Billioux Bridgette Jeanne, Smith Bryan, Nath Avindra
Section of Infections of the Nervous System, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD, USA.
Neurotherapeutics. 2016 Jul;13(3):461-70. doi: 10.1007/s13311-016-0457-z.
Ebola virus disease is one of the deadliest pathogens known to man, with a mortality rate between 25-90% depending on the species and outbreak of Ebola. Typically, it presents with fever, headache, voluminous vomiting and diarrhea, and can progress to a hemorrhagic illness; neurologic symptoms, including meningoencephalitis, seizures, and coma, can also occur. Recently, an outbreak occurred in West Africa, affecting > 28,000 people, and killing > 11,000. Owing to the magnitude of this outbreak, and the large number (>17,000) of Ebola survivors, the medical and scientific communities are learning much more about the acute manifestations and sequelae of Ebola. A number of neurologic complications can occur after Ebola, such as seizures, memory loss, headaches, cranial nerve abnormalities, and tremor. Ebola may also persist in some immunologically privileged sites, including the central nervous system, and can rarely lead to relapse in disease. Owing to these findings, it is important that survivors are evaluated and monitored for neurologic symptoms. Much is unknown about this disease, and treatment remains largely supportive; however, with ongoing clinical and basic science, the mechanisms of how Ebola affects the central nervous system and how it persists after acute disease will hopefully become more clear, and better treatments and clinical practices for Ebola patients will be developed.
埃博拉病毒病是人类已知的最致命病原体之一,其死亡率在25%至90%之间,具体取决于埃博拉病毒的种类和疫情情况。通常,它表现为发热、头痛、大量呕吐和腹泻,并可能发展为出血性疾病;还可能出现神经症状,包括脑膜脑炎、癫痫发作和昏迷。最近,西非爆发了疫情,感染人数超过28000人,死亡人数超过11000人。由于此次疫情的规模以及大量(超过17000名)埃博拉幸存者,医学和科学界对埃博拉的急性表现和后遗症有了更多了解。埃博拉康复后可能会出现一些神经并发症,如癫痫发作、记忆丧失、头痛、颅神经异常和震颤。埃博拉病毒也可能在一些免疫特权部位持续存在,包括中枢神经系统,并且很少会导致疾病复发。基于这些发现,对幸存者进行神经症状评估和监测非常重要。关于这种疾病仍有很多未知之处,治疗在很大程度上仍以支持性治疗为主;然而,随着临床和基础科学的不断发展,埃博拉病毒如何影响中枢神经系统以及急性疾病后如何持续存在的机制有望变得更加清晰,并且将开发出针对埃博拉患者的更好治疗方法和临床实践。