Journal Article

Clinical Presentation of Nipah Virus Infection in Bangladesh

M. Jahangir Hossain, Emily S. Gurley, Joel M. Montgomery, Michael Bell, Darin S. Carroll, Vincent P. Hsu, P. Formenty, A. Croisier, E. Bertherat, M. A. Faiz, Abul Kalam Azad, Rafiqul Islam, M. Abdur Rahim Molla, Thomas G. Ksiazek, Paul A. Rota, James A. Comer, Pierre E. Rollin, Stephen P. Luby and Robert F. Breiman

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 7, pages 977-984
Published in print April 2008 | ISSN: 1058-4838
Published online April 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/529147
Clinical Presentation of Nipah Virus Infection in Bangladesh

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  • Immunology
  • Public Health and Epidemiology
  • Microbiology

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Background. In Bangladesh, 4 outbreaks of Nipah virus infection were identified during the period 2001–2004.

Methods. We characterized the clinical features of Nipah virus-infected individuals affected by these outbreaks. We classified patients as having confirmed cases of Nipah virus infection if they had antibodies reactive with Nipah virus antigen. Patients were considered to have probable cases of Nipah virus infection if they had symptoms consistent with Nipah virus infection during the same time and in the same community as patients with confirmed cases.

Results. We identified 92 patients with Nipah virus infection, 67 (73%) of whom died. Although all age groups were affected, 2 outbreaks principally affected young persons (median age, 12 years); 62% of the affected persons were male. Fever, altered mental status, headache, cough, respiratory difficulty, vomiting, and convulsions were the most common signs and symptoms; clinical and radiographic features of acute respiratory distress syndrome of Nipah illness were identified during the fourth outbreak. Among those who died, death occurred a median of 6 days (range, 2–36 days) after the onset of illness. Patients who died were more likely than survivors to have a temperature >37.8eg;C, altered mental status, difficulty breathing, and abnormal plantar reflexes. Among patients with Nipah virus infection who had well-defined exposure to another patient infected with Nipah virus, the median incubation period was 9 days (range, 6–11 days).

Conclusions. Nipah virus infection produced rapidly progressive severe illness affecting the central nervous and respiratory systems. Clinical characteristics of Nipah virus infection in Bangladesh, including a severe respiratory component, appear distinct from clinical characteristics reported during earlier outbreaks in other countries.

Journal Article.  4037 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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