存活患者通常会出现迁延性恢复,特征为乏力、体重下降和移行性关节痛。皮肤脱屑和暂时性脱发也经常发生。
恢复期的晚期表现不常见,但可能包括睾丸炎、脊髓炎、腮腺炎、胰腺炎、肝炎、精神疾病和听力损失/耳鸣。[17]Bwaka MA, Bonnet MJ, Calain P, et al. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. J Infect Dis. 1999 Feb;179 Suppl 1:S1-7.
https://jid.oxfordjournals.org/content/179/Supplement_1/S1.long
http://www.ncbi.nlm.nih.gov/pubmed/9988155?tool=bestpractice.com
幸存者也有患葡萄膜炎(前、后或全葡萄膜炎)的风险,这可能导致继发结构性并发症、视力障碍或失明。[192]Shantha JG, Yeh S, Nguyen QD. Ebola virus disease and the eye. Curr Opin Ophthalmol. 2016 Nov;27(6):538-44.
http://www.ncbi.nlm.nih.gov/pubmed/27585217?tool=bestpractice.com
一项非对照的回顾性横断面研究发现,约 28% 的存活者出现葡萄膜炎,3% 的存活者出现视神经病变。38.5% 的葡萄膜炎患者出现失明。[193]Shantha JG, Crozier I, Hayek BR, et al. Ophthalmic manifestations and causes of vision impairment in Ebola virus disease survivors in Monrovia, Liberia. Ophthalmology. 2017 Feb;124(2):170-7.
http://www.ncbi.nlm.nih.gov/pubmed/27914832?tool=bestpractice.com
一名存活者在感染发作后 14 周、病毒从血液中清除后 9 周时发生急性葡萄膜炎,并被检测到活病毒。[194]Varkey JB, Shanth JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med. 2015 Jun 18;372(25):2423-7.
http://www.ncbi.nlm.nih.gov/pubmed/25950269?tool=bestpractice.com
还报告了单眼白内障和解剖上沿视神经轴突分布的新型视网膜病变。[196]Steptoe PJ, Scott JT, Baxter JM, et al. Novel retinal lesion in Ebola survivors, Sierra Leone, 2016. Emerg Infect Dis. 2017 Jul;23(7):1102-9.
https://wwwnc.cdc.gov/eid/article/23/7/16-1608_article
http://www.ncbi.nlm.nih.gov/pubmed/28628441?tool=bestpractice.com
2015 年,一名外籍医护人员在严重的原发性埃博拉病毒病康复后 9 个月出现脑膜脑炎(CSF 和血浆的病毒 RT-PCR 检测呈阳性)。对其进行全基因组测序,以比较最初就诊时在其血液中发现的病毒与 10 个月时在 CSF 中发现的病毒,结果并未发现编码区改变。这项研究的作者总结道,他们并不能辨别病毒是处于潜伏和再激活状态,还是持续复制状态,但通过基因测序可确定未出现免疫逃逸的病毒变异株。[198]Jacobs M, Rodger A, Bell DJ, et al. Late Ebola virus relapse causing meningoencephalitis: a case report. Lancet. 2016 Jul 30;388(10043):498-503.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967715
http://www.ncbi.nlm.nih.gov/pubmed/27209148?tool=bestpractice.com
还报道了一例晚发性脑炎和多发性关节炎。[199]Howlett P, Brown C, Helderman T, et al. Ebola virus disease complicated by late-onset encephalitis and polyarthritis, Sierra Leone. Emerg Infect Dis. 2016 Jan;22(1):150-2.
https://wwwnc.cdc.gov/eid/article/22/1/15-1212_article
http://www.ncbi.nlm.nih.gov/pubmed/26690042?tool=bestpractice.com
这些表现的病因尚不明确,但可能与免疫复合物现象或病毒在免疫豁免部位的持续存在有关。