Persistence of Ebola Virus in Ocular Fluid during Convalescence

Abstract

Summ a r yAmong 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.T he 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.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. C a se R eportA 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 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 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 From the Department of Medicine, Division of Infectious Diseases (J.