Clinical Manifestations of Nipah Virus–Infected Patients Who Presented to the Emergency Department During an Outbreak in Kerala State in India, May 2018

Abstract

Background An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described. Methods The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed. Results The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing. Conclusion The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.

Proteome Based Approach Defines Candidates for Designing a Multitope Vaccine against the Nipah Virus

“…In addition to that, humans can be infected with NiV through eating NiV infected pork or even through contacting the body fluids of infected humans where man-to-man transmission occurs [4]. After the infection, cases usually suffer from mild to moderate symptoms of headache, vomiting, and fever where these symptoms may develop into severe encephalitis or acute harmful manifestations to the respiratory system, leading eventually to death [5]. Because of the high virulence, the simple way of dissemination, and the continuously elevated rates of mortality and morbidity of the viral outbreaks, NiV was categorized as a biosafety level 4 virus [6].…”

Nipah virus, an emerging zoonotic disease causing fatal encephalitis

“…10 Neurological symptoms are common throughout all reported case series, with the majority of patients presenting with a reduced level of consciousness and prominent neurological symptoms including signs of brainstem dysfunction, behavioural disturbances, myoclonus and seizures. 7 The incubation period after exposure to NiV can range from a few days to months, with an average of <2 weeks. 6,7 Once inside the central nervous system (CNS), gross pathology illustrates that NiV causes neuronal damage through a dual mechanism of vasculitisinduced disseminated thrombosis and direct neuronal infection.…”

“…7 The incubation period after exposure to NiV can range from a few days to months, with an average of <2 weeks. 6,7 Once inside the central nervous system (CNS), gross pathology illustrates that NiV causes neuronal damage through a dual mechanism of vasculitisinduced disseminated thrombosis and direct neuronal infection. 11 This leads to a severe encephalitis which can either develop acutely or sub-acutely as a late-onset encephalitis (the latter being unique to NiV and difficult to diagnose due to exposure potentially occurring months earlier).…”

The Immunobiology of Nipah Virus

“…The variation in severity of symptoms and mortality between NiV cases in both regions could be attributed to the different genetic makeup of the strains pervasive in either region, or the differences in access and quality of medical care between the two regions [16]. Nevertheless, NiV infections are generally associated with acute respiratory distress, encephalitis and in some cases myocarditis [17]. Additionally, some patients experienced drowsiness, extreme lethargy, mental confusion and in the worst cases coma.…”