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Ebola nurse Pauline Cafferkey nearly died from meningitis, doctors say Ebola nurse Pauline Cafferkey nearly died from meningitis, doctors say
(about 1 hour later)
British nurse Pauline Cafferkey, who contracted Ebola nine months ago in west Africa, came close to death from meningitis caused by the lingering virus, doctors have revealed.British nurse Pauline Cafferkey, who contracted Ebola nine months ago in west Africa, came close to death from meningitis caused by the lingering virus, doctors have revealed.
Dr Mike Jacobs, infectious diseases consultant at the Royal Free hospital in London, said she had not become reinfected with the virus since her recovery in January but it had persisted in the brain and had lead to the meningitis. Her condition has now significantly improved and she is well enough to chat to the nurses, use her iPad and sit up in bed and doctors are expecting her to make a slow but full recovery.
Dr Mike Jacobs, infectious diseases consultant at the Royal Free hospital in London, said she had not become reinfected with the virus since her recovery in January but it had persisted in the brain and had lead to viral meningitis.
“The virus re-emerged around the brain and around the spinal column to cause meningitis,” said Jacobs.“The virus re-emerged around the brain and around the spinal column to cause meningitis,” said Jacobs.
Jacobs also confirmed she had come close to death. “It is really important to understand the word critical. It means someone is at imminent risk of dying, we were all extremely concerned about Pauline’s condition a week ago,” he said.
He said she had made significant improvements and was now well enough to sit up in bed, but not yet to get up and walk around.
“She has a long road to full recovery,” he said at a press conference that was called with her consent.
“She developed some serious neurological complications,” he said describing the illness so long after the original infection as “unprecedented”.“She developed some serious neurological complications,” he said describing the illness so long after the original infection as “unprecedented”.
When asked how ill she had become, he explained: “It is really important to understand the word critical. It means someone is at imminent risk of dying, we were all extremely concerned about Pauline’s condition a week ago.
“We’re very hopeful that Pauline will slowly make a full recovery, that’s very much in our sights. Over time we anticipate that the virus will be completely eradicated.”
At a press conference that was called with Cafferkey’s consent, Jacobs added: “She has a long road to full recovery.”
Cafferkey, who contracted Ebola in December while volunteering in Sierra Leone, was readmitted to a specialist isolation unit at the Royal Free earlier this month after suffering unusual complications linked to the original infection. The nurse, who originally contracted Ebola in December while working in Sierra Leone, was treated with an experimental antiviral drug known as GS5734 being developed by the US drugmaker Gilead Sciences.
Related: British Ebola nurse readmitted to hospital in 'serious condition'Related: British Ebola nurse readmitted to hospital in 'serious condition'
But Jacobs said “she is much better now” after suffering neurological complications caused by the meningitis. He said she was still in bed inside the isolation unit but was talking to staff, using an iPad and even eating a little. But he cautioned: “I think she has a long recovery ahead of her.” Jacobs described Cafferkey’s readmission as unprecedented. “This is a situation we didn’t expect to face and is new to us.”
He revealed that she had tested positive for the Ebola virus when she went to hospital in Glasgow before her transfer to London. “It was a surprise for sure and I felt pretty devastated for Pauline. It seemed incredibly unlucky that this happened to someone who had volunteered to go and help in Sierra Leone and assist the humanitarian effort,” he said.
“She became unwell with meningitis caused by the Ebola virus. She had not been reinfected with Ebola,” he said. “It was inside the brain replicating at a very low level probably.” The Ebola virus is known persist in some sites in the body including the testes, the spinal cord and the eye chamber, after it has cleared the bloodstream, but scientists are only now beginning to find out more about how long it can survive and where, whether and when it might re-emerge.
Jacobs said she still has some of the neurological complications from the virus meaning that some of her nerves aren’t working. “As with all types of meningitis, it can affect the functioning of nerves,” he said. Jacobs revealed Cafferkey had been treated with an experimental drug, GS5734, which is being tested on humans. “We hope in time the virus will be completely eradicated,” he added. “It is an extraordinary evolving scientific story and we are clearly not at the end,” said Jacobs.
Cafferkey was admitted to the Royal Free two weeks ago. Her condition deteriorated and last Wednesday the hospital announced that she was critically ill. Cafferkey was flown to the hospital from her Glasgow home on 9 October after falling ill. Jacob told the Guardian that Cafferkey had presented herself initially with classic symptoms of meningitis which include fever and headaches.
A day before she was admitted, the 39-year-old was well enough to visit Mossneuk primary school in East Kilbride, where she gave a presentation to thank children for their fundraising efforts. There was no suggestion that she appeared unwell while she was there. “She had a test on her spinal fluid because it was quite clear that the syndrome was meningitis,” he said.
According to the BBC, relatives said when she first felt ill and saw her GP she described symptoms similar to those of meningitis. Because of her history, they then tested her blood and found “very low levels of the virus, the sort of levels you would see in patients that were about to recover”.
Every step that followed from that was precautionary.
“We didn’t know what the trajectory was – if the virus in the blood was heralding the fact that something was going to happen or was it just what we would call incidental because we have never seen anything like this before, we were not sure what was going to happen whether this was going to turn into full blown Ebola virus and let’s be absolutely clear about this, it did not,” said Jacobs.
Cafferkey, from South Lanarkshire, had complained of feeling unwell two weeks ago and was transferred from the Queen Elizabeth University Hospital in Glasgow to the Royal Free specialist isolation unit where she had been first treated for Ebola.
He said she had developed “serious neurological complications from meningitis” and some of her nerves had stopped working.
But he cautioned: “To be very clear about this, she hasn’t been re-infected with the Ebola virus,” said Jacobs.
“This is the original Ebola virus that she had many months ago, which has been lying inside the brain, replicating at a very low level probably, and has now re-emerged to cause this clinical illness of meningitis. And this is obviously a serious thing.”
“We’re very hopeful that Pauline will slowly make a full recovery,” he said, adding that he hoped Cafferkey’s own immune system would eventually fight off and eliminate the virus completely.
Her readmission and subsequent deterioration caused shock among medical experts because the latent virus has never known to trigger a life-threatening illness so long after the original infection.
Dan Bausch, who leads the World Health Organisation’s epidemic diseases team, said that meningitis had been caused in the acute stages of the virus but so far this has only happened in the initial infection.
Jacobs said she still has some of the neurological complications from the virus meaning that some of her nerves aren’t working. “As with all types of meningitis, it can affect the functioning of nerves,” he said.
Little is known about the long-term side effects of Ebola, but with 17,000 survivors it is imperative that research continues said Dan Bausch, who leads the World Health Organisation’s clinical management team for epidemic diseases.
Related: Ebola study finds women in Guinea who appear immune to the virusRelated: Ebola study finds women in Guinea who appear immune to the virus
Little is known about the long-term side effects of Ebola, but it is now known that the virus lingers on in areas the immune defence system cannot reach including the testicles, the central nervous system and eyes. There are an estimated 17,000 survivors in west Africa and it was vital that the world’s aid community did not withdraw and fail to recognise the serious side effects, medical and psychosocial, he said.
It is believed that the virus continues to leach out of these “immune privileged” sites but that the immune response to the first infection remains at a heightened level for at least a year and instantly kills off the remaining virus as it enters the blood stream. Jacobs said that the two other British health workers who had recovered from Ebola , nurses Will Pooley and Anna Cross had been contacted but only as precautionary. “We are past the acute stage of this epidemic and we are in range of getting to zero cases, we have to think about what happens next, there are a great many needs among survivors,” he said.
Dr Daniel Bausch, technical lead on the clinical management team for pandemic and epidemic diseases at the World Health Organisation, said: “She was being treated for complications after tests showed the infection was still present in her system.”
Cafferkey was first diagnosed with Ebola after spending four weeks working in Sierra Leone, mostly with Save the Children at its Ebola treatment centre outside the capital, Freetown. She began to feel ill when she arrived back at Heathrow airport on 28 December last year. At that point, Cafferkey informed staff from Public Health England, who were assessing returnees, but she was cleared to fly on to Glasgow.Cafferkey was first diagnosed with Ebola after spending four weeks working in Sierra Leone, mostly with Save the Children at its Ebola treatment centre outside the capital, Freetown. She began to feel ill when she arrived back at Heathrow airport on 28 December last year. At that point, Cafferkey informed staff from Public Health England, who were assessing returnees, but she was cleared to fly on to Glasgow.
The following day, she was admitted to the infectious diseases unit of Gartnavel general hospital in Glasgow and was transferred by RAF aircraft to the Royal Free on 30 December.The following day, she was admitted to the infectious diseases unit of Gartnavel general hospital in Glasgow and was transferred by RAF aircraft to the Royal Free on 30 December.
On 3 January, the hospital issued a statement saying Cafferkey was in a critical condition, but her immune system rallied with the help of intensive medical support. On 24 January she was discharged, saying she was “happy to be alive”.On 3 January, the hospital issued a statement saying Cafferkey was in a critical condition, but her immune system rallied with the help of intensive medical support. On 24 January she was discharged, saying she was “happy to be alive”.