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

  • Heng Thay Chong (a1), Sree Raman Kunjapan (a1), Tarmizi Thayaparan (a1), Jenny May Geok Tong (a2), Vijayasingham Petharunam (a2), Mohd Rani Jusoh (a3) and Chong Tin Tan (a4)...

Abstract

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: 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.

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References

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

  • Heng Thay Chong (a1), Sree Raman Kunjapan (a1), Tarmizi Thayaparan (a1), Jenny May Geok Tong (a2), Vijayasingham Petharunam (a2), Mohd Rani Jusoh (a3) and Chong Tin Tan (a4)...

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