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An analysis of Ebola survivors in Sierra Leone revealed that patients with post-Ebola syndrome experience clusters of symptoms that occur together, including some with a seemingly rheumatologic pattern of disease, researchers reported.“Ebola survivors have a broad array of symptoms that fall into distinct patterns. One of these patterns resembles rheumatologic disease and may be related to gut dysfunction,” Sarah Talia Himmelfarb, MD, a resident in internal medicine and pediatrics at Tulane University School of Medicine, explained to Healio. Research has shown that Ebola survivors may face long-term health effects from the illness. “To date,” Himmelfarb said, “several studies have been performed to determine if specific markers of inflammation are associated with post-Ebola syndrome. No marker has been identified when looking at survivors as a homogeneous group.” To identify patterns within the variety of symptoms experienced by Ebola survivors, Himmelfarb and colleagues identified survivors in Eastern Sierra Leone through the Sierra Leone Association of Ebola Survivors and household contacts of survivors and recruited them for a study. Himmelfarb presented findings from the study at IDWeek. Participants from both groups received a questionnaire regarding self-reported symptoms and underwent a physical exam. The researchers compared symptoms between the groups and analyzed correlations between clusters.
“Our motivation in doing this was to see if any patterns fit known disease processes,” Himmelfarb said. “In particular, we wanted to investigate the possibility that they fit the pattern of a rheumatologic or autoimmune disease. This would help us better understand this poorly characterized syndrome and might help lead to therapies for those who suffer from it.” Between March 2016 and January 2019, 375 Ebola survivors and 1,040 contacts were enrolled in the study. According to Himmelfarb and colleagues, at the time of enrollment, Ebola survivors across all age groups reported significantly more symptoms than contacts in all categories. The researchers identified six symptom clusters “representing distinct organ systems” and two general phenotypes with or without rheumatologic symptoms. According to the study, clusters including rheumatologic symptoms were correlated with one another (r = 0.63) but not with other clusters (r < 0.35). Additionally, ophthalmologic/auditory symptoms were moderately correlated with the nonrheumatologic clusters (r > 0.5), whereas psychologic/neurologic, cardiac/gastrointestinal and constitutional clusters correlated with one another (r >0.6) in all cases.
After mapping the symptom clusters, the researchers determined that each symptom cluster was separated from the rest, particularly the phenotypes with rheumatologic symptoms. The group of survivors with the seemingly rheumatologic pattern of disease complained of symptoms that included joint pain and decreased range of motion, Himmelfarb said. This group overlapped with a group with gastroenterological symptoms, such as abdominal tenderness. “An intriguing possibility is that inflammation stemming from impaired gut barrier, as was detected in a previous study, may be an etiologic cause of this group of symptoms,” Himmelfarb said. “This work has significance for the thousands of Ebola survivors who emerged from the 2014-2016 epidemic in Western Africa. It also contributes a small but growing body of knowledge of post-viral sequelae. This field has only become more relevant in the age of COVID-19.”
