Premium
Relapsed and late‐onset Nipah encephalitis
Author(s) -
Tan Chong Tin,
Goh Khean Jin,
Wong Kum Thong,
Sarji Sazilah Ahmad,
Chua Kaw Bing,
Chew Nee Kong,
Murugasu Paramsothy,
Loh Yet Lin,
Chong Heng Thay,
Tan Kay Sin,
Thayaparan Tarmizi,
Kumar Shalini,
Jusoh Mohd Rani
Publication year - 2002
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.10212
Subject(s) - encephalitis , medicine , asymptomatic , central nervous system disease , pathology , outbreak , magnetic resonance imaging , viral encephalitis , virology , virus , radiology
An outbreak of infection with the Nipah virus, a novel paramyxovirus, occurred among pig farmers between September 1998 and June 1999 in Malaysia, involving 265 patients with 105 fatalities. This is a follow‐up study 24 months after the outbreak. Twelve survivors (7.5%) of acute encephalitis had recurrent neurological disease (relapsed encephalitis). Of those who initially had acute nonencephalitic or asymptomatic infection, 10 patients (3.4%) had late‐onset encephalitis. The mean interval between the first neurological episode and the time of initial infection was 8.4 months. Three patients had a second neurological episode. The onset of the relapsed or late‐onset encephalitis was usually acute. Common clinical features were fever, headache, seizures, and focal neurological signs. Four of the 22 relapsed and late‐onset encephalitis patients (18%) died. Magnetic resonance imaging typically showed patchy areas of confluent cortical lesions. Serial single‐photon emission computed tomography showed the evolution of focal hyperperfusion to hypoperfusion in the corresponding areas. Necropsy of 2 patients showed changes of focal encephalitis with positive immunolocalization for Nipah virus antigens but no evidence of perivenous demyelination. We concluded that a unique relapsing and remitting encephalitis or late‐onset encephalitis may result as a complication of persistent Nipah virus infection in the central nervous system.