclear, the low cycle threshold on quantitative RT-PCR assay shows that a high burden of
viable EBOV was present at the time that the patient’s ocular symptoms were worsening.
Further studies to investigate the mechanisms responsible for the ocular persistence of
EBOV and the possible presence of the virus in other immune-privileged sites (e.g., in the
central nervous system, gonads, and articular cartilage) are warranted.
Author Manuscript
Few systematic studies have examined post-EVD sequelae, so the incidence and clinical
manifestations of post-EVD ocular complications are uncertain. Of 71 EVD survivors from
the 1995 Ebola outbreak in the Democratic Republic of Congo, 20 were enrolled in a small,
retrospective study.4 Three of the 20 survivors in this limited sample were found to have
evidence of uveitis (anterior, posterior, or panuveitis) that occurred 42 to 72 days after the
onset of EVD. Data on the incidence of ocular complications among survivors of the current
West African EVD outbreak are also limited. Although 40% of participants in a recent
survey of 85 EVD survivors in Sierra Leone reported having “eye problems,” the incidence
of uveitis in this cohort is unknown.16
In conclusion, our patient’s recovery from EVD was complicated by acute anterior uveitis,
which rapidly evolved into a sight-threatening panuveitis with detection of persistent EBOV
within the eye. This case highlights an important complication of EVD with major
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
Page 5
Author Manuscript
implications for both individual and public health that are immediately relevant to the
ongoing West African outbreak. It is reassuring that samples of conjunctivae and tears tested
negative for EBOV, a finding that supports previous studies suggesting that patients who
recover from EVD pose no risk of spreading the infection through casual contact.3,17 Further
studies are needed to assess the persistence of EBOV during convalescence, to elucidate the
mechanisms underlying this persistence in ocular and other immune-privileged tissue sites,
and to identify effective treatment strategies for the clinical management of EVD
complications.
Acknowledgments
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the CDC.
Author Manuscript
Supported by a grant from the National Center for Advancing Translational Sciences of the National Institutes of
Health (UL1TR000454, to the Atlanta Clinical and Translational Science Institute), an unrestricted grant from
Research to Prevent Blindness and a grant from the National Eye Institute (P30-EY06360, to the Department of
Ophthalmology, Emory University School of Medicine), and a fellowship grant from the Australian Research
Council (FT130101648, to Dr. Smith). Favipiravir was provided by the Department of Defense Joint Project
Manager Medical Countermeasure Systems.
We thank Alison Boess and the family of Dr. Ian Crozier; staff members at the Biotechnology Core Facility Branch
of the CDC for their assistance in generating viral sequences; Dr. William Bornstein, Dr. Bryce Gartland, Crystal
Evans, Maureen Lindsey, Brian Frislie, Emily Beck, Connie Wilbanks, Paula DesRoches, and all the investigators
at the Emory Serious Communicable Diseases Unit; Kimberly Lovitt, Rhonda Waldron, Debora Jordan, Jannah
Dobbs, Matthew Raeber, and the staff at the Department of Ophthalmology at Emory University; Dr. Monica
Farley and the staff at the Division of Infectious Diseases at Emory University; and MediVector.
References
Author Manuscript
Author Manuscript
1. Global alert and response: Ebola virus disease. Geneva: World Health Organization; 2014. (http://
www.who.int/csr/don/archive/disease/ebola/en).
2. Ebola situation report - 29 April 2015. Geneva: World Health Organization; 2015. (http://
www.who.int/csr/disease/ebola/situation-reports/en/?m=20141231).
3. Kibadi K, Mupapa K, Kuvula K, et al. 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–S14. [PubMed: 9988158]
4. Sierra Leone: helping the Ebola survivors turn the page. Geneva: World Health Organization; 2014.
(http://www.who.int/features/2014/post-ebola-syndrome/en).
5. Kraft CS, Hewlett AL, Koepsell S, et al. The use of TKM-100802 and convalescent plasma in 2
patients with Ebola virus disease in the United States. Clin Infect Dis. 2015 Apr 22. (Epub ahead of
print).
6. Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am
Soc Nephrol. 2015; 26:31–37. [PubMed: 25398785]
7. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of Ebola virus during
the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(Suppl
1):S170–S176. [PubMed: 9988181]
8. Ebola (Ebola virus disease): Q&As on transmission. Atlanta: Centers for Disease Control and
Prevention; 2015. (http://www.cdc.gov/vhf/ebola/transmission/qas.html).
9. Hill CE, Burd EM, Kraft CS, et al. Laboratory test support for Ebola patients within a highcontainment facility. Lab Med. 2014; 45(3):e109–e111. [PubMed: 25184220]
10. Gire SK, Goba A, Anderson KG, et al. Genomic surveillance elucidates Ebola virus origin and
transmission during the 2014 outbreak. Science. 2014; 345:1369–1372. [PubMed: 25214632]
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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Author Manuscript
11. Ebola (Ebola virus disease): Ebola-associated waste management. Atlanta: Centers for Disease
Control and Prevention; 2015. (http://www.cdc.gov/vhf/ebola/hcp/medical-wastemanagement.html).
12. Gear JS, Cassel GA, Gear AJ, et al. Outbreake of Marburg virus disease in Johannesburg. Br Med
J. 1975; 4:489–493. [PubMed: 811315]
13. Kuming BS, Kokoris N. Uveal involvement in Marburg virus disease. Br J Ophthalmol. 1977;
61:265–266. [PubMed: 557985]
14. Amano S, Oshika T, Kaji Y, Numaga J, Matsubara M, Araie M. Herpes simplex virus in the
trabeculum of an eye with corneal endotheliitis. Am J Ophthalmol. 1999; 127:721–722. [PubMed:
10372885]
15. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus
anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008; 145:834–840. [PubMed:
18255045]
16. Trenchard T. Survivors cope with new Ebola after-effects. Al-Jazeera. 2014 (http://
www.aljazeera.com/news/africa/2014/12/survivors-cope-with-new-ebola-aftereffects-2014121573521561384.html).
17. Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic follow- up of
convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic
Republic of the Congo: Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999;
179(Suppl 1):S28–S35. [PubMed: 9988162]
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Figure 1. Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right
eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black
arrow) is adjacent to a chorioretinal scar in the left eye.
Author Manuscript
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N Engl J Med. Author manuscript; available in PMC 2015 December 18.
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Figure 2. Slit-Lamp Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Mild corneal edema, rare keratic precipitates (arrows), and inflammatory cells and protein in
the anterior chamber are consistent with acute anterior uveitis.
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
Page 9
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Figure 3. Fundus Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Severe vitritis is indicated by the obscuration of the optic nerve and blood vessels.
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�
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Title
A name given to the resource
Persistence of Ebola Virus in Ocular Fluid during Convalescence
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Develop
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
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URL
https://www.ncbi.nlm.nih.gov/pubmed/25950269
Read Online
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547451/
Citation
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh (2015). "Persistence of Ebola Virus in Ocular Fluid during Convalescence." N Engl J Med 372(25): 2423-2427.
Abstract
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
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free online - Pubmed Central
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Title
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Persistence of Ebola Virus in Ocular Fluid during Convalescence
Creator
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh
Subject
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Research
Description
An account of the resource
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown.<br /><br />This article was corrected in volume 372 on page 2469.
Date
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2015-06-18
Type
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Publication
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2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Ebola
Eye/Ocular Health
Follow up
Infection Prevention and Control
Laboratory Testing
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Specimen Collection
Specimen Handling
Survivors
-
https://repository.netecweb.org/files/original/b2d4b1c0e67c08838eb2f4febc42055c.xlsx
580d4dc1af03f772eaf1657206033790
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Unit Closure and Set-Up Checklists
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Unit Closure and Set-Up Checklists
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Training and Exercises
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Leadership Toolbox, More Tools: Serious Communicable Diseases Unit Closure Checklist
Date
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2018-01-25
Contributor
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2023-10-17 by Darrell Ruby, T & E group, will be reviewed with LT in Jan.
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2024-02-01 - with LT
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
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http://www.who.int/ebola/en/
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World Health Organization Ebola Virus Disease Information
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WHO
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General
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WHO | World Health Organization
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2018-01-08
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2022-12-07 general asset review - IPC
2024-03-28 by J. Mundy – IPC review 2023 (Q2) skipped – bumping to 2024 (Q4)
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2024-06-10
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Infection Prevention and Control
Ebola
Epidemic
Follow up
Infection Prevention and Control
Outbreaks
Patient Care
Public Health
R-IPC
Survivors