Nipah virus infection: pathology and pathogenesis of an emerging paramyxoviral zoonosis.
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.
Wong
Kum Thong
KT
University of Malaya, Kuala Lumpur, Malaysia.
Shieh
Wun-Ju
WJ
Kumar
Shalini
S
Norain
Karim
K
Abdullah
Wahidah
W
Guarner
Jeannette
J
Goldsmith
Cynthia S
CS
Chua
Kaw Bing
KB
Lam
Sai Kit
SK
Tan
Chong Tin
CT
Goh
Khean Jin
KJ
Chong
Heng Thay
HT
Jusoh
Rani
R
Rollin
Pierre E
PE
Ksiazek
Thomas G
TG
Zaki
Sherif R
SR
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