Nipah virus infection

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Nipah virus infection
Henipavirus structure.svg
Structure of a Henipavirus
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg
Symptoms None, fever, cough, headache, diarrhea, confusion [1]
Complications Inflammation of the brain, seizures [2]
Usual onset5 to 14 days after exposure [1]
CausesNipah virus (spread by direct contact) [1]
Diagnostic method Based on symptoms, confirmed by laboratory testing [1]
PreventionAvoiding exposure to bats and to sick pigs and people.
Treatment Supportive care only [2]
Prognosis The case fatality rate of Nipah virus infection is estimated at 40–75% but can vary by outbreak depending on surveillance and clinical management in affected areas. [3]
Frequency~701 human cases (1998 to May 2018) [4] [5]
Deaths~50 to 75% risk of death [4] [6]

Nipah virus infection is an infection caused by the Nipah virus. Symptoms from infection vary from none to fever, cough, headache, shortness of breath, and confusion. This may worsen into a coma over a day or two, and 50% to 75% of those infected die. Complications can include inflammation of the brain and seizures following recovery. [2] [1]

Contents

The Nipah virus (NiV) is a type of RNA virus in the genus Henipavirus, which normally circulates among fruit bats of the genus Pteropus. [7] Spread typically requires direct contact with an infected source; it can both spread between people and from other animals to people. Diagnosis is based on symptoms and confirmed by laboratory testing. [2] [1]

Management is restricted to supportive care; as of 2021 there is neither vaccine nor specific treatment. [2] Preventive measures include avoiding exposure to bats and infected animals such as pigs, and not drinking raw date palm sap. [1] As of May 2018 about 700 human cases of Nipah virus were estimated to have occurred, and 50 to 75 percent of those infected died. [4] [6] [5]

The disease was first identified in 1998 by a team of researchers at the Faculty of Medicine, University of Malaya during an outbreak in Malaysia. [8] The majority of the patients in Malaysia diagnosed with the disease were referred to and treated at the University of Malaya Medical Centre. The virus was isolated and identified in 1999. [2] The disease is named after a village in Malaysia, Sungai Nipah. Pigs may also be infected, millions of which were culled by Malaysian authorities in 1999 to successfully stop the spread of the disease. [2] [9]

Signs and symptoms

Human infections range from asymptomatic infection to acute respiratory infection, seizures and fatal encephalitis. This illness typically initially presents as 3-14 days of fever and headache, often accompanied by a cough, sore throat, difficulty breathing, and other signs of respiratory illness. [1] Infected people initially develop symptoms that include fever, headaches, myalgia, vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours. [1]

The incubation period is from 4 to 14 days but an incubation period as long as 45 days has been reported. [1]

Death occurs in 40-75% of cases, and some long-term side effects of infection include persistent convulsions and personality changes. Most survivors make a full recovery, although some are left with residual neurological conditions after acute encephalitis. Some cases of relapse have been reported. [1]

Transmission

The initial case in human outbreaks of Nipah virus has always been zoonotic [8] from exposure to contaminated secretions or tissues of infected bats or pigs. Subsequent human-to-human transmission of Nipah virus occurs via close contact with NiV-infected persons or exposure to NiV-infected body fluids (e.g., blood, urine, nasal secretions). [1]

Most experts do not classify Nipah virus as airborne, though there is consensus that transmission can—and does—occur from short-range exposure to NiV-infected respiratory droplets in close contact settings. [10]

Indirect transmission of Nipah virus via contaminated fomites is likely responsible for many cases in which there was no known direct contact with a NiV-infected person or animal. [1]

Risk factors

The risk of exposure is high for hospital workers and caretakers of those infected with the virus. In Malaysia and Singapore, Nipah virus infected people with close contact to infected pigs. In Bangladesh and India, the disease has been linked to consumption of raw date palm sap (toddy), eating of fruits partially consumed by bats, and using water from wells inhabited by bats. [11] [12]

Diagnosis

Transmission electron micrograph (TEM) depicted a number of Nipah virus virions from a person's cerebrospinal fluid (CSF). Nipah.jpg
Transmission electron micrograph (TEM) depicted a number of Nipah virus virions from a person's cerebrospinal fluid (CSF).

During acute and convalescent stages of the disease, RNA can be detected using reverse transcriptase polymerase chain reaction (RT-PCR) from throat swabs, cerebrospinal fluid, urine and blood analysis. [1]

After recovery, IgG and IgM antibody detection can confirm a prior Nipah virus infection. Immunohistochemistry on tissues collected during autopsy also confirms the disease. [1]

Prevention

Prevention through sanitary practices is the best protection. The likelihood of infection through animal transmission can be reduced by avoiding exposure to sick pigs, and to bats where the disease is endemic. Bats harbor a significantly higher proportion of zoonotic viruses than all other mammalian orders, [14] and are known not to be affected by the many viruses they carry, apparently due to their developing special immune systems to deal with the stress of flying. [15] Infection via bats can be caused by drinking raw palm sap (palm toddy) contaminated by bat excreta, [16] eating fruits partially consumed by bats, and using water from wells infested by bats. [12] Bats are known to drink toddy that is collected in open containers, and occasionally urinate in it, which contaminates it with the virus. [16]

Standard infection control practices can protect against human-to-human hospital-acquired infections. [1] These include isolating patients, using personal protective equipment (PPE), and maintaining strict hand hygiene practices. Individuals identified through contact tracing are tested and monitored until confirmed negative. Healthcare facilities must enforce rigorous infection prevention protocols when caring for suspected or confirmed cases. [17]

In January 2024 a candidate vaccine, ChAdOx1 NipahB, commenced Phase I clinical trials after completing laboratory and animal testing. [18] [19]

Treatment

As of 2020, there is no specific treatment for Nipah virus infection. [20] The mainstay of treatment is supportive care. While tentative evidence supports the use of ribavirin, it has not yet been studied in people with the disease. [1] Specific antibodies have also been studied in an animal model with potential benefit. [1] Acyclovir, favipiravir, [20] and remdesivir [21] have been assessed as potential antivirals against Nipah virus.

M 102.4 is a nonpatented monoclonal antibody developed by Christopher C. Broder, a professor of immunology and microbiology at Uniformed Services University of the Health Sciences in Maryland. It proved highly effective in animal models. 50 doses were sent to Kerala in 2018, but it is not clear if they were used in humans.[ citation needed ]

Prognosis

Nipah virus infection is fatal in 40 to 70 percent of cases, [1] though some outbreaks have had 100% case fatality rate. [22]

Sequelae

Those who survive the initial infection often struggle with debilitating long-term neurological sequelae, including memory loss, impaired cognition, seizures, convulsions, and personality changes. [1]

Moreover, Nipah virus is known to be able to persist and lie dormant in survivors and to re-activate many months or years after the initial infection. [1] Deaths from re-activation of latent Nipah virus have been reported. [23]

Outbreaks

Map showing locations of outbreaks of Nipah and Hendra virus as well as the range of Pteropus bats as of 2014 Hendra-distribution-map.jpg
Map showing locations of outbreaks of Nipah and Hendra virus as well as the range of Pteropus bats as of 2014

Nipah virus outbreaks have been reported in Malaysia, Singapore, Bangladesh and India. The area is known as the Nipah Belt. The highest mortality due to Nipah virus infection was found in Bangladesh,[ citation needed ] where outbreaks are typically seen in winter. [24] Nipah virus was first seen in 1998 in peninsular Malaysia in pigs and pig farmers. By mid-1999, more than 265 human cases of encephalitis, including 105 deaths, had been reported in Malaysia, and 11 cases of either encephalitis or respiratory illness with one fatality were reported in Singapore. [25] In 2001, Nipah virus was reported from Meherpur District, Bangladesh [26] [27] and Siliguri, India. [26] The outbreak again appeared in 2003, 2004 and 2005 in Naogaon District, Manikganj District, Rajbari District, Faridpur District and Tangail District. [27] In Bangladesh there were further outbreaks in subsequent years. [28] [6]

Research

Ribavirin, m102.4 monoclonal antibody, and favipiravir were being studied as treatments as of 2019. [54]

Medication

Ribavirin has been studied in a small number of people. As of 2011, it was unclear whether it was useful, although a few people had returned to normal life after treatment. [55] In vitro studies and animal studies have shown conflicting results in the efficacy of ribavirin against NiV and Hendra, with some studies showing effective inhibition of viral replication in cell lines, [56] [57] whereas some studies in animal models showed that ribavirin treatment only delayed but did not prevent death after NiV or Hendra virus infection. [58] [59]

In 2013, the anti-malarial drug chloroquine was shown to block the critical functions needed for maturation of Nipah virus, although no clinical benefit was observed. [4]

Immunization

Passive immunization using a human monoclonal antibody, m102.4, that targets the ephrin-B2 and ephrin-B3 receptor-binding domain of the henipavirus Nipah G glycoprotein was evaluated in the ferret model as post-exposure prophylaxis. [4] [1] m102.4 has been used in people on a compassionate use basis in Australia, and was in pre-clinical development in 2013. [4]

Society and culture

The fictional MEV-1 virus featured in the 2011 film Contagion was based on a combination of Nipah and measles virus. [60]

A Malayalam movie, Virus , was released in 2019, based on the 2018 outbreak of Nipah virus in Kerala, India. [61] [62]

In series 4 episode 1 of The Good Karma Hospital , a patient is admitted with Nipah.[ citation needed ]

Episode 7 of the Korean drama Doctor John also features a Nipah virus outbreak.[ citation needed ]

See also

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