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Report: Ebola Survivors Develop New Symptoms After ‘Recovery’

Authors find ocular, psychological, and cognitive complications

Survivors of Ebola virus disease (EVD) are known to experience vision, hearing, and other problems during their recovery, but now it appears that they may also have to deal with health issues, such as depression, anxiety, and nerve damage, after they leave the hospital. These signs and symptoms can persist for months, according to a small survey of individuals whose care was managed in the U.S.

The survey, conducted by investigators at the Centers for Disease Control and Prevention, was published as a letter in the New England Journal of Medicine.

According to the authors, a total of 10 adult patients with EVD were treated in U.S. hospitals from August 2 to December 31, 2014; of these patients, eight survived. In March 2015, telephone surveys were conducted with the survivors to identify symptoms, diagnostic testing, and treatments that occurred at any time during the recovery period. The survivors’ medical records were not reviewed.

The median interval between hospital discharge and survey administration was 5 months (range, 4 to 7 months). All of the survivors reported having had at least one symptom during their recovery periods. These symptoms ranged from mild (e.g., alopecia) to more-severe complications requiring rehospitalization or treatment. The most commonly reported symptoms included lethargy or fatigue, arthralgia, and alopecia.

Three quarters of the survivors returned to normal daily activities within 8 weeks after discharge. Five patients (63%) reported having ocular symptoms, including pain, discomfort, or blurriness; of these patients, four underwent ophthalmologic evaluation, and two were treated for unilateral uveitis, which was diagnosed from 2 to 8 weeks after hospital discharge. Six patients (75%) reported experiencing psychological or cognitive symptoms, including short-term memory loss, insomnia, and depression or anxiety. Three patients (38%) reported having paresthesia or dysesthesia, and one received treatment for peripheral neuropathy. Two patients (25%) were rehospitalized briefly for a non–EVD-related febrile illness.

Although most symptoms resolved or improved over time, only one survivor reported complete resolution of all symptoms, the authors reported. Therefore, they said, some EVD survivors may benefit from psychological and subspecialty assessment (e.g., rheumatologic, musculoskeletal, or neurologic evaluation) in addition to primary care. Further, the frequency of ocular symptoms, including two cases of uveitis among the few U.S. survivors, suggests that ophthalmologic evaluation of EVD survivors may be important. The authors did not assess whether reported symptoms were directly caused by EVD.

“We’re happy that most of the EVD patients who were managed in the U.S. survived, but surviving EVD is not the end of the story,” lead author Dr. Timothy Uyeki told Reuters. “There are complications, sequelae, and symptoms reported by these survivors, and we need a lot more research into the frequency, duration, and the pathogenesis of the post-Ebola signs and symptoms, and how to manage them.”

Previous research has shown that the virus can be detected in semen as many as 101 days after symptoms appear. The virus is also known to lurk in eye tissue.

Sources: NEJM; December 17, 2015; and Reuters; December 16, 2015.

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