Tulane University, New Orleans, Louisiana, USA.
Kenema Government Hospital, Kenema, Sierra Leone.
Clin Infect Dis. 2021 Sep 15;73(6):1046-1054. doi: 10.1093/cid/ciab267.
Following the 2013-2016 West African Ebola outbreak, distinct, persistent health complaints were recognized in Ebola virus disease (EVD) survivors. Here we provide an in-depth characterization of post-Ebola syndrome >2.5 years after resolution of disease. Additionally, we report subphenotypes of post-Ebola syndrome with overlapping symptom clusters in survivors from Eastern Sierra Leone.
Participants in Eastern Sierra Leone were identified by the Sierra Leone Association of Ebola survivors. Survivors and their contacts were administered a questionnaire assessing self-reported symptoms and a physical examination. Comparisons between survivors and contacts were conducted using conditional logistic regression. Symptom groupings were identified using hierarchical clustering approaches. Simplified presentation of incredibly complex evaluations (SPICE), correlation analysis, logistic regression, and principal component analysis (PCA) were performed to explore the relationships between symptom clusters.
Three hundred seventy-five EVD survivors and 1040 contacts were enrolled into the study. At enrollment, EVD survivors reported significantly more symptoms than their contacts in all categories (P < .001). Symptom clusters representing distinct organ systems were identified. Correlation and logistic regression analysis identified relationships between symptom clusters, including stronger relationships between clusters including musculoskeletal symptoms (r = 0.63, P < .001; and P < .001 for correlation and logistic regression, respectively). SPICE and PCA further highlighted subphenotypes with or without musculoskeletal symptoms.
This study presents an in-depth characterization of post-Ebola syndrome in Sierra Leonean survivors >2.5 years after disease. The interrelationship between symptom clusters indicates that post-Ebola syndrome is a heterogeneous disease. The distinct musculoskeletal and non-musculoskeletal phenotypes identified likely require targeted therapies to optimize long-term treatment for EVD survivors.
2013-2016 年西非埃博拉疫情后，埃博拉病毒病（EVD）幸存者出现了明显且持续的健康问题。在此，我们深入描述了疾病痊愈后 2.5 年以上的埃博拉后综合征。此外，我们报告了来自塞拉利昂东部的幸存者中具有重叠症状群的埃博拉后综合征亚表型。
通过塞拉利昂埃博拉幸存者协会，在塞拉利昂东部识别出参与者。对幸存者及其接触者进行问卷调查，评估自我报告的症状和体格检查。使用条件逻辑回归比较幸存者和接触者。使用层次聚类方法识别症状分组。简化呈现难以置信的复杂评估（SPICE）、相关分析、逻辑回归和主成分分析（PCA）用于探索症状群之间的关系。
共纳入 375 名 EVD 幸存者和 1040 名接触者。在入组时，EVD 幸存者在所有类别中报告的症状明显多于接触者（P<0.001）。确定了代表不同器官系统的症状群。相关和逻辑回归分析确定了症状群之间的关系，包括肌肉骨骼症状的相关性更强（r=0.63，P<0.001；相关性和逻辑回归分别为 P<0.001）。SPICE 和 PCA 进一步突出了有或没有肌肉骨骼症状的亚表型。
本研究深入描述了塞拉利昂幸存者在疾病痊愈后 2.5 年以上的埃博拉后综合征。症状群之间的相互关系表明埃博拉后综合征是一种异质性疾病。确定的独特肌肉骨骼和非肌肉骨骼表型可能需要靶向治疗，以优化 EVD 幸存者的长期治疗。
