Post-Ebola Syndrome

Topics with scientific, medical or general health related information and discussion that is not specifically related to Lyme disease.
RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

Post-Ebola Syndrome

Postby RitaA » Fri 8 May 2015 7:58

Thanks, Camp Other, for tweeting the link to this fascinating article.

I have been wondering about post-Ebola syndrome for several months – and especially after hearing and reading about people who may recover from the virus, but who are sometimes left with debilitating health issues that prevent them from returning to work in their former capacity. Thankfully for them, these symptoms aren’t cavalierly chalked up to “the aches and pains of daily living” or the physical manifestation of a psychological disorder.

http://www.nytimes.com/2015/05/08/healt ... s-eye.html

Health

After Nearly Claiming His Life, Ebola Lurked in a Doctor’s Eye

By DENISE GRADY MAY 7, 2015

ATLANTA — When Dr. Ian Crozier was released from Emory University Hospital in October after a long, brutal fight with Ebola that nearly ended his life, his medical team thought he was cured. But less than two months later, he was back at the hospital with fading sight, intense pain and soaring pressure in his left eye.

Test results were chilling: The inside of Dr. Crozier’s eye was teeming with Ebola.

[snip]

A Secondary Problem

Dr. Crozier, 44, ruefully calls himself a poster child for “post-Ebola syndrome”: Besides eye trouble, he has had debilitating joint and muscle pain, deep fatigue and hearing loss. Similar problems are being reported in West Africa, but it is not clear how common, severe or persistent they are.

[snip]

“The main problems they’re telling me about are lots of body and joint pains, chronic headaches and women who stopped having menstrual periods, and for some it’s been several months,” Dr. Schieffelin said. “There’s quite a bit of vision problems.”

[snip]

The inside of the eye is mostly shielded from the immune system to prevent inflammation that could damage vision. The barriers are not fully understood, but they include tightly packed cells in minute blood vessels that keep out certain cells and molecules, along with unique biological properties that inhibit the immune system. But this protection, called immune privilege, can sometimes turn the inner eye into a sanctuary for viruses, where they can replicate unchecked. The testes are also immune-privileged, which is why Ebola can persist in semen for months.

[snip]

In addition, the severe inflammation suggested that the barriers that normally protect the eye from the immune system had been breached. So what was damaging Dr. Crozier’s eye? The virus, the inflammation or both? They could not be sure.

The usual treatment for inflammation is steroids. But they can make an infection worse.

“What if it unleashed the virus?” Dr. Crozier said. “We were on a tightrope.”

[snip]

With time and help from his colleagues, I hope Dr. Crozier makes a full recovery.

RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

Re: Post-Ebola Syndrome

Postby RitaA » Fri 8 May 2015 8:08

http://www.msf.org/article/ebola-surviv ... r-recovery

Ebola: Surviving Survival - Life after recovery

13 April 2015

Dr Maria Barstch spends her days in the small house that serves as MSF’s Ebola survivor clinic in Freetown, Sierra Leone. The peak of the epidemic may have passed in Sierra Leone but new cases continue to emerge almost every day, and with new cases come new survivors. While they are relieved to have defeated the deadly virus, some survivors are facing other debilitating symptoms of the so called “post-Ebola syndrome.”

“I see a lot of people with severe joint pain,” says Dr Maria. “I also see a lot of rashes and skin infections, eye problems, general fatigue and weakness and genito-urinary tract infections. Many issues can be treated very easily here in our clinic but without treatment some of the complications can be very severe and can cause irreversible damage.”

One of the most common and serious complications seen in Ebola survivors like Mamadou is an inflammation of the eye called uveitis. It is a complication also seen after other severe viral illnesses but the results can be debilitating. “This is where we, at the MSF survivor clinic, can have a huge impact,” adds Dr Maria. “Most patients suffering from uveitis can be treated with eye drops by an ophthalmologist but, if left untreated, uveitis can lead to blindness. We refer patients to the specialist before the damage becomes irreversible and the success rate is high.”



http://www.who.int/features/2014/post-e ... ndrome/en/

Sierra Leone: Helping the Ebola survivors turn the page

October 2014

As the Ebola outbreak grows and spreads, a small but significant group of people is also growing - the Ebola survivors. Emerging shell-shocked from what one described as a "glimpse of hell", the survivors have not found life easy on the other side of the Ebola ward.

[snip]

Dr Nanyonga said that people with what she calls "post-Ebola syndrome" have a range of symptoms. These have been seen in survivors of previous outbreaks and cause long-term disability. Apart from visual problems which affect approximately 50% of Ebola survivors in Kenema, people complain of "body aches" such as joint, muscle and chest pain. They also suffer headaches and extreme fatigue, making it difficult to take up their former lives – especially if it involved manual work – as farmers, labourers and housewives.

Need for more information on post-Ebola syndrome

We need to understand why these symptoms persist, whether they are caused by the disease or treatment, or perhaps the heavy disinfection,” says Dr Nanyonga who has developed an assessment tool that will be used to establish the most common and disabling symptoms and what can be done to help survivors with these problems.

Dr Andrew Ramsay, field coordinator for WHO in Kenema, says it is essential that potentially disabling physical and psychological problems be diagnosed and, where possible, treated as quickly as possible.


http://www.reuters.com/article/2015/02/ ... WA20150204

Health | Wed Feb 4, 2015 11:36am EST

Free from Ebola, survivors complain of new syndrome

DAKAR/MONROVIA | By Emma Farge and James Harding Giahyue

[snip]

Some of those who have survived the disease report a mixture of symptoms after their recovery, including vision problems, joint pain, hair and memory loss and anxiety attacks.

[snip]

Kelly said some Ebola after-effects appear linked to the infection itself, with some patients developing symptoms similar to so-called autoimmune disorders - where the immune system is over stimulated and begins to attack the body's own tissues. Other patients develop symptoms similar to uveitis, he said, an eye inflammation causing blindness.

"With post-Ebola syndrome there is an autoimmune response: it's revved up, and we don't really know why," he told Reuters by telephone from Sierra Leone where he is helping with the Ebola response.


Edited to add the following article:

http://www.nature.com/news/ebola-surviv ... es-1.17068

Ebola survivors offer clues to body's virus defences

Immune responses of four people treated in a US hospital yield useful data for developing vaccines.

Erika Check Hayden

09 March 2015

[snip]

The researchers found that these two patients continued to make cells that were primed to fight Ebola virus for as long as a month after they were cured of their infections and released from the hospital. This indicates that although the patients cleared the infectious virus out of their bodies, viral fragments remained, keeping the immune system on alert.

That might provide clues as to why some survivors experience what doctors are calling 'post-Ebola syndrome' — the persistence of symptoms such as body aches and pains, vision problems, fatigue and skin problems even after they recover. The immune system goes into 'battle mode' to fight the virus, but if it does not stand down after the infection is gone, it might still do damage.

“It is certainly conceivable that a hyperactivated immune system following recovery from the live infection could account for some of the prolonged symptoms,” Fauci says.

But McElroy says the paper involves too few survivors to know for sure what underlies the post-Ebola syndrome, and that Ebola takes a tremendous physical toll on patients that may cause some of the the disease's lingering effects.
Last edited by RitaA on Sun 10 May 2015 8:09, edited 2 times in total.

Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Post-Ebola Syndrome

Postby Lorima » Sun 10 May 2015 2:06

Oops - just posted a new topic on a similar subject - see "Ebola persisting in the eye."

No confusion about persistent infection versus autoimmunity in that case. Although the blood was presumed clear, the affected eye was "teeming" with Ebola.
"I have to understand the world, you see."
Richard Feynman

RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

Re: Post-Ebola Syndrome

Postby RitaA » Sun 10 May 2015 2:48

Lorima wrote:No confusion about persistent infection versus autoimmunity in that case. Although the blood was presumed clear, the affected eye was "teeming" with Ebola.


Hi Lorima,

While I agree completely that Dr. Crozier had a persistent infection in his eye, it's not as clear (at least not yet) if that was/is also responsible for his other health issues:

Dr. Crozier, 44, ruefully calls himself a poster child for “post-Ebola syndrome”: Besides eye trouble, he has had debilitating joint and muscle pain, deep fatigue and hearing loss.


Perhaps he was dealing with both a persistent infection AND something else -- whether it be permanent damage caused by the infection and/or other factors.

RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

Re: Post-Ebola Syndrome

Postby RitaA » Sun 10 May 2015 17:14

I stumbled upon this article quite by accident (while trying to keep up with elephant rescue news) and thought it was worthwhile posting here. It's the first time I recall reading that only certain viruses and bacteria are capable of producing a post-infectious syndrome that includes pain. I'm not sure how much (if any) of this applies to Ebola or Lyme disease.

Source (which my anti-virus software doesn't like very much):

http://www.thehindu.com/features/magazi ... 184122.ece

May 9, 2015
Updated: May 10, 2015 11:48 IST

Doc talk

A question of pain

Experts offer advice on getting rid of the excruciating and persistent joint pain after viral fever

Mr. U is a retired senior executive in his sixties. Around three months ago, the active gentleman came down with a fever and excruciating body pain that subsided in a few days. A month later, he suffered severe pain in the knee and ankles. He tried a gamut of treatment options — physiotherapy, yoga and herbal concoctions in that order — and felt some relief after eight weeks. Soon after, he began to experience pain in the shoulder.

Maheshwari, in her forties, works as a domestic help. An attack of chikunguniya about three years ago has left her with a persistent knee problem. From quack doctors promising miraculous cures to erratic physiotherapy and massages, she has given it all a shot but finds no relief. The fact that she is overweight and her knees were already wearing out has only aggravated her condition.

The pain, says Dr Jayateerth Kulkarni, Arthroscopy and Joint Replacement Surgeon, Fortis Hospital, Bangalore, is the result of the counter-attack by the body’s immune system to an infection. “The immune system is activated when exposed to certain antigens (unique proteins or other distinct molecules) present in the infecting virus/bacterium. The body’s own antigens do not usually activate the immune system but some viruses have antigens that resemble that of the body. The immune response to such a virus will be to attack the body’s cells. This phenomenon — known as cross-reactivity — results in inflammation of tissues and damage to the cells. When this occurs in muscles and joints, it causes muscle pain and inflammatory arthritis. Only a few viruses have cross-reacting antigens and only these will cause post-viral arthritis. The classic example is the Chikungunya virus.

Dr. Pon Singh, Secretary, Indian Medical Practitioners Cooperative Pharmacy & Stores (IMCOPS), adds, “According to the Siddha system, some fevers are caused by krimis, (micro-organisms such as virus and bacteria). Whenever a krimi enters the human body, it invades the saptha dhatus (seven vital tissues) that constitute the human body. Viruses that cause Chikungunya, dengue, or flu reside at the major joints such as elbow, wrist, knee and ankle. They produce toxins and affect the immune mechanism, leading to muscular and joint pains accompanied by fever. The cartilages also get affected and cause joint inflammation, which presents as pronounced pain. Typically this occurs a few weeks after the viral infection. By the time arthritis develops, the virus is no longer present in the body. “

So how does one treat a problem like this? Dr. V. Ramasubramanian — Consultant, Infectious Diseases, Apollo Hospitals & Adjunct Professor of Infectious Diseases, Sri Ramachandra Medical College, Chennai and Director, Immune Boosters Adult Vaccination & Travel Clinic — says, “Treatment is purely supportive and symptomatic with pain killers as there are no specific anti-viral medicines for these viruses.” About other options like Physiotherapy, herbal concoctions and Yoga, he says, “All these therapies give a feeling of well being but may also have unknown benefits. As an allopath I am not qualified to discuss their benefits. But any kind of graded exercise, physiotherapy or movement in general will help strengthen the muscle and support the joint.” Dr. Kulkarni adds that anti-inflammatory drugs, splinting, ice packs, physiotherapy, and Ayurvedic massage will also help.

Dr. Singh feels that curative and even preventive treatments are available in the Siddha system. “Several concoctions are actually administered in Government allopathic hospitals during mass attacks. Pranayama boosts the immune system but yogic postures and physiotherapy are contraindicated as the pain may be aggravated. Patients should drink plenty of water and liquids such as fruit juices, gruel or porridge, which are easily digested. The recovery also depends on the type of virus and the quantum of viral load entering the blood stream. The cure is not complete with the death of the virus because the immune system is affected severely.”

How long does it take for complete release from pain? Dr. Ramasubramanian observes that viral arthritis generally lasts only for a few days post-infection. “Post-Chikungunya, it can last up to three months, in some cases over a year. Studies have shown that in 12 per cent of chikungunya patients, the pain can last for over three years but will settle eventually. No viral arthritis by itself lasts indefinitely. Since there is no specific anti-viral medication, early treatment is only supportive and not beneficial. In general, the healthier the body, lower the debility. Healthy food, good exercise and avoiding obesity is the way forward. Once the infection resolves, graded mobility would help”


Hopefully, one day, doctors will have more to offer than simply pain medication. Any treatment that modulates -- without suppressing -- the immune system seems like a worthwhile goal in cases like this.

RitaA
Posts: 2768
Joined: Thu 1 Jul 2010 8:33

Re: Post-Ebola Syndrome

Postby RitaA » Sun 10 May 2015 18:25

While this article was published several years ago, I think some of the information is still relevant. Here's hoping it doesn’t take another 50 years before there is significant progress in this type of research.

http://pmj.bmj.com/content/64/753/559.full.pdf

Postgraduate Medical Journal (1988) 64, 559-567

Post-infectious disease syndrome

B.A. Bannister

The Royal Free Hospital Department of Infectious Diseases at Coppetts Wood Hospital, Coppetts Road,
Muswell Hill, London N1O IJN, UK.

Summary: Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis.

Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research.

This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.

Introduction

Most patients who have had an acute infection expect to pass through a variable period of convalescence before they regain their usual health. An unlucky minority recover from the symptoms of acute disease only to be assailed by a new illness; a post-infectious syndrome. Many post-infectious syndromes have characteristic clinical features and can be traced to their causative organism both on epidemiological evidence and by laboratory testing. By no means all post-infectious syndromes are viral in aetiology, a fact that is well illustrated by two of the best-established syndromes: rheumatic fever, first shown to follow Streptococcus pyogenes infection by Coburn in 1931,1 and post-streptococcal glomerulonephritis, first defined by Ellis in 1942,2 as his type I glomerulonephritis. An indication of the range of post-infectious disorders and their causative agents is given in Table I, together with some original and review references.

Fatigue syndromes

A post-infectious complaint which is not found in this well-accepted list of syndromes is the syndrome of fatigue, muscle weakness and variable neurological abnormalities which has been described from various parts of the world. This syndrome has been described both as sporadic illness and in outbreaks. Some of the more noteworthy outbreaks are listed in Table II.

The main symptoms of these fatigue syndromes are described as muscular and neurological. The muscular symptoms are predominantly of weakness with or without pain. In many cases the weakness is described as following muscular effort, and persisting for several hours or even a number of days afterwards. The leg muscles are those most often affected, but the upper arms and the back are also frequently involved.

The neurological symptoms are very variable. Mental exhaustion and poor concentration are almost universally present, but other complaints include paraesthesiae in the limbs or face, local weaknesses of a wrist or ankle, or the face, diplopia, blurred vision and headaches. Many patients also describe periods of excessive sweating, and severe coldness of the limbs. Other symptoms described by the patients, and elicited by some investigators 23 include altered hearing, frequency of micturition or retention of urine, emotional lability and vivid dreams.

In spite of the number of symptoms described by sufferers, the physical signs elicited are often subtle and few. Fever is not a major sign, though many patients have a temperature of 37 to 37.5°C throughout the day, described by many as a lowgrade fever.

[snip]

Possible pathogenetic mechanisms for post-viral fatigue

The pathogenesis of post-infectious conditions is a complex and entrancing subject on which whole books could be written, and indeed have been, even about individual illnesses. The subject is very wide, and some good, up-to-date reviews are available. 59 The main categories of immune mechanisms discussed in this context are molecular mimicry and autoimmunity, immune complex disorders, lymphocyte function and dysfunction, the role of allergy and the role of host susceptibility. Methods and facilities for studying these factors routinely have to date been limited but they are now diversifying in both number and sophistication. Their relevance to post-viral fatigue syndromes and the emerging results of their application will be discussed briefly.

[snip]

It can be seen from this discussion that fatigue syndromes are beginning to become established as bona-fide illnesses and that persistent research into their nature and cause is gradually being rewarded. The development of knowledge, like the course of the disease, is slow and unpredictable so that for the investigator as well as the patient the game is only now getting under way, and all has yet to be played for.


I find the words “game” and “played for” in the last sentence to be unfortunate, however it’s important to keep in mind the article was written for medical professionals and researchers as opposed to patients who are desperate for answers and relief from their symptoms.

As discussed previously in other threads, the term “fatigue syndrome” is grossly misleading given the frequent (and often predominant) muscular and neurological symptoms that are described above.


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