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Nipah encephalitis outbreak in Malaysia, clinical features in patients from Seremban

Published online by Cambridge University Press:  02 December 2014

Heng Thay Chong ,
Sree Raman Kunjapan ,
Tarmizi Thayaparan ,
Jenny May Geok Tong ,
Vijayasingham Petharunam ,
Mohd Rani Jusoh  and
Chong Tin Tan
Heng Thay Chong
Affiliation:
Department of Medicine, Seremban Hospital, Seremban
Sree Raman Kunjapan
Affiliation:
Department of Medicine, Seremban Hospital, Seremban
Tarmizi Thayaparan
Affiliation:
Department of Medicine, Seremban Hospital, Seremban
Jenny May Geok Tong
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Seremban Hospital, Seremban
Vijayasingham Petharunam
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Seremban Hospital, Seremban
Mohd Rani Jusoh
Affiliation:
Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur
Chong Tin Tan
Affiliation:
Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract

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Background:

An outbreak of viral encephalitis occurred among pig industry workers in Malaysia in September 1998 to April 1999. The encephalitis was attributed to a new paramyxovirus, Nipah virus. This is a description of the clinical features of 103 patients treated in the Seremban Hospital with characterization of the prognostic factors.

Methods:

Clinical case records and laboratory investigations were reviewed. The case definition was: patients from the outbreak area, direct contact or in close proximity with pigs, clinical or CSF features of encephalitis.

Results:

The mean age was 38 years, 89% were male, 58% were ethnic Chinese, 78% were pig farm owners or hired workers. The mean incubation period was 10 days. The patients typically presented with nonspecific systemic symptoms of fever, headache, myalgia and sore throat. Seizures and focal neurological signs were seen in 16% and 5% respectively. In the more severe cases, this was followed by drowsiness and deteriorating consciousness requiring ventilation in 61%. Autonomic disturbances and myoclonic jerks were common features. The mortality was high at 41%. Systolic hypertension, tachycardia and high fever were associated with poor outcome. On the other hand, 40% recovered fully. As for the other 19%, the residual neurological signs were mostly mild.

Conclusion:

Nipah virus caused an encephalitis illness with short incubation period and high mortality. The prognosis for the survivors was good.

Résumé:

RÉSUMÉ:Introduction:

Il y a eu une éclosion d'encéphalite virale chez les travailleurs de l'industrie du porc en Malaisie de septembre 1998 à avril 1999. L'encéphalite a été attribuée à un nouveau paramyxovirus, le virus de Nipah. Cet article décrit les caractéristiques cliniques et les facteurs pronostiques de 103 patients traités à l'Hôpital de Seremban.

Méthodes:

Les dossiers cliniques et les rapports de laboratoire ont été révisés. Les cas étaient définis comme suit: un patient provenant de la région touchée, un contact direct ou un voisinage immédiat avec des porcs, des caractéristiques d'encéphalite selon la clinique ou l'analyse du LCR.

Résultats:

L'âge moyen était de 38 ans, 89% étaient des hommes, 58% étaient d'ethnie chinoise, 78% étaient des propriétaires ou des travailleurs de l'industrie porcine. La période d'incubation moyenne était de 10 jours. Le patient type consultait pour des symptômes systémiques non spécifiques tels de l'hyperthermie, de la céphalée, des myalgies et un mal de george. Des convulsions et des signes neurologiques focaux ont été observés chez 16% et 5% respectivement. Dans les cas plus sévères, ces symptômes étaient suivis de somnolence et d'une détérioration de l'état de conscience nécessitant une ventilation assistée chez 61%. Des troubles neurovégétatifs et des secousses myocloniques étaient fréquemment observés. La mortalité était élevée, soit 41%. Une hypertension systolique, de la tachycardie et une forte fièvre étaient associées à un mauvais pronostic. D'autre part, 40% ont récupéré complètement. Chez 19%, les signes neurologiques résiduels étaient plutôt légers.

Conclusion:

Le virus de Nipah a causé une encéphalite dont la période d'incubation était courte et la mortalité élevée. Le pronostic chez les survivants était bon.

Type
Exchange Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 1 , February 2002 , pp. 83 - 87
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Centre for Disease Control. Update: Outbreak of Nipah virus – Malaysia and Singapore, 1999. MMWR Morb Mort Wkly Rep 1999;48:265–269.Google Scholar
2. Centers for Disease Control. Outbreak of Hendra-like virus – Malaysia and Singapore, 1998–1999. MMWR Morb Mort Wkly Rep 1999;48:335–337 Google Scholar
3. Paton, NI, Leo, YS, Zaki, SR, et al. Outbreak of Nipah-virus infectionamong abattoir workers in Singapore. Lancet 1999;354:1253–1256.Google Scholar
4. Lee, KE, Umapathi, T, Tan, CB, et al. The neurological manifestationsof Nipah encephalitis, a novel paramyxovirus. Ann Neurol 1999;46:428–432.Google Scholar
5. Chua, KB, Goh, KJ, Wong, KT, et al. Fatal encephalitis due to Nipahvirus among pig farmers in Malaysia. Lancet 1999;354:1256–1259.Google Scholar
6. Chua, KB, Bellini, WJ, Rota, PA, et al. Nipah virus: a recentlyemergent deadly paramyxovirus. Science 2000;288:1432–1435.CrossRefGoogle ScholarPubMed
7. Tan, KS, Tan, CT, Goh, KJ. Epidemiology aspects of Nipah virusinfection. Neurol J Southeast Asia 1999;4:77–81.Google Scholar
8. Goh, KJ, Tan, CT, Chew, NK, et al. Clinical features of Nipah virusinfection among pig farmers in Malaysia. N Eng J Med 2000; 342:1229–1235.Google Scholar
9. Chew, , Goh, KJ, Tan, CT. The mechanism of areflexia in patients with Nipah encephalitis. Neurol J Southeast Asia 2000;5:29–33.Google Scholar
10. Chua, KB, Lam, SK, Tan, CT, et al. High mortality in Nipahencephalitis is associated with presence of virus in cerebrospinalfluid. Ann Neurol 2000;48:802–805.Google Scholar
11. Ramasundrum, V, Tan, CT, Chong, HT, et al. Presence of CSF IgM donot have protective effect in Nipah encephalitis. Neurol J Southeast Asia 1999;4:73–76.Google Scholar
12. Ahmad Sarji, S, Abdullah, BJ, Goh, KJ, et al. MR Imaging features of Nipah encephalitis. AJR 2000;175:437–442.Google Scholar
13. Chew, NK, Goh, KJ, Tan, CT, et al. Electroencephalography in acuteNipah encephalitis. Neurol J Southeast Asia 1999;4:45–51.Google Scholar
14. Ramasundrum, V, Tan, CT, Chua, KB, et al. Kinetics of IgG and IgMin Nipah virus infection. Neurol J Southeast Asia 2000;5:23–28.Google Scholar
15. Chua, KB, Lam, SK, Goh, KJ, et al. The presence of Nipah virus inrespiratory secretions and urine of patients during an outbreak of Nipah virus encephalitis in Malaysia. J Infect 2001;42:1–4.Google Scholar
16. Parashar, UD, Lye, MS, Ong, F, et. al. Case control study of riskfactors for human infection with a new zoonotic Nipah virus during a 1998-1999 outbreak of severe encephalitis in Malaysia. J Infect Dis 2000;181:1755–1759.CrossRefGoogle Scholar
17. Chew, MHL, Arguin, PM, Shay, DK, et al. Risk factors for Nipahvirus infection among abattoir workers in Singapore. J Infect Dis 2000;181:1760–1763.CrossRefGoogle ScholarPubMed
18. Mohd Nor, MN, Gan, CH, Ong, BL. Nipah virus of pigs in PeninsularMalaysia. Rev Sci Tech Off Int Epiz 2000;19:160–165.Google Scholar
19. Thongcharoen, Prasert. Japanese encephalitis virus encephalitis: anoverview. Southeast Asian J Trop Med Pub Health 1989;20:559–573.Google Scholar