An American physician diagnosed with Ebola virus infection in September continued to carry the virus and developed serious ocular complications 14 weeks after his diagnosis, according to research published in the New England Journal of Medicine.

“Among survivors of [Ebola virus disease (EVD)], late complications that include ocular disease can develop during convalescence,” according to Jay B. Varkey, MD, of the department of medicine, division of infectious diseases at Emory University School of Medicine, and colleagues. “However, few systematic studies have been conducted on post-EVD sequelae, so the incidence and clinical manifestations of post-EVD ocular complications are unclear.”

The physician, aged 43 years and previously healthy, was diagnosed with Ebola virus (EBOV) on Sept. 6, 2014, while treating Ebola patients in Sierra Leone. He arrived at Emory University Hospital 4 days after the onset of symptoms, and was treated with an experimental, small interfering RNA antiviral agent, TKM-100802 (TKM-Ebola, Tekmira Pharmaceuticals), convalescent plasma and aggressive supportive care.

His health began to improve on day 44 of illness, and after his blood and urine tested negative for the disease on reverse-transcriptase PCR (RT-PCR) assay, the patient was discharged. Shortly later, however, the patient began experiencing sporadic bilateral ocular burning, photophobia and foreign-body sensation, according to the researchers. The patient, whose ocular history included only myopia, required an adjustment to his prescription reading glasses. After evaluation at the Emory Eye Center, he was diagnosed with posterior uveitis, a likely complication of EVD, the researchers wrote.

One month later — 14 weeks after his Ebola diagnosis — the patient presented with acute redness in his left eye, blurred vision, pain and photophobia. During the next 2 days, his symptoms worsened, and Emory specialists performed paracentesis of the physician’s anterior chamber. He was later diagnosed with acute anterior uveitis that progressed to panuveitis.

Aqueous humor samples sent to Emory University Hospital tested positive for EBOV RNA, but a conjunctival swab and tear-film specimens tested negative for EBOV RNA. Repeat peripheral blood also tested negative, according to Varkey and colleagues.

“It is reassuring that samples of conjunctivae and tears tested negative for EBOV, a finding that supports previous studies suggesting that patients who recover from EVD pose no risk of spreading the infection through casual contact,” the researchers wrote. The patient was treated with multiple interventions including topical and systemic corticosteroids.

At a 3-month follow-up visit, his visual acuity had returned to normal, and follow-up evaluations are ongoing.

Although there have been few confirmed cases where EBOV has been detected in conjunctival samples, it is an issue that should not be ignored, according to the researchers.

“The current outbreak has resulted in the largest number of EVD survivors in history,” Varkey told Infectious Disease News. “EVD survivors require ongoing medical care to manage complications from the infection that may develop during recovery.” – by David Jwanier