Late Ebola virus relapse causing meningoencephalitis: a case report.
Michael Jacobs1, Alison Rodger2, David J Bell3
1Department of Infection, Royal Free London NHS Foundation Trust, London, UK.
Lancet (London, England)
|May 23, 2016
Summary
Late Ebola virus relapse can occur in survivors, even months after recovery, affecting the central nervous system. This finding highlights the need for ongoing vigilance in Ebola survivors for potential new transmission chains.
Area of Science:
- Infectious Diseases
- Virology
- Neurology
Background:
- Ebola virus (EVD) survivors face potential long-term complications.
- Viral persistence in immune-privileged sites can lead to late relapses.
- Late, severe relapses of Ebola virus disease have not been previously described.
Observation:
- A nurse treated for severe EVD with high viral load experienced a relapse 9 months post-discharge.
- The patient presented with symptoms of acute meningitis and had Ebola virus in cerebrospinal fluid (CSF).
- Infectious Ebola virus was detected in CSF but not plasma.
Findings:
- Ebola virus RNA was significantly higher in CSF than plasma upon readmission.
- The patient developed progressive meningoencephalitis.
- Clinical recovery was achieved with supportive care, experimental antiviral GS-5734, and high-dose corticosteroids.
Implications:
- This case redefines the natural history of Ebola virus infection.
- Late relapses in the central nervous system (CNS) pose a significant public health concern.
- Continued surveillance of Ebola survivors is crucial to detect and manage relapsed infections and prevent further transmission.
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