Physicians from Emory University Hospital have reported a case of live Ebola virus detected in aqueous humor 9 weeks after the patient recovered from the disease systematically. The case has significant implications for survivors of Ebola and for the physicians who care for them.
Published in the New England Journal of Medicine, the case report describes a 43-year-old physician treated for Ebola at Emory University Hospital and released 6 weeks later with no virus detected in blood or urine samples. Fourteen weeks after the initial diagnosis, the patient presented with acute anterior uveitis and severe ocular hypertension.
The patient developed progressive visual decline while undergoing initial treatment with topical corticosteroids and intraocular pressure-lowering medications, and his disease progressed to a severe, sight-threatening panuveitis. Viral culture and molecular testing of intraocular fluid were positive for the Ebola virus. However, conjunctival and tear samples tested negative for the virus.
It is known that Ebola survivors are at risk of uveitis, but studies evaluating uveitis in the context of the post-Ebola syndrome are rare.
Although the pathogenesis of Ebola-associated uveitis is unknown, the authors believe that the severe, acute panuveitis that developed in this patient was a direct cytopathic effect of active replication of the virus persisting in an immune privileged organ. The acute onset of symptoms, unilateral location and extreme elevation of intraocular pressure seen in this 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.
It is imperative that health care providers and institutions caring for Ebola survivors take appropriate infection control precautions for the safety of all individuals involved in the treatment of ocular complications secondary to Ebola.
Specific measures include the development of standard operating protocols for donning and doffing of personal protective equipment, laboratory specimen handling and waste management. The samples of conjunctivae and tears were negative for the virus, which demonstrates that survivors pose no risk of spreading the infection through casual contact (e.g. ophthalmic examination including intraocular pressure, gonioscopy).
Invasive procedures such as intraocular injections and surgical procedures (e.g. cataract surgery, glaucoma procedures) should be performed with extreme caution during convalescence and only after careful infection control precautions and protocols have been established.
The patient’s visual acuity improved at 3-month follow-up, but he continues to undergo ophthalmic monitoring and treatment.