Late Ebola virus relapse causing meningoencephalitis: a case report

作者：Michael Jacobs, Alison Rodger, David Bell, Sanjay Bhagani, Ian Cropley, Ana da Silva Filipe, Robert J. Gifford, Susan Hopkins, Joseph Hughes, Farrah Jabeen, Ingólfur Johannessen, Drosos E. Karageorgopoulos, Angie Lackenby, Rebecca Lester, Rebecca S. N. Liu, Alisdair MacConnachie, Tabitha Mahungu, Daniel Martín, Neal Marshall, Stephen Mepham, Richard Orton, Massimo Palmarini, Monika Patel, Colin Perry, S Erica Peters, Duncan Porter, David Ritchie, Neil Ritchie, R.A. Seaton, Vattipally B. Sreenu, Kate Templeton, Simon Warren, Gavin S. Wilkie, Maria Zambon, Robin Gopal, Emma C. Thomson · 发表于：The Lancet · 年份：2016 · DOI：10.1016/s0140-6736(16)30386-5 · 被引用次数：363 · 研究领域：Viral Infections and Outbreaks Research、Disaster Response and Management、Infection Control and Ventilation

BACKGROUND: There are thousands of survivors of the 2014 Ebola outbreak in west Africa. Ebola virus can persist in survivors for months in immune-privileged sites; however, viral relapse causing life-threatening and potentially transmissible disease has not been described. We report a case of late relapse in a patient who had been treated for severe Ebola virus disease with high viral load (peak cycle threshold value 13.2). METHODS: A 39-year-old female nurse from Scotland, who had assisted the humanitarian effort in Sierra Leone, had received intensive supportive treatment and experimental antiviral therapies, and had been discharged with undetectable Ebola virus RNA in peripheral blood. The patient was readmitted to hospital 9 months after discharge with symptoms of acute meningitis, and was found to have Ebola virus in cerebrospinal fluid (CSF). She was treated with supportive therapy and experimental antiviral drug GS-5734 (Gilead Sciences, San Francisco, Foster City, CA, USA). We monitored Ebola virus RNA in CSF and plasma, and sequenced the viral genome using an unbiased metagenomic approach. FINDINGS: On admission, reverse transcriptase PCR identified Ebola virus RNA at a higher level in CSF (cycle threshold value 23.7) than plasma (31.3); infectious virus was only recovered from CSF. The patient developed progressive meningoencephalitis with cranial neuropathies and radiculopathy. Clinical recovery was associated with addition of high-dose corticosteroids during GS-57...