Clinical Features of Nipah Virus Encephalitis among Pig Farmers in Malaysia
Between September 1998 and June 1999, there was an outbreak of febrile encephalitis in several pig-farming villages in Malaysia. More than 200 patients were admitted to hospitals nationwide, many of whom died. 1 – 3 The pig-farming industry was disrupted by the culling of many pigs to control the ou...
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| Published in | The New England journal of medicine Vol. 342; no. 17; pp. 1229 - 1235 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Massachusetts Medical Society
27.04.2000
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Between September 1998 and June 1999, there was an outbreak of febrile encephalitis in several pig-farming villages in Malaysia. More than 200 patients were admitted to hospitals nationwide, many of whom died.
1
–
3
The pig-farming industry was disrupted by the culling of many pigs to control the outbreak and the closing of farms. Several abattoir workers in neighboring Singapore were also affected.
4
,
5
Japanese encephalitis, a viral encephalitis associated with pigs that is endemic in Southeast Asia, was initially suspected, but clinical and epidemiologic features suggested that a different disease was responsible.
The isolation of a new paramyxovirus, subsequently named . . . |
|---|---|
| AbstractList | BACKGROUNDBetween September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia.METHODSWe studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings.RESULTSNinety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits.CONCLUSIONSNipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs. Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia. We studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings. Ninety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits. Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs. Background Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia. Methods We studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings. Results Ninety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits. Conclusions Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs. Between September 1998 and June 1999, there was an outbreak of febrile encephalitis in several pig-farming villages in Malaysia. More than 200 patients were admitted to hospitals nationwide, many of whom died. 1 – 3 The pig-farming industry was disrupted by the culling of many pigs to control the outbreak and the closing of farms. Several abattoir workers in neighboring Singapore were also affected. 4 , 5 Japanese encephalitis, a viral encephalitis associated with pigs that is endemic in Southeast Asia, was initially suspected, but clinical and epidemiologic features suggested that a different disease was responsible. The isolation of a new paramyxovirus, subsequently named . . . There was an outbreak of severe viral encephalitis due to Nipah virus in Malaysia between Sep 1998 and June 1999. Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. |
| Author | Chew, Nee Kong Lam, Sai Kit Tan, Patrick Seow Koon Tan, Chong Tin Wong, Kum Thong Chua, Kaw Bing Kamarulzaman, Adeeba Goh, Khean Jin Abdullah, Basri Johan Jeet Sarji, Sazilah Ahmad |
| Author_xml | – sequence: 1 givenname: Khean Jin surname: Goh fullname: Goh, Khean Jin – sequence: 2 givenname: Patrick Seow Koon surname: Tan fullname: Tan, Patrick Seow Koon – sequence: 2 givenname: Chong Tin surname: Tan fullname: Tan, Chong Tin – sequence: 3 givenname: Nee Kong surname: Chew fullname: Chew, Nee Kong – sequence: 5 givenname: Adeeba surname: Kamarulzaman fullname: Kamarulzaman, Adeeba – sequence: 6 givenname: Sazilah Ahmad surname: Sarji fullname: Sarji, Sazilah Ahmad – sequence: 7 givenname: Kum Thong surname: Wong fullname: Wong, Kum Thong – sequence: 8 givenname: Basri Johan Jeet surname: Abdullah fullname: Abdullah, Basri Johan Jeet – sequence: 9 givenname: Kaw Bing surname: Chua fullname: Chua, Kaw Bing – sequence: 10 givenname: Sai Kit surname: Lam fullname: Lam, Sai Kit |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/10781618$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| ContentType | Journal Article |
| Copyright | Copyright © 2000 Massachusetts Medical Society. All rights reserved. |
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| DOI | 10.1056/NEJM200004273421701 |
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| References | 10781626 - N Engl J Med. 2000 Apr 27;342(17):1280-1 r006 Thongcharoen P (r008) 1989; 20 r003 r004 Selvey LA (r007) 1995; 162 r005 (r002) 1999; 48 (r001) 1999; 48 |
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| Snippet | Between September 1998 and June 1999, there was an outbreak of febrile encephalitis in several pig-farming villages in Malaysia. More than 200 patients were... Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia. We... There was an outbreak of severe viral encephalitis due to Nipah virus in Malaysia between Sep 1998 and June 1999. Nipah virus causes a severe, rapidly... Background Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in... BACKGROUNDBetween September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in... |
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| SubjectTerms | Adult Animal Husbandry Animals Antibodies, Viral - blood Antibodies, Viral - cerebrospinal fluid Cerebrospinal Fluid - chemistry Cerebrospinal Fluid - immunology Disease Outbreaks - statistics & numerical data Electroencephalography Encephalitis Encephalitis, Viral - epidemiology Encephalitis, Viral - mortality Encephalitis, Viral - physiopathology Encephalitis, Viral - virology Female Hogs Humans Logistic Models Magnetic Resonance Imaging Malaysia Malaysia - epidemiology Male Nervous System Diseases - etiology Nipah virus NMR Nuclear magnetic resonance Paramyxoviridae Infections - complications Paramyxoviridae Infections - epidemiology Paramyxoviridae Infections - mortality Paramyxoviridae Infections - physiopathology Paramyxovirinae - immunology pigs Recurrence Swine |
| Title | Clinical Features of Nipah Virus Encephalitis among Pig Farmers in Malaysia |
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