Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Reverse Transcription-Polymerase Chain Reaction and Cataract Surgery Outcomes of Ebola Survivors in Sierra Leone

Shantha, Jessica G.; Mattia, John; Goba, Augustine; Barnes, Kayla G.; Ebrahim, Faiqa K.; Kraft, Colleen S.; Hayek, Brent; Hartnett, Jessica N.; Shaffer, Jeffrey G.; Schieffelin, John S.; Sandi, John Demby; Momoh, Mambu; Jalloh, Simbirie; Grant, Donald S.; Dierberg, Kerry; Chang, Joyce; Mishra, Sharmistha; Chan, Adrienne K.; Fowler, Rob; O’Dempsey, Tim; Kaluma, Erick; Hendricks, Taylor; Reiners, Roger; Reiners, Melanie; Gess, Lowell; O’Neill, Kwame; Kamara, Sarian; Wurie, Alie; Mansaray, Mohamed; Acharya, Nisha R.; Liu, William J.; Bavari, Sina; Palacios, Gustavo; Teshome, Moges; Crozier, Ian; Farmer, Paul; Uyeki, Timothy M.; Bausch, Daniel G.; Garry, Robert F.; Vandy, Matthew Jusu; Yeh, Steven

doi:10.1016/j.ebiom.2018.03.020

Cited by 49 publications

(67 citation statements)

References 19 publications

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“…Besides the eye, other immune privileged sites where Ebola virus persistence has been documented, with resultant clinical implications, include the central nervous system and reproductive organs [17,21,23]. Meningoencephalitis has been reported as a late sequela in an Ebola survivor [14] and sexual transmission was reported in association with viral persistence in West Africa [23,24].…”

Section: More Recently Zeng Et Al Evaluated Persistent Asymptomatmentioning

confidence: 99%

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Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models

et al. 2020

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Ebola virus disease (EVD) and emerging infectious disease threats continue to threaten life, prosperity and global health security. To properly counteract EVD, an improved understanding of the long-term impact of recent EVD outbreaks in West Africa and the Democratic Republic of Congo are needed. In the wake of recent outbreaks, numerous health sequelae were identified in EVD survivors. These findings include joint pains, headaches, myalgias, and uveitis, a vision-threatening inflammatory condition of the eye. Retrospective and more recent prospective studies of EVD survivors from West Africa have demonstrated that uveitis may occur in 13–34% of patients with an increase in prevalence from baseline to 12-month follow-up. The clinical spectrum of disease ranges from mild, anterior uveitis to severe, sight-threatening panuveitis. Untreated inflammation may ultimately lead to secondary complications of cataract and posterior synechiae, with resultant vision impairment. The identification of Ebola virus persistence in immune privileged organs, such as the eye, with subsequent tissue inflammation and edema may lead to vision loss. Non-human primate models of EVD have demonstrated tissue localization to the eye including macrophage reservoirs within the vitreous matter. Moreover, in vitro models of Ebola virus have shown permissiveness in retinal pigment epithelial cells, potentially contributing to viral persistence. Broad perspectives from epidemiologic studies of the outbreak, animal modeling, and immunologic studies of EVD survivors have demonstrated the spectrum of the eye disease, tissue specificity of Ebola virus infection, and antigen-specific immunologic response. Further studies in these areas will elucidate the mechanisms of this highly prevalent disease with the potential for improved therapeutics for Ebola virus in immune-privileged sites.

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Section: More Recently Zeng Et Al Evaluated Persistent Asymptomatmentioning

confidence: 99%

“…To address this question, we designed the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study [17]. In this study, 50 EVD survivors were recruited for ocular fluid sampling, the majority of whom required cataract surgery.…”

Section: Medical and Surgical Management Of Ophthalmic Sequelae Of Evdmentioning

confidence: 99%

Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models

et al. 2020

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“…A study of 96 Ebola virus disease survivors in Liberia found that three‐quarters reported blurry vision, while over half reported photophobia, tearing and/or eye pain . However, the main ocular complication of EBOV infection was uveitis, with over 180 cases being documented in survivors of the 2014‐2016 West African epidemic . Reported rates of uveitis in Ebola survivors vary, but the condition may affect as many as one‐third of these individuals, who present on average 3 to 8 wk after discharge from the Ebola treatment unit .…”

Section: Ebola Virus Diseasementioning

confidence: 99%

“…6 However, the main ocular complication of EBOV infection was uveitis, with over 180 cases being documented in survivors of the 2014-2016 West African epidemic. 6,68,72,[76][77][78][79] Reported rates of uveitis in Ebola survivors vary, but the condition may affect as many as one-third of these individuals, who present on average 3 to 8 wk after discharge from the Ebola treatment unit. 68,76,77 Risk factors for developing uveitis include a high viral load while in the treatment unit, presumed conjunctivitis during the acute phase of disease and older age.…”

Section: Post-ebola Uveitismentioning

confidence: 99%

“…Given the association of cataract with uveitis in Ebola survivors, a study of viral persistence in intraocular fluid was performed in 50 people who were candidates for intraocular surgery to ascertain the safety of cataract surgery in this group. 79 Of 46 survivors with cataract, three-quarters had cataract surgery. Median visual acuity improved from hand motions to 6/9 by the fourth post-operative month.…”

Section: Post-ebola Uveitismentioning

confidence: 99%

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Emerging infectious uveitis: Chikungunya, dengue, Zika and Ebola: A review

Oliver

Carr

Smith

2019

Clinical Exper Ophthalmology

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Recently recognized forms of uveitis include intraocular inflammations that occur during or following one of several emerging infectious diseases: chikungunya fever, dengue, Zika virus disease and Ebola virus disease. Anterior, intermediate, posterior and pan‐uveitis have been described in individuals infected with chikungunya virus. Persons who contract dengue or Zika viruses also may develop different types of uveitis in the course of the infection: maculopathy is a common manifestation of dengue eye disease, and Zika eye disease may cause hypertensive anterior uveitis or mimic a white dot syndrome. Up to one‐third of Ebola survivors develop aggressive uveitis, which is frequently associated with vision loss and complicated by cataract. There are no specific anti‐viral drugs for these forms of uveitis, and thus treatment is largely supportive. In this article, we summarize the systemic infectious diseases and virology, and describe the clinical presentations, outcomes and management of emerging viral forms of uveitis.

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Characterization of Ebola Virus–Associated Eye Disease

Eghrari¹,

Bishop

Ross

et al. 2021

JAMA Netw Open

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IMPORTANCESurvivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease. OBJECTIVE To assess features of ophthalmic disease specific to EVD. DESIGN, SETTING, AND PARTICIPANTS This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020. EXPOSURES All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein. MAIN OUTCOMES AND MEASURES Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibodypositive survivors and antibody-negative close contacts. RESULTS A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8[15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, −1.2 mm Hg; 95% CI, −1.6 to −0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.

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Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Reverse Transcription-Polymerase Chain Reaction and Cataract Surgery Outcomes of Ebola Survivors in Sierra Leone

Cited by 49 publications

References 19 publications

Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models

Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models

Emerging infectious uveitis: Chikungunya, dengue, Zika and Ebola: A review

Characterization of Ebola Virus–Associated Eye Disease

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