Global & Disaster Medicine

A novel retinal sign that appears to be specific to Ebola survivors.

Citation:  Steptoe PJ, Scott JT, Baxter JM, Parkes CK, Dwivedi R, Czanner G, et al. Novel retinal lesion in Ebola survivors, Sierra Leone, 2016. Emerg Infect Dis. 2017 Jul [date cited]. https://dx.doi.org/10.3201/eid2307.161608

Abstract:  We conducted a case–control study in Freetown, Sierra Leone, to investigate ocular signs in Ebola virus disease (EVD) survivors. A total of 82 EVD survivors with ocular symptoms and 105 controls from asymptomatic civilian and military personnel and symptomatic eye clinic attendees underwent ophthalmic examination, including widefield retinal imaging. Snellen visual acuity was <6/7.5 in 75.6% (97.5% CI 63%–85.7%) of EVD survivors and 75.5% (97.5% CI 59.1%–87.9%) of controls. Unilateral white cataracts were present in 7.4% (97.5% CI 2.4%–16.7%) of EVD survivors and no controls. Aqueous humor from 2 EVD survivors with cataract but no anterior chamber inflammation were PCR-negative for Zaire Ebola virus, permitting cataract surgery. A novel retinal lesion following the anatomic distribution of the optic nerve axons occurred in 14.6% (97.5% CI 7.1%–25.6%) of EVD survivors and no controls, suggesting neuronal transmission as a route of ocular entry.

 

Volume 23, Number 7—July 2017

Research

Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016

Paul J. SteptoeComments to Author , Janet T. Scott, Julia M. Baxter, Craig K. Parkes, Rahul Dwivedi, Gabriela Czanner, Matthew J. Vandy, Fayiah Momorie, Alimamy D. Fornah, Patrick Komba, Jade Richards, Foday Sahr, Nicholas A.V. Beare, and Malcolm G. Semple
Author affiliations: University of Liverpool, Liverpool, UK (P.J. Steptoe, J.T. Scott, G. Czanner, N.A.V. Beare, M.G. Semple); Royal Liverpool Hospital, Liverpool (P.J. Steptoe, J.M. Baxter, C.K. Parkes, R. Dwivedi, N.A.V. Beare); National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool (J.T. Scott, M.G. Semple); Connaught Hospital, Freetown, Sierra Leone (M.J. Vandy); 34th Regiment Military Hospital, Freetown (F. Momorie, A.D. Fornah, P. Komba, F. Sahr); Public Health England Laboratory, Makeni, Sierra Leone (J. Richards)

Main Article

Figure 2

Composite scanning laser ophthalmoscope retinal images showing type 6 Ebola peripapillary or peripheral lesions, observed following the anatomic distribution of the ganglion cell axon (retinal nerve fiber layer), in a case–control study of ocular signs in Ebola virus disease survivors, Sierra Leone, 2016. A) Example 1, right eye. B) Illustration of the ganglion cell axon anatomic distribution. Courtesy of W.L.M. Alward. C) Example 2, right eye. Asterisks indicate curvilinear lesions distinct fro

Figure 2. Composite scanning laser ophthalmoscope retinal images showing type 6 Ebola peripapillary or peripheral lesions, observed following the anatomic distribution of the ganglion cell axon (retinal nerve fiber layer), in a case–control study of ocular signs in Ebola virus disease survivors, Sierra Leone, 2016. A) Example 1, right eye. B) Illustration of the ganglion cell axon anatomic distribution. Courtesy of W.L.M. Alward. C) Example 2, right eye. Asterisks indicate curvilinear lesions distinct from the retinal vasculature. White arrowhead indicates retinal nerve fiber wedge defect.

Figure 3

Characteristic features of lesions observed in a case–control study of ocular signs in Ebola virus disease survivors, Sierra Leone, 2016. A) Composite scanning laser ophthalmoscope retinal image, left eye. Arrow indicates direction of the optical coherence tomography scan. B) Optical coherence tomography. White, long, dashed line indicates cross-sectional plane; white arrowhead indicates Ebola lesion limited to the retinal layers with an intact retinal pigment epithelium. Magnified 1.5× from ori

Figure 3. Characteristic features of lesions observed in a case–control study of ocular signs in Ebola virus disease survivors, Sierra Leone, 2016. A) Composite scanning laser ophthalmoscope retinal image, left eye. Arrow indicates direction of the optical coherence tomography scan. B) Optical coherence tomography. White, long, dashed line indicates cross-sectional plane; white arrowhead indicates Ebola lesion limited to the retinal layers with an intact retinal pigment epithelium. Magnified 1.5× from original image (panel A). C) Examples of straight-edged, sharp angulated lesions (magnified from panel A). D) Example of tangential section through the human fovea with illustrative highlighting of a triangular photoreceptor matrix corresponding to Ebola lesional shape. Courtesy of Ahnelt et al. (17).


Comments are closed.

Categories

Recent Posts

Archives

Admin