Nipah virus Encephalitis

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Nipah virus Encephalitis
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What?
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a new strain of paramyxovirus, an RNA virus 90
homology with Hendra virus (HeV) named after
Kampung Sungei Nipah, the village in Malaysia
where the virus was first isolated from the
cerebrospinal fluid (CSF) of a patient in March
1999.
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Reservoir
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Flying foxes (fruit bats)
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Reservoir Flying foxes (fruit bats) - Bats
are asymtomatic - Virus found in
Urine ?? Partially
eaten fruit - Migratory
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Why?
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The outbreak of Nipah virus encephalitis started
in September 1998 and reached its peak in March
1999, with 268 human cases reported and 105 (40)
fatalities.
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Malaysian Nipah Virus Outbreak 1.1 million pigs
were culled.(US 97million) Loss of export
trade ( US120 million)
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How to Dx Nipah virus encephalitis?
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Hx of contact with pigs? 93 had direct contact
with pigs. Two patients had had direct contact
with infected dogs (the dogs later died.) pig
farmers or an abattoir. selling animal vaccines.
repairing pig cages. pig-culling. Ref.GOH KJ
et al . N Engl J Med 20003421229-35
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Clustering of cases ? 56 had affected family
members. Ref.GOH KJ et al . N Engl J Med
20003421229-35
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Incubation period lt 2 weeks in 92 of
patients Ref.GOH KJ et al . N Engl J Med
20003421229-35
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Pigs ? Dead? 41 reported that the animals with
which they had recently had contact had died
after contracting an unusual respiratory tract
illness. Ref.GOH KJ et al . N Engl J Med
20003421229-35 .
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Pigs ? Symptomatic? Frequently asymptomatic or
Fever gt40C plus Open-mouth breathing or
forced respiration Harsh, nonproductive cough.
Head pressing, agitation and biting at bars,
Tetanic spasms, trembling, and muscle
fasciculations. Ref. Nor MNM. Nipah disease in
Malaysia. In Disease Information. Paris Office
International des Epizooties 1999126770
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???????????? ???????????????????????? ????????
???? ??????????????? (neurologic twitches)
???????????????????? 40 ???????????
..........(??.?. ???? ?????????)
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?????????????? gt 4 ??????? ??????????
???????????? ???????????? 1-2 ??? ??????????
??????????????????????????????????????
?????????????????????? 1-5 ????????????????????
? 100 ..........(??.?. ???? ?????????)
?????????????????????????????????
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????????????????
??.?. ???? ?????????
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?????????? ???????????? / ?????????????????
??.?. ???? ?????????
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Onset of Fever Hx of fever before admission
3.5 d (range, 1 to 14). Ref.GOH KJ et al . N
Engl J Med 20003421229-35
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Brainstem Encephalitis Abnormal dolls-eye
reflex, pinpoint pupils, and prominent vasomotor
changes consisting of hypertension and
tachycardia, suggested involvement of the
medullary vasomotor center.Goh KJ et al . N Engl
J Med 20003421229-35 Central hypoventilation
respiratory failure occurred in 3 of 11 patients.
Kim ELet al. Ann Neurol 19994642832
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Ref.GOH KJ et al . N Engl J Med 20003421229-35
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Segmental myoclonus focal, rhythmic jerking of
the muscles present in 32 percent. focal
involvement of neurons in the lower brain stem,
the upper cervical spinal cord, and the lower
spinal cord.
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Nipah virus ?in Thailand? Stored cerebrospinal
fluid samples from 69 patients with encephalitis
in southern Thailand were studied for the
presence of Nipah virus RNA by a RT-PCR method
None gave positive result. Ref. Silpapojakul K
et al. Testing for Nipah Virus in banked
cerebrospinal fluid specimens from Thai patients
with encephalitis. (submitted for publication)
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Nipah virus ?in Thailand? A 1999-2003
prospective, systematic randomized antibody
survey of 9,736 pigs found no evidence of swine
Nipah virus infection in Thailand. Ref.Buranatha
i C et al. Nipah surveillance in Thailand during
1999-2003. Proceedings of the First Asian Pig
Veterinarian Society Congress. 2003 Sept.21-23
Seoul, Korea. Korean Association of Swine
Veterinarians 2003 pp62-63
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Results
Source National Institute of Animals Health
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Nipah virus ?in Thailand? A retrospective
immunohistochemistry study of lung tissues
obtained from 395 pigs with interstitial
pneumonia gave negative results.
Ref.Patchimasiri T et al.. Immunohistochemistry
investigation of Nipah virus A retrospective
study in Thailand. Proceedings of the First Asian
Pig Veterinarian Society Congress. 2003
Sept.21-23 Seoul, Korea. Korean Association of
Swine Veterinasrians 2003 pp64-65
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In January 2004, Nipah virus struck
Bangladesh killing 17 of 23 cases, and
preliminary evidence suggest that Pteropus bats
may have been the source of the outbreak.
ICDDR,B. Nipah Encephalitis Outbreak Over
Wide Area of Western Bangladesh, 2004. Health and
Science Bulletin 200427-11
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Reservoir
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EID 20017439-441
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