title: Nipah virus infection: pathology and pathogenesis of an emerging paramyxoviral zoonosis.
abstract: In 1998, an outbreak of acute encephalitis with high mortality rates among pig handlers in Malaysia led to the discovery of a novel paramyxovirus named Nipah virus. A multidisciplinary investigation that included epidemiology, microbiology, molecular biology, and pathology was pivotal in the discovery of this new human infection. Clinical and autopsy findings were derived from a series of 32 fatal human cases of Nipah virus infection. Diagnosis was established in all cases by a combination of immunohistochemistry (IHC) and serology. Routine histological stains, IHC, and electron microscopy were used to examine autopsy tissues. The main histopathological findings included a systemic vasculitis with extensive thrombosis and parenchymal necrosis, particularly in the central nervous system. Endothelial cell damage, necrosis, and syncytial giant cell formation were seen in affected vessels. Characteristic viral inclusions were seen by light and electron microscopy. IHC analysis showed widespread presence of Nipah virus antigens in endothelial and smooth muscle cells of blood vessels. Abundant viral antigens were also seen in various parenchymal cells, particularly in neurons. Infection of endothelial cells and neurons as well as vasculitis and thrombosis seem to be critical to the pathogenesis of this new human disease.
authors.affiliation: University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Kum Thong
authors.initials: KT
authors.lastname: Wong
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Shalini
authors.initials: S
authors.lastname: Kumar
authors.forename: Karim
authors.initials: K
authors.lastname: Norain
authors.forename: Wahidah
authors.initials: W
authors.lastname: Abdullah
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Goldsmith
authors.forename: Kaw Bing
authors.initials: KB
authors.lastname: Chua
authors.forename: Sai Kit
authors.initials: SK
authors.lastname: Lam
authors.forename: Chong Tin
authors.initials: CT
authors.lastname: Tan
authors.forename: Khean Jin
authors.initials: KJ
authors.lastname: Goh
authors.forename: Heng Thay
authors.initials: HT
authors.lastname: Chong
authors.forename: Rani
authors.initials: R
authors.lastname: Jusoh
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Rollin
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Ksiazek
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001210:Asia, Southeastern / Q000453:epidemiology; D001808:Blood Vessels / Q000473:pathology / Q000821:virology; D002490:Central Nervous System / Q000473:pathology / Q000821:virology; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D021821:Communicable Diseases, Emerging / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000648:ultrastructure / Q000821:virology; D018184:Paramyxoviridae Infections / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000821:virology; D018098:Paramyxovirinae / Q000302:isolation & purification* / Q000502:physiology; D013552:Swine; D015047:Zoonoses