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United Kingdom - Scottish nurse treated for Ebola 'complication' - full recovery from Ebola , discharged

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  • #16
    I am not sure what is going on. Is this a case of a relapse, or a complication from the initial disease phase?
    "May the long time sun
    Shine upon you,
    All love surround you,
    And the pure light within you
    Guide your way on."

    "Where your talents and the needs of the world cross, lies your calling."
    Aristotle

    “In a gentle way, you can shake the world.”
    Mohandas Gandhi

    Be the light that is within.

    Comment


    • #17
      I'm not sure either, and neither is CIDRAP:

      http://www.cidrap.umn.edu/news-persp...ses-ebola-case

      [snip]

      Post-Ebola complications that recently hospitalized a Scottish nurse who had initially recovered from her infection in January include a severe central nervous system (CNS) disorder, and her spinal fluid has tested positive for the virus, an official said.

      Scottish health officials said last week that Pauline Cafferkey, sickened by Ebola last December while working in Sierra Leone, was hospitalized and is critical condition after suffering an unusual late complication from the disease. Developments such as the tracing of her contacts, vaccination of those though to have had contact with her body fluids, her treatment in a high-containment unit, and her deteriorating condition, however, have raised concerns about whether her illness involved a full-blown Ebola relapse.

      The closely watched case has infection control implications and promises to shed more light on the clinical spectrum of complications in survivors.

      Comment


      • #18
        My understanding is that this is now a full blown relapse. Until an official statement is made however, nothing can be confirmed.

        Comment


        • #19
          UK | Fri Oct 16, 2015 2:54pm BST Related: UK

          UK Ebola 'relapse' case takes virus specialists to uncharted waters

          LONDON, | BY KATE KELLAND AND HEALTH AND SCIENCE CORRESPONDENT
          ...
          The Scottish nurse's critically ill situation, described as "staggering" by one British virologist, signals just how complex and formidable a foe the Ebola virus may turn out to be now that scientists have the chance to study its survivors.

          Previous studies and preliminary data from research in survivors of the vast West African outbreak have detected Ebola virus in semen, breast milk, vaginal secretions, spinal fluid and fluids around the eyes.

          But scientific literature has never documented an Ebola relapse case before, meaning Cafferkey's is likely to generate great fear and anxiety for the 17,000 or so other Ebola survivors across West Africa.

          "This is totally unprecedented. We've never seen this, and there's so much uncertainty," said Jeremy Farrar, a specialist in infectious diseases and director of the Wellcome Trust.
          ...
          Doctors at the London Royal Free hospital where Cafferkey is in a high level isolation unit say she is "critically ill" and is being "treated for Ebola".
          ...
          "Even if you don't have the virus in your bloodstream it can be hiding out," said Messaoudi. "And we need to be aware of that because it's setting up the stage for potentially new outbreaks."

          For now, she said, the key message amid all the unknowns is "it's not over when we think it's over."
          ...

          http://uk.reuters.com/article/2015/1...0S91ZZ20151016
          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

          Comment


          • #20
            I am in Glasgow. Anyone interested can read my previous posts last year when ironically I highlighted the inherent dangers to NHS lab staff when treating possible EBOV samples. It saddens me therefore to read the following article, and I know some of the staff involved, but that's not relevant.


            LABORATORY staff at a Glasgow hospital have been told not to leave the country.

            http://m.eveningtimes.co.uk/news/138...r_Ebola_fears/


            As the article says, The staff in the Queen Elizabeth University Hospital in Glasgow ( locally known as the death star), say they were not made aware that samples may contain Ebola. It is alleged that CSF fluid, Blood, Urine,Faecal, Throat Swabs, etc all went by a common tube system to the labs. Many of the processing was done by hand, and not assigned to senior experienced staff ( as would have happened if EBOV was suspected). The staff said patient details contained name, symptoms, the usual, but no mention anywhere on paperwork for the labs of previous Ebola infection.

            The staff have
            asked for an explanation for this. They have been told that the possibility was raised via a medic dealing with Miss Caferkey, the virology consultants initially dismissed the idea. As experts had not deemed Pauline a status of a " probable Ebola case," there was no need to mention the disease on the patient details on the lab work. It is all in the article.

            The conclusion the virologists reached was we believe based on data gathered from the West Africa outbreak, and as we have seen many of the links posted in this thread state Pauline Cafferkey is a rare case, one article saying it has left the experts "staggered".

            My question is how do the specialists know Pauline's case is rare, what are they basing this information on. In all experimental systems "like " must be compared with " like" and any variables between systems must be considered.

            How then can they possibly compare the mechanisms involved in Pauline's initial recovery to all those who survived the virus naturally in West Africa. The only similarity I can see is that they all survived, but Pauline's unlike theirs was an artificially induced survival.

            She did not erradicate the virus herself, the Zmap antibodies and donated plasma rich in ant-EBOV antibodies would have literally hoovered the virus out of her body. This was perhaps aided by the various antivirals that they gave. This situation is so far removed from natural recovery from Ebola, where initial strong innate immune responses develop into specific high affinity antibody responses, and lastly generate the all important immunological memory in order to rapidly deal with any future exposure, or reactivation.

            Paulines recovery did not follow such a natural physiological process. For all we know Pauline's immune system may have never made a good enough response, perhaps she didn't generate good memory, and so later when virus gets reactivated in immunoprivilaged sites such as CNS, the immune response isn
            t primed ready and waiting to tackle it when it reappears in the systemic system.

            The survivors in West Africa fought the virus and their immune systems won. Pauline was kept from dying by donated antibodies and antivirals, there is a big difference in the end product, and the immunological imprint left. So how can the long term outcome for survivors in West Africa automatically be applied to what Pauline should experience.

            Reactivation of virus in Pauline therefore may not be rare because we have nothing to compare it to.

            What I find staggering is not Pauline's condition, but the so called experts comparing apples to lemons. If these experts remembered their simple rules of experimental design from their PhD days, they would have perhaps entertained the notion that Pauline may have had Ebola again and not put these medical staff on a 21 day hell marathon, nor have them in a situation where they feel they have to have an experimental vaccine, nor have delayed Pauline's return to London and the treatment she needed.


            Foxp3.



            Comment


            • #21
              Excellent points, foxp3. I agree 100%. In the future, I think virology and immunology will become more integrated, but for now they are not. I did read about some of the world's top virologists opening up to considering host factors at a conference recently, so fingers crossed this progresses.
              “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

              Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

              Comment


              • #22
                My first post here but I am refugee from the old FluWiki site.

                I'm very disappointed (not to say surprised) that her extraordinary medical history was not flagged up when she presented unwell at an OOH primary care centre. And that she visited a school shortly before being admitted 2 days later.

                I have also been wondering about the plasma/antiviral treatment and whether her immunity was different to an untreated survivor. Could it be possible that Will Pooley's infection was with a mutated strain that was less virulent (as I understand he did not become very unwell)?

                Comment


                • #23
                  Welcome to flutrackers, Ruby! I think one of the concerns about experimental immune treatments was that they could make things worse, but another factor here could be age or individual immune genetics. I think Pooley was about 10 years younger than Ms. Caferkey. I think both she and the doctor who later had an eye complication both wondered if their age set them up for worse infections, since the nurses who recovered much more easily were younger. Age was considered a possible risk factor in other ebola outbreaks.
                  “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

                  Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

                  Comment


                  • #24
                    How Pauline Cafferkey's Ebola relapse tears up everything doctors thought they knew
                    ...
                    Sarah Boseley Health editor
                    Friday 16 October 2015 12.05 EDT Last modified on Friday 16 October 2015 17.25 EDT
                    ...
                    The UK has a world-class health service. Cafferkey’s family were angry that the possibility that her symptoms were linked to Ebola was not immediately picked up, but even though she did not have the usual fever and vomiting, within days the virus had been identified once more and she had been flown to specialised care.

                    But a resurgence of illness that did not look like classic Ebola in survivors in countries with fragile or collapsed health systems, such as Sierra Leone, Liberia and Guinea or – for that matter – DRC or Uganda, which have had outbreaks in the past, would not have been recognised. It is entirely possible that people have died from Ebola complications unnoticed, months after their initial recovery, and more could still die.
                    ...
                    Earlier this year there was another clue, this time from studies of macaque monkeys, that the virus might re-emerge from one of its hiding places and wreak more damage.

                    “On two occasions two of the animals appeared to have recovered from the virus and then they had a relapse which involved the brain. It was really debilitating for them,” said Ball. “It probably would have been a life-threatening illness but because it was an animal they put them to sleep – that’s what the protocol states.

                    “And when they looked at those animals, basically looking for any changes in the body, they didn’t see any changes in the organs that you’d associate with Ebola virus. The spleen and the liver and things like that were all fine, there were no traces of Ebola, but the brain was very heavily involved, as was the eye.

                    When Cafferkey fell ill last week, it did not look like Ebola. “We’ve been reassured and there’s absolutely no reason to doubt it – that she wasn’t presenting with symptoms that would pose a risk to other people,” said Ball. “She wasn’t presenting with classic Ebola symptoms.”
                    ...

                    http://www.theguardian.com/world/201...ught-they-knew
                    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                    -Nelson Mandela

                    Comment


                    • #25
                      Earlier this year there was another clue, this time from studies of macaque monkeys, that the virus might re-emerge from one of its hiding places and wreak more damage.

                      “On two occasions two of the animals appeared to have recovered from the virus and then they had a relapse which involved the brain. It was really debilitating for them,” said Ball. “It probably would have been a life-threatening illness but because it was an animal they put them to sleep – that’s what the protocol states.
                      There were clues much earlier than those studies.

                      http://jid.oxfordjournals.org/conten...nt_2/S323.full
                      Viral Pathogenesis - Supplement Articles:
                      • Thomas Larsen,
                      • Edward L. Stevens,
                      • Kelly J. Davis,
                      • Joan B. Geisbert,
                      • Kathleen M. Daddario-DiCaprio,
                      • Peter B. Jahrling,
                      • Lisa E. Hensley,
                      • and Thomas W. Geisbert
                      Pathologic Findings Associated with Delayed Death in Nonhuman Primates Experimentally Infected with Zaire Ebola Virus J Infect Dis. (2007) 196 (Supplement 2): S323-S328 doi:10.1086/520589

                      Interestingly, rhesus macaques that have died from untreated EHF typically do not show detectable lesions or evidence of viral replication in the parenchymal tissue of the brain, eye, lung, pancreas, or thyroid [3, 4]. However, we report here our findings of viral infection and tissue injury in these organs in macaques that have had death significantly delayed as a result of various experimental therapies....
                      ...

                      Notable discrepancies in pathologic findings between historical control animals and the treated animals experiencing delayed death were observed in several tissues. In historical control animals infected with ZEBOV, brain, endocrine pancreas, thyroid, eye, and pulmonary parenchyma are typically devoid of viral antigens or pathology. In contrast, the subject animals in this study exhibited lesions and/or viral antigens in many of these tissues. In addition, some animals experiencing delayed death also had diminished or no evidence of disease or viral antigens in major target tissues, compared with that in control animals.
                      ....
                      That was presented in 2006 - so why the surprise now?

                      The data presented here demonstrate an interesting phenomenon of altered tissue tropism in ZEBOV-challenged macaques that survive beyond the normal course of disease. It is not clear why ZEBOV replicated so effectively in tissues that were not usually affected. In the 6 animals in this study, exposure to a variety of host mediators during the course of the prolonged illness may have changed the phenotype of some cells, making them more susceptible to ZEBOV. Alternatively, it is possible that ZEBOV can replicate in these cells and tissues but that replication and spread occurs more slowly than in more-preferred cells and tissues; thus, an increase in the duration of the disease course gives the virus time to gain a foothold in these secondary target organs.
                      These were the experimental treatments studied:

                      These therapies included (1) recombinant nematode anticoagulant protein c2, a drug that blocks the factor VIIa/tissue factor pathway of blood coagulation [5]; (2) recombinant human activated protein C, which is licensed for the treatment of cases of severe sepsis in humans at high risk of death [6]; (3) human monoclonal antibody KZ52, which is reactive with ZEBOV glycoprotein [7]; and (4) recombinant human interferon-β1a (Serono).
                      The result was a slower death from treatment with different tissues infected.

                      How the leap to optimism for ZMapp happened is a mystery to me. Maybe someone can point to the research on that.

                      http://www.pnas.org/content/111/48/17182.full

                      ETA:
                      I have found the primate study with good success with ZMapp. For now I am NOT aware of ZMapp survivors with complications.
                      Last edited by Emily; October 21st, 2015, 07:20 PM. Reason: Added ETA
                      “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

                      Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

                      Comment


                      • #26
                        I look at what happened to Dr. Crozier's eye as a result of Ebola virus replication there long after it was cleared from the rest of his body and I imagine that if the same thing happened if this patient's spinal cord or the meninges of her brain, it might present like this and be life-threatening.

                        That's what it looks like is going on, at least to me.

                        Comment


                        • #27
                          Welcome Ruby!
                          "May the long time sun
                          Shine upon you,
                          All love surround you,
                          And the pure light within you
                          Guide your way on."

                          "Where your talents and the needs of the world cross, lies your calling."
                          Aristotle

                          “In a gentle way, you can shake the world.”
                          Mohandas Gandhi

                          Be the light that is within.

                          Comment


                          • #28
                            http://www.nytimes.com/2015/10/15/wo...-ill.html?_r=0
                            Ebola Survivor From Scotland Is Critically Ill

                            By SHERI FINKOCT. 14, 2015
                            ...


                            While virus was not found in Dr. Crozier’s blood or cerebrospinal fluid, a scan of his brain indicated that he had suffered from encephalitis, Dr. Bausch said. In West Africa, patients as ill as Dr. Crozier or Ms. Cafferkey might not have survived “to experience these later manifestations,” he surmised.
                            One possibility is that late complications could be an unanticipated consequence of experimental treatments that include antibodies, like ZMapp, that help remove the virus from the patient’s blood, but are not thought to be capable of crossing from the bloodstream into the brain.
                            By decreasing the amount of virus in the blood, “you perhaps blunt the immune system,” Dr. Bausch said. “It’s all speculation, but it’s scientifically sound speculation.”
                            “‘i love myself.’ the quietest. simplest. most powerful. revolution ever.” ---- nayyirah waheed

                            Avatar: Franz Marc, Liegender Hund im Schnee 1911 (My posts are not intended as advice or professional assessments of any kind.)

                            Comment


                            • #29
                              So It Turns Out There's A Lot We Don't Know About Ebola

                              OCTOBER 17, 2015 7:03 AM ET

                              ...
                              "It's an explosive virus. It replicates like crazy ... and it destroys everything in its path," says Messaoudi, a viral immunologist and professor of biomedical sciences at the University of California, Riverside, who is studying how the virus works in the human body. "So, how is it just hanging out in the testes for like nine months?"
                              ...
                              "The immune system is a little heavy-handed at times," she says. Inflammation caused by the immune system's activity could cause serious damage in places like the eyes, brain, placenta, fetus, testes, joint spaces and central nervous system. Messaoudi likens members of the immune system to the Navy SEALs. "They are trained killers," she says, "so if you drop them in the wrong place and they misread their orders, it could lead to really big damage."

                              So, for the most part, the immune system stays away from those sites, making them great spots for viruses to hide out. (That's what other viruses do, like hepatitis B, and herpes viruses, including chicken pox, which hides in neurons for years and has the potential to re-emerge as shingles.)

                              But those viruses are different from Ebola, says Messaoudi. "Acute viruses like influenza, Ebola, yellow fever, West Nile [virus] — they infect, they replicate, and they're cleared. That's just how we've always thought of them. I've never heard of a yellow fever reservoir or a West Nile reservoir. Maybe they exist, and we just don't know about it."

                              Messaoudi says one of the most confusing things about the Ebola virus is its size. It's a "no-frills virus" with a tiny genome, she says. Viruses that can hide in immune-privileged places and live for years usually have a lot more genes that allow them to quietly survive.

                              But Ebola is managing to scrape by in some corners of survivors' bodies, and those places are, by nature, hard to get to. "It presents a huge challenge, because how do we get enough antivirals into these sites?" says Messaoudi. Getting to fluid in the spine requires a spinal tap. Patients with the virus inside their eye might need a fine needle to go straight into the space between the iris and the cornea. "So how do we eradicate those reservoirs?" she asks. "And why do some people end up developing these reservoirs and other people don't?"
                              ...

                              http://www.npr.org/sections/goatsand...ow-about-ebola
                              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                              -Nelson Mandela

                              Comment


                              • #30
                                Update on Pauline Cafferkey

                                19 October 2015
                                Updated: 3pm

                                We are able to announce that Pauline Cafferkey’s condition has improved to serious but stable.

                                https://www.royalfree.nhs.uk/news-me...ine-cafferkey/
                                "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                                -Nelson Mandela

                                Comment

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