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Peer reviewedOpen accessEbolaHemorrhagic Fever

Late Ebola virus relapse causing meningoencephalitis: a case report

The Lancet·

Michael Jacobs, Alison Rodger, David J Bell, Sanjay Bhagani, Ian Cropley, Ana Filipe, Robert J Gifford, Susan Hopkins, Joseph Hughes, Farrah Jabeen, Ingolfur Johannessen, Drosos Karageorgopoulos, Angie Lackenby, Rebecca Lester, Rebecca S N Liu, Alisdair MacConnachie, Tabitha Mahungu, Daniel Martin, Neal Marshall, Stephen Mepham, Richard Orton, Massimo Palmarini, Monika Patel, Colin Perry, S Erica Peters, Duncan Porter, David Ritchie, Neil D Ritchie, R Andrew Seaton, Vattipally B Sreenu, Kate Templeton, Simon Warren, Gavin S Wilkie, Maria Zambon, Robin Gopal, Emma C Thomson

DOI
10.1016/s0140-6736(16)30386-5
PMID
27209148
PMCID
PMC4967715
OpenAlex
W2399907638
Study type
Journal article
Publisher
Elsevier BV
Article type
journal-article
Integrity
current

Why this research matters now

This report documents the first described case of late, severe Ebola relapse in the central nervous system, suggesting the need for ongoing vigilance among thousands of Ebola survivors for relapsed infection, with consideration of transmission potential.

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Structured evidence summary

Research question

Whether late viral relapse of Ebola virus can cause severe, potentially transmissible disease in survivors who previously cleared peripheral blood infection.

Study design

Case report describing a single patient readmitted 9 months after initial Ebola disease, with detailed clinical monitoring and genomic sequencing of matched plasma and cerebrospinal fluid samples.

Population and setting

A 39-year-old female nurse from Scotland who had worked in Sierra Leone during the 2014 Ebola outbreak and received treatment for severe Ebola virus disease with high initial viral load.

Main findings

The patient was readmitted 9 months post-discharge with Ebola virus detected in cerebrospinal fluid at higher levels than plasma, with infectious virus recovered only from CSF. She developed progressive meningoencephalitis. Genome sequencing showed only two non-coding changes compared to the initial infecting virus. Treatment with GS-5734 combined with corticosteroids was associated with clinical recovery and undetectable CSF viral RNA after 14 days.

Public-health relevance

This report documents the first described case of late, severe Ebola relapse in the central nervous system, suggesting the need for ongoing vigilance among thousands of Ebola survivors for relapsed infection, with consideration of transmission potential.

Important limitations

This summary is limited to the supplied single-article abstract and metadata. Decision-grade interpretation requires access to the original paper, including full clinical details, laboratory methods, and complete follow-up data.

GIDS interpretation

This single documented case of Ebola relapse in a survivor is presented as a novel clinical observation that the authors state redefines understanding of Ebola natural history, with implications for survivor monitoring protocols.

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Related GIDS surveillance

Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.

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Evidence relationships

This article has 11 auditable classifier relationships to diseases, places, topics, and study design.

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