NIPAH VIRUS INFECTION

Overview and Facts

Nipah virus infection is caused by a virion Henipavirus which was discovered in 1998 in Malaysia where it caused an outbreak. It is said that infection from Nipah virus is derived from the consumption of fruit bats, but transmission from one person to the other is inevitable. 

The typical incubation period varies from the initial contact, 4 to 14 days after, the infected person may manifest non-specific signs and symptoms. Carrier status sometimes lasts up to 45 days, for those people with a healthy immune system. 

However, carriers shed off the virus in their environment and result in more people getting infected.

The subset of a population that is highly infected by Nipah virus include (this data is taken from the statistics of the previous outbreak) hospital personnel and persons who are in close contact with those who were infected by the virus. 

The transmission was observed to be mainly caused by eating fruits that are laced with the saliva of fruit bats, drinking of contaminated water straight off from the wells and ponds that are near the living environment of bats and consumption of dates that have not undergone hygienic preparation.

Types and Symptoms

TYPES

Nipah Virus is derived from the Paramyxoviridae class and the genus Henipaviiridae.

SYMPTOMS

The presentation of Nipah virus infection varies from asymptomatic to flu-like illness which can rapidly deteriorate within 24 to 48 hours after contracting the virus. 

Majority of the cases presents with the following:

  • Pain in the head and back
  • Gastrointestinal symptoms- nausea, vomiting and diarrhea
  • Decreased alertness
  • Unsteady feeling
  • Coma
  • May or may have a seizure (late presentation which signifies severe encephalitis. 
  • Non-productive cough
  • Throat itchiness

Diagnosis & Medications

DIAGNOSIS

The clinical presentation, coupled with the environmental data, can aid in making the appropriate diagnosis. Ancillary findings such as those listed below are for confirmation purposes. 

  • Use of polymerase chain reaction (PCR) reverse transcriptase with specimens taken from nasal and throat swabs, cerebrospinal fluid from a lumbar tap, analysis of urine and blood samples especially during the early stages of the disease.
  • Antibody detection tests (identification of antibodies present IgG and IgM) to determine the response of the patient to therapy
  • Examination of tissue samples taken during autopsy subjected to immunohistochemical testing is highly specific for Nipah virus.
  • Isolation of virus from the saliva of persons infected with the virus

TREATMENT

Viral infections are self-limiting. As they say, if there is a viral infection, let them run its course, and it will go away on its own, this is granting that the immune system of the person infected is healthy enough to mount an appropriate response to the virus. 

Supportive care is still the first choice in the treatment of such infections. Endotracheal intubation may need to be done in cases of severe respiratory distress. 

Antibiotic regimens for severe pneumonia complicating the viral illness. 

The antiviral drugs Rivapirin, Acyclovir and Fabipiravir have been used but is still currently being investigated as to their efficacy in treating such disease.

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