Features
Ebola is an enveloped, single-strand, negative polarity RNA virus transmitted through direct contact with bodily fluids/tissues from humans (e.g., blood, secretions, semen, saliva, urine, and breast milk) or animal vectors (e.g., bats, chimpanzees, gorillas, and duikers). Infection of macrophages leads to activation and release of cytokines, while dendritic cell activation causes a decrease in cytokine release and T-cell activation with downregulation of key components of the innate immune viral response. These responses cause an increase in vascular permeability, hypovolemic shock, multisystem failure, disseminated intravascular coagulation, hemorrhage, rash, and a high case fatality rate. Given the number of Ebola survivors in the latest outbreak, new observations are being made of the enduring consequences following survival from this hemorrhagic fever. Acute clinical symptoms are summarized and an array of lingering symptoms and signs having affected survivors (as documented from prior outbreaks from the Democratic Republic of Congo and Uganda, as well as more recent evidence from the most recent West African outbreak) follows. Ophthalmic sequelae may include various inflammatory features.
60.1.1 Common Symptoms
Acute Ocular Symptoms
Subconjunctival hemorrhage and vision loss (of unclear etiology due to inability to perform ophthalmic examination acutely) and conjunctival injection have been reported in 48 to 58% of patients during active infection.
Acute Systemic Symptoms
Initially, a flu-like presentation with fever, headache, malaise, and diarrhea. Ebola virus (EBOV) is known to cause a “viral hemorrhagic fever.”
Long-Term Sequelae
Arthralgias (may include joint pain or ache without swelling); tenosynovitis (rare), fatigue, headache, abdominal pain, audiologic symptoms (tinnitus, aural fullness, and subjective hearing loss), anxiety, depression, insomnia, alopecia, Ebola virus persistence in immune privileged sites (i.e., reproductive organs, central nervous system, and eye fluid), and tenosynovitis (rare).
60.1.2 Exam Findings
Findings include anterior uveitis, intermediate uveitis, posterior uveitis with chorioretinal scar, panuveitis, and posterior synechiae. Cataract as a secondary complication may present as a uveitic white cataract, posterior subcapsular cataract, and anterior capsular fibrotic plaque (▶ Fig. 60.1, ▶ Fig. 60.2, ▶ Fig. 60.3).
Fig. 60.1 Uveitic white cataract is a known sequela of Ebola virus disease.
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