1318 • CID 2018:66 (15 April) • CORRESPONDENCE resistance gene acquisition as the result of FMT is an important consideration in using FMT therapy. Tis risk should be balanced against the potential bene- fts of the FMT procedure for preventing recurrent CDI and for multidrug-resist- ant organism (MDRO) decolonization. Tird, it is interesting to note that deple- tion of clinically meaningful resistance genes occurred in almost all recipients, despite the inclusion of 8 unique donors. However, the degree of gene depletion var- ied by donor–recipient pair. For example, pairs 5 and 8 experienced the loss of many more resistance genes than the other pairs. Currently, the clinical evidence for FMT MDRO decolonization efcacy is still very limited, and there may be signifcant dif- ferences in efcacy by unrecognized host factors and by the bacterial species being targeted (eg, extended spectrum β-lacta- mase–producing Escherichia coli vs van- comycin-resistant enterococci). More intervention studies of FMT are needed to determine MDRO decolonization efect- iveness, safety, durability, and mechanism of action in a wider spectrum of potential recipients. Note Potential conflicts of interest. A. R. M. has received research funding from a 2011 Pfizer Aspire Antibacterial Research Award. M. M. has been an employee of bioMérieux since October 2012. C. V. received a student- ship from the Research Institute of the McGill University Health Centre, as well as a Frederick Banting and Charles Best Canada Graduate Scholarship (Doctoral Award) from the Canadian Institutes of Health Research (GSD- 113375). C. V. also has been an employee of Roche Diagnostics since 2016. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Victor Leung, 1 Caroline Vincent, 2 Thaddeus J. Edens, 3 Mark A. Miller, 4 and Amee R. Manges 5,6 1 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, 2 Department of Microbiology and Immunology, McGill University, Montreal, Quebec, 3 Devil’s Staircase Consulting, West Vancouver, British Columbia, 4 Division of Infectious Diseases, McGill University, Montreal, Quebec, 5 School of Population and Public Health, and 6 British Columbia Centre for Disease Control, University of British Columbia, Vancouver, Canada References 1. Leung V, Vincent C, Edens T, Miller M, Manges AR. Antimicrobial resistance gene acquisition and depletion following fecal microbiota transplanta- tion (FMT) for recurrent Clostridium difficile infec- tion [manuscript published online ahead of print 15 September 2017]. Clin Infect Dis 2017;66:456–457. 2. Davido B, Salomon J, Lawrence C, et al. Impact of fecal microbiota transplantation for decolonization of multidrug-resistant organisms may vary accord- ing to donor microbiota. Clin Infect Dis 2018; 66:1316–7. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. DOI: 10.1093/cid/cix964 Correspondence: Amee R. Manges, UBC School of Population and Public Health, British Columbia Centre for Disease Control, 215–655 W 12th Ave, Vancouver, BC V5Z 4R4, Canada (amee.manges@ubc.ca). Clinical Infectious Diseases ® 2018;66(8):1317–8 Visual Disability in Ebola Survivors To the Editor—We commend Jagadesh et al [1] for their important contribu- tion highlighting the levels of disability among Ebola survivors in Sierra Leone following the 2013–2016 Ebola epidemic. Quantifable measures of disability, especially in relation to psychological and social impacts on survivors and their fami- lies, following the epidemic are challenging to quantify and neglected in Sierra Leone. Visual disability following the Ebola epidemic is one aspect which is amen- able to quantifable assessment with defned defnitions of visual impairment. In Jagadesh et al [1], Ebola survivors (n = 27) describe major limitations in vision and a higher odds of self-reported blurred vision (adjusted odds ratio, 7.6; 95% confdence interval [CI], 2.0–27.9) in comparison to their close contacts (n = 54) using the Washington Group Disability Extended Questionnaire. Our recent study [2] recalled survivors (n = 82) from the 34 Military Hospital Survivors clinic who had previously reported ocular symptoms, in addition to Ebola survivors who self-presented to the eye clinic with a median time from Ebola treatment unit discharge over 1 year (411 days; interquartile range, 368–470 days). We reported their best eye visual acuity was normal (uncorrected Snellen visual acuity <6/7.5) in 74.7% (97.5% CI, 62.1%–84.9%) of survivors in this cohort. Moderate or worse visual acuity (uncorrected Snellen visual acuity >6/24) in their best eye was only found in 2.6% (97.5% CI, 0–7.8%). In the discussion, it is stated that “long- term cataract replacement is frequently indicated.” In our cohort, we found that only 7.3% (97.5% CI, 2.3%–16.5%) of survivors (who had previously reported ocular symptoms) had evidence of white cataract, all of which were unilateral, with vision preserved in their contralateral eye. Eighty percent of eyes with cataract secondary to Ebola uveitis also had evi- dence of hypotony. In these cases, surgery is likely to be complex, with a poor visual prognosis, and may increase the risk of phthisis bulbi. Terefore, cataract surgery may not always be indicated. It is worth considering visual disabil- ity among Ebola survivors within the wider context of visual disability in Sierra Leone. Te latest Rapid Assessment of Avoidable Blindness survey in Sierra Leone, conducted in 2010, reported a rate of blindness of 1% [3], 50 times greater than that of the United Kingdom [4] and potentially reversible in the 39% of blind- ness secondary to cataracts [3]. With only 5 ophthalmology consultants in Sierra Leone serving a population of 7.3 mil- lion [5], interventions toward improving eye care for Ebola survivors should not overlook the need and opportunity to strengthen the eye care sector as a whole, which may be limited by ring-fenced Ebola survivor–specifc international funding. Note Potential conficts of interest. N. A. V. B. has received nonfnancial support from Optos, grant support from Bayer, and personal fees from AbbVie. M. G. S. has received grants from the Wellcome Trust, Bill & Melinda Gates Foundation, and UK National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections. Downloaded from https://academic.oup.com/cid/article/66/8/1318/4591666 by guest on 02 December 2021