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Monday, July 13, 2015

Ebola Nearly Claimed His Life, Then It Hid in His Eye

Satellite image of Sierra Leone
Satellite image of Sierra Leone (Photo credit: Wikipedia)

ATLANTA - When Dr. Ian Crozier was released from Emory University Hospital in October after a long, brutal fight with Ebola that nearly ended his life, his medical team thought he was cured. But less than two months later, he was back at the hospital with fading sight, intense pain and soaring pressure in his left eye.

Test results were chilling: The inside of Dr. Crozier’s eye was teeming with Ebola.

His doctors were amazed. Months had passed since he became ill while working in an Ebola treatment ward in Sierra Leone as a volunteer for the World Health Organization. By the time he left Emory, his blood was Ebola-free.

Almost nothing was known about the ability of Ebola to lurk inside the eye, but despite the infection, Dr. Crozier’s tears and the surface of his eye were virus-free, so he posed no risk to anyone who had casual contact with him.

More than a year after the epidemic in West Africa was recognized, doctors are still learning about Ebola and Lingering effects on survivors. Now, however, with at least 10,000 survivors in Guinea, Liberia and Sierra Leone, patterns are emerging.

Dr. Crozier, 44, calls himself a poster child for “post-Ebola syndrome.” Besides eye trouble, he has had debilitating joint and muscle pain, deep fatigue and hearing loss.

At ELWA Hospital in Monrovia, Liberia, run by the missionary group SIM, Dr.John Fankhauser, the medical director, said such ailments were the most common physical problems among the hundred or so people attending a special clinic for Ebola survivors.

In Sierra Leone, the picture is much the same, according to Dr. John S. Schieffelin, a physician from the Tulane University School of Medicine in New Orleans who volunteered there. He said a well-organized survivor group met regularly in Kenema.

“The main problems they’re telling me about are lots of body and joint pains, chronic headaches and women who stopped having menstrual periods, and for some it’s been several months,” Dr. Schieffelin said.” There’s quite a bit of vision problems.”

The inside of the eye is mostly shielded from the immune system to prevent vision damage. The barriers are not fully understood, but they include tightly packed cells in minute blood vessels that keep out certain cells, along with unique biological properties that inhibit the immune system. But this “immune privilege” can sometimes turn the inner eye into a sanctuary for viruses.

The question was whether Dr. Crozier’s sight could be saved. Severe inflammation suggested that the barriers that normally protect the eye from the immune system had been breached. So what was damaging Dr. Crozier’s eye? The virus, the inflammation or both?

The usual treatment for inflammation is steroids. But they can make an infection worse.

“What if it unleashed the virus?” Dr. Crozier said. “We were on a tightrope.”

Though Dr. Crozier was the patient, he was also part of his own medical team, and his focus on the scientific details helped counter his mounting fear that he was going blind. As he and his physicians struggled to balance treating the inflammation with fighting the infection, his eyesight continued to deteriorate.

He also had significant hearing loss on the same side. “The whole left side of your life is gone, “he said. “It was a very dark and depressing time.”

The biggest shock came when he glanced in the mirror one morning and saw that his eye color had changed from bright blue to a vivid green.

“It was like an assault,” he said. “It was so personal.”

Dr. Jay Varkey, an infectious-disease specialist who had handled much of Dr. Crozier’s care, got special permission from the United States Food and Drug Administration to use an experimental antiviral drug taken in pill form. (The doctors declined to name it.)

At first, there seemed to be no effect. But a week or so later, Dr. Crozier realized that if he turned his head this way and that, he could find “portals” through the obstructions in his eye.

His sight returned in a few months, and his eye turned blue again.

Was it the antiviral drug? He cannot be sure, but he think so.

Dr. Varkey said, “I think the cure was Ian’s own immune system.” He said he suspected the treatments had reduced Dr. Crozier’s symptoms and helped preserve his sight long enough for his immune system to kick in and clear out the virus-just as supportive care during the worst phase of his initial illness had kept him alive until his natural defenses could take over.

Dr. Crozier believes information from his case may help prevent blindness in Ebola survivors in West Africa. In April, he headed to Liberia with Dr. Steven Yeh, an ophthalmologist, and several other Emory physicians to see patients who had recovered from Ebola and examine their eyes.

“Maybe we can change the natural history of the disease for survivors,” Dr. Crozier said. “I want to start that conversation.”

Taken from TODAY Saturday Edition, The New York Times International Weekly, May 23, 2015

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