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Ebola nurse Pauline Cafferkey nearly died from meningitis, doctors say
Ebola nurse Pauline Cafferkey nearly died from meningitis, doctors say
(35 minutes 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.
Pauline Cafferkey, the British nurse who contracted Ebola nine months ago in west Africa, came close to death from meningitis caused by the lingering virus, doctors have revealed.
Her condition has significantly improved and she is well enough to chat to nurses, use her iPad and sit up in bed. Doctors are expecting her to make a slow but full recovery.
Her condition has significantly improved and she is well enough to chat to medics, use her iPad and sit up in bed. Doctors expect 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 led to viral meningitis.
Dr Mike Jacobs, an infectious diseases consultant at the Royal Free hospital in London, said Cafferkey had not become reinfected with the virus since her recovery in January but it had persisted in the brain, and this had led 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,” Jacobs said.. “She developed some serious neurological complications.”
“She developed some serious neurological complications,” he said describing the illness so long after the original infection as “unexpected”.
Asked how ill Cafferkey had become, Jacobs said: “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.”
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.
He added: “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. She has a long road to full recovery.”
“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.”
Cafferkey, from South Lanarkshire, contracted Ebola in December while working in Sierra Leone and was treated with an experimental antiviral drug known as GS5734, being developed by the US drugmaker Gilead Sciences.
At a press conference that was called with Cafferkey’s consent, Jacobs added: “She has a long road to full recovery.”
She 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.
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'
Jacobs described Cafferkey’s readmission as unexpected. “This is a situation we didn’t expect to face and is new to us,” he said.
Jacobs said Cafferkey’s readmission had been unexpected. “This is a situation we didn’t expect to face and is new to us. 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.”
“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.”
The Ebola virus is known to 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 where it can survive and for how long, and when it might re-emerge. “It is an extraordinary evolving scientific story and we are clearly not at the end,” Jacobs said.
The Ebola virus is known to 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 where it can survive and for how long and when it might re-emerge.
He said Cafferkey had presented herself initially with classic symptoms of meningitis, which include a fever and headaches. “She had a test on her spinal fluid because it was quite clear that the syndrome was meningitis,” he said.
“It is an extraordinary evolving scientific story and we are clearly not at the end,” said Jacobs.
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.
He added that Cafferkey had presented herself initially with classic symptoms of meningitis, which include a fever and headaches. “She had a test on her spinal fluid because it was quite clear that the syndrome was meningitis,” he said.
“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,” Jacobs said.
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”.
He said he hoped Cafferkey’s immune system would eventually fight off and eliminate the virus completely.
“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,” Jacobs said.
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. Jacobs 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. 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.”
He added 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. However, there may have been similar complications in survivors in west Africa that have gone undetected because of poor medical systems.
Bausch said the WHO still had 1,000 staff in west Africa and the emergency was not over, adding: “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.”
Jacobs, meanwhile, said Cafferkey still has some of the neurological complications from the virus, meaning that some of her nerves are not working. “As with all types of meningitis, it can affect the functioning of nerves,” he said.
Related: Ebola study finds women in Guinea who appear immune to the virus
Related: Ebola study finds women in Guinea who appear immune to the virus
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 latent Ebola virus has not previously been known to trigger a life-threatening illness so long after the original infection.
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.
Dan Bausch, who leads the World Health Organisation’s epidemic diseases team, said meningitis had been caused in the acute stages of the virus, but this had only happened in the initial infection. However, there may have been similar complications in survivors in west Africa that have gone undetected because of poor medical systems.
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”.
Bausch said the WHO still had 1,000 staff in west Africa and the emergency was not over. “We are past the acute stage of this epidemic and we are in range of getting to zero cases,” he said. “We have to think about what happens next, there are a great many needs among survivors.”
