Novel retinal lesion identified in Ebola survivors

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Researchers from the University of Liverpool (UK) have conducted a study of Ebola survivors to better determine the symptoms of post-Ebola syndrome (PES) including ocular sequale.

The study, published recently in Emerging Infectious Diseases, assessed survivors from the 2014–2016 Ebola outbreak who were discharged from the Ebola Treatment Unit in the 34th Regiment Military Hospital, Freetown, Sierra Leone.

Symptoms of PES have previously been reported to include joint and muscle pains, neurological and psychiatric problems. Here, the team led by Paul Steptoe from the University of Liverpool, examined ocular consequences of this disease.

In a case-controlled study, the researchers compared 82 PES patients, who had previously reported ocular problems, with a control population of 105 ophthalmically symptomatic and asymptomatic individuals. The team carried out ocular examinations, including widefield retinal imaging, and discovered a novel retinal lesion in 14.6% of the Ebola survivors.

The team reported that the retinal scar appeared to be Ebola-specific. In addition, they observed the lesion followed the anatomic distribution of the optic nerve axons, suggesting neuronal transmission of Ebola virus as a route of ocular entry.

Steptoe commented: “The distribution of these retinal scars or lesions provides the first observational evidence that the virus enters the eye via the optic nerve to reach the retina in a similar way to West Nile Virus. Luckily, they appear to spare the central part of the eye so vision is preserved. Follow up studies are ongoing to assess for any potential recurrence of Ebola eye disease.

“Our study also provides preliminary evidence that in survivors with cataracts causing reduced vision but without evident active eye inflammation (uveitis), aqueous fluid analysis does not contain Ebola virus therefore enabling access to cataract surgery for survivors.”

Sources: Steptoe PJ, Scott JT, Baxter JM et al. Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016. Emerg. Infect. Dis. doi:10.3201/eid2307.161608 (2017) (Epub ahead of print); https://www.eurekalert.org/pub_releases/2017-05/uol-esh051517.php

You can read more about post-Ebola syndrome in our exclusive opinion piece from Jean-François Etard, “Life after Ebola in Guinea – The Postebogui cohort

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