Physician Ebola Survivor Describes Lasting Effects

Marcia Frellick

October 08, 2015

SAN DIEGO — "It's a great pleasure to be here this evening. It's a great pleasure to be anywhere this evening," Ebola survivor Ian Crozier, MD, said here at the opening night of IDWeek 2015, to hearty applause.

Dr Crozier was working in a Sierra Leone clinic through the World Health Organization last year when he contracted the virus.

He told the crowd about the September day in 2014 when he was isolated in his hotel room with fever, headache, and intense fatigue. He drew his own blood and a few hours later, a polymerase chain reaction (PCR) test showed that he had Ebola. After difficult conversations with family and colleagues, he began preparations for evacuation to Emory University Hospital in Atlanta.

He has been called potentially the sickest Ebola survivor ever with multisystem organ failure, but was discharged after 6 weeks in the hospital. He is now one of the nine American survivors of Ebola.

He recently returned to West Africa to fight the persistent effects of recent outbreaks.

Dr Crozier was born in Zimbabwe and has dual American and Zimbabwean citizenship. It's one of many dichotomies he talked about, along with being both Ebola patient and Ebola doctor.

Lingering Effects

Dr Ian Crozier (Source: Susan Urmy/Vanderbilt University)

There is a paucity of global data to document common residual effects of Ebola infection, said Dr Crozier, whose case is being followed by the medical community.

He still experiences lingering effects of the disease, including sacroiliac back pain, inflammation in his palms and soles, and pain and stiffness that is particularly noticeable the morning after a day of inactivity.

Two to 3 weeks after discharge, the hearing in his left ear suddenly decreased, and he later developed a constant high-pitched tinnitus, which he expects will last a long time. Months later, he experienced a tonic–clonic seizure and is currently acclimating to antiepileptic treatment.

Last November, he began to experience mild ocular burning and a slight reduction in near vision in both eyes.

"And then it all changed," he said. On December 11, he developed left eye pain, headache, nausea, blurred vision, and prominent halos. His symptoms worsened, and a needle test showed that the Ebola virus was lurking in a pocket of his eye.

"A quantitative PCR showed levels of the virus in the billions of copies/mL. In fact, the virus was teeming in the anterior chamber of my eye 100 days after the onset of illness," he reported. "There were more copies of the Ebola virus in my eye than there had been at the peak of my acute infection."

Questions arose from this incident: Was this a novel finding? Has the Ebola virus ever before been found in a "sanctuary site," such as the anterior chamber, and how it could hijack that space?

Dr Ian Crozier (Source: Emory Eye Center)

Eventually his once-blue eye turned green. His vision has improved, he reported, although it is not back to baseline. Literature will be coming soon detailing the ocular effects, but pending another eye tap, "every clinical observation would indicate that the virus has been cleared."

It is important to figure out how the virus operates. "There's an immediate need to develop diagnostic treatments and protocols," Dr Crozier said. "This is the urgency within the emergency."

"A Superhero in Medicine"

The extended standing ovation that followed the talk is quite unusual, said James Hughes, MD, from Emory University, who is the Infectious Diseases Society of America conference chair.

"I believe Dr Crozier received a well-deserved one because of his willingness to share the details of his catastrophic acute illness and its sequelae, his empathy for affected patients, colleagues, and their communities, and his courage and commitment to continue to work to address the epidemic and its implications for the global community," Dr Hughes told Medscape Medical News.

"You have to love the man for what he has done," said John Bartlett, MD, professor emeritus from Johns Hopkins University School of Medicine in Baltimore.

"He is a superhero in medicine because he really has a commitment to take care of people who have desperate needs in areas of the world where most of us would feel uncomfortable," Dr Bartlett told Medscape Medical News.

On a personal level, Dr Bartlett said he has nothing but admiration for Dr Crozier and his contribution to science.

The fact that a virus or antigen could exist in a protected environment such as a chamber of the eye brings a new concept to the field of infectious disease. "That's a wow," he said.

The West African Ebola outbreak is a reminder of the constant possibility of a major disease outbreak and the need for higher levels of preparedness, he added.

"We didn't take it seriously when it was discovered in Zaire in 1976," Dr Bartlett said. "There will be another Ebola at some point, with different stripes."

Dr Crozier, Dr Hughes, and Dr Bartlett have no financial disclosures.

IDWeek 2015. Presented October 7, 2015.

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