Glasgow Ebola Nurse in isolation AGAIN 4th time

This is the Scottish nurse who flew despite being ill with a temperature and was diagnosed with Ebola 24 hrs after landing in Scotland. Now she keeps getting Ebola reactivation. This woman has had Ebola 3 times ( and has had a viral load high enough to be infectious each time), .....and now this could be her fourth round. She is in isolation again today which is better than last time when medical staff treating her without proper protection had to get vaccinated. Clearly though the virus can stay latent, perhaps she is immunocompromised and this is why it keeps coming back. She should have immunological memory to the virus now which should hold it in check.She has also got the Ebola vaccine last time. All very strange.



http://www.bbc.co.uk/news/uk-scotland-glasgow-west-37574256

A Scots nurse who was treated for Ebola is in a stable condition after being taken to hospital under police escort.
Pauline Cafferkey, 40, was admitted to Glasgow's Queen Elizabeth University Hospital after being taken from her home in South Lanarkshire at 09:30.
She is undergoing routine monitoring by the Infectious Diseases Team and remains in a stable condition.
Ms Cafferkey contracted Ebola while working as part of a UK team in Sierra Leone in 2014

A spokeswoman for NHS Greater Glasgow and Clyde said: "Ms Cafferkey was admitted to the Queen Elizabeth University Hospital under routine monitoring by the Infectious Diseases Team.
"She is undergoing further investigations and her condition remains stable."
Paramedics arrived at the nurse's flat in Halfway, Cambuslang, on Thursday morning.
Residents told the BBC that an ambulance, escorted by police cars left the flats on Lightburn Road, at about 09:30.
Police confirmed that officers had "assisted in the transfer of a patient" on Thursday morning.

Ms Cafferkey contracted Ebola while working as part of a UK team at the Kerry Town Ebola treatment centre in Sierra Leone.
She spent almost a month in isolation at the Royal Free hospital in London at the beginning of 2015 after the virus was detected when she arrived back in the UK.

Ms Cafferkey was later discharged after apparently making a full recovery, and in March 2015 returned to work as a public health nurse at Blantyre Health Centre in South Lanarkshire.

But it was later discovered that the virus was still present in her body, and she was readmitted to the same London hospital in October 2015.She again recovered, before being treated at the Royal Free for a third time in February of this year due to a further complication related to her initial Ebola infection. This morning is now her fourth admission to hospital.

I think she is suffering enough....the bigger concern is how is the virus inside her adapting and evolving and how will it impact the world!?!?!?!?

The latest news is that she tested negative.  http://www.bbc.com/news/uk-scotland-glasgow-west-37574256


There seems to be serious on-going health issues in people who had Ebola, but I have not heard anything (not really looked for it either) from West Africa about the on-going health issues.

Yes you are right this time she tested negative in serum but she is still in hospital for further investigation.    Last year the virus suddenly became detectable again in CSF and serum 9 months after she had been declared totally Ebola virus free.

For those interested in the science below is an abstract from science publication on what happened last year on her 2nd full blown Ebola illness. The further link to the full article is worth a read. It explains what actually happened, how they tried to give the ZMap for this second flare up, Pauline developed severe allergy to it. How with ZMap rendered useless they had to use an experimental drug only used on primates before.

Frighteningly not only did the virus reactivate from her CNS to cause meningitis, but it was potentially transmissible live viable virus she was walking about Glasgow with.   

They are working on the theory that this nurse had the highest ever viral load ever recorded at initial presentation. This high load may have caused virus to gain access to her CNS (hidden) to reemerge 9 months later.

It is unknown whether the virus lay dormant in the spinal fluid and reactivated, or if it had continually replicated slowly for 9 months. Genetic sequencing showed it was the same virus as the original Ebola and had not simply mutated to escape the immune system.   

Lastly it highlights all the neurological and other problems the nurse now has, including deafness in one ear, inability to use one leg properly, horrific pain in joints, and of course physiologically knowing she may always be a carrier ( there are a few immunoprivellage sites that are immunologically silent in the body, all potential hiding places for the virus)

Insert,:
Lancet. 2016 Jul 30;388(10043):498-503. doi: 10.1016/S0140-6736(16)30386-5. Epub 2016 May 18.

Late Ebola virus relapse causing meningoencephalitis: a case report.
Jacobs M1, Rodger A2, Bell DJ3, Bhagani S4, Cropley I4, Filipe A5, Gifford RJ5, Hopkins S4, Hughes J5, Jabeen F6, Johannessen I7, Karageorgopoulos D4, Lackenby A8, Lester R4, Liu RS9, MacConnachie A3, Mahungu T4, Martin D10, Marshall N11, Mepham S4, Orton R5, Palmarini M5, Patel M12, Perry C3, Peters SE3, Porter D3, Ritchie D3, Ritchie ND3, Seaton RA3, Sreenu VB5, Templeton K7, Warren S4, Wilkie GS5, Zambon M8, Gopal R12, Thomson EC13.


Abstract

BACKGROUND:
There are thousands of survivors of the 2014 Ebola outbreak in west Africa. Ebola virus can persist in survivors for months in immune-privileged sites; however, viral relapse causing life-threatening and potentially transmissible disease has not been described. We report a case of late relapse in a patient who had been treated for severe Ebola virus disease with high viral load (peak cycle threshold value 13.2).

METHODS:
A 39-year-old female nurse from Scotland, who had assisted the humanitarian effort in Sierra Leone, had received intensive supportive treatment and experimental antiviral therapies, and had been discharged with undetectable Ebola virus RNA in peripheral blood. The patient was readmitted to hospital 9 months after discharge with symptoms of acute meningitis, and was found to have Ebola virus in cerebrospinal fluid (CSF). She was treated with supportive therapy and experimental antiviral drug GS-5734 (Gilead Sciences, San Francisco, Foster City, CA, USA). We monitored Ebola virus RNA in CSF and plasma, and sequenced the viral genome using an unbiased metagenomic approach.

FINDINGS:
On admission, reverse transcriptase PCR identified Ebola virus RNA at a higher level in CSF (cycle threshold value 23.7) than plasma (31.3); infectious virus was only recovered from CSF. The patient developed progressive meningoencephalitis with cranial neuropathies and radiculopathy. Clinical recovery was associated with addition of high-dose corticosteroids during GS-5734 treatment. CSF Ebola virus RNA slowly declined and was undetectable following 14 days of treatment with GS-5734. Sequencing of plasma and CSF viral genome revealed only two non-coding changes compared with the original infecting virus.

INTERPRETATION:
Our report shows that previously unanticipated, late, severe relapses of Ebola virus can occur, in this case in the CNS. This finding fundamentally redefines what is known about the natural history of Ebola virus infection. Vigilance should be maintained in the thousands of Ebola survivors for cases of relapsed infection. The potential for these cases to initiate new transmission chains is a serious public health concern.

Full version

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967715/