title: Long-term neurological and functional outcome in Nipah virus infection.
abstract: OBJECTIVE
  Nipah virus (NiV) is an emerging zoonosis. Central nervous system disease frequently results in high case-fatality. Long-term neurological assessments of survivors are limited. We assessed long-term neurologic and functional outcomes of 22 patients surviving NiV illness in Bangladesh.
  
  
  METHODS
  During August 2005 and May 2006, we administered a questionnaire on persistent symptoms and functional difficulties to 22 previously identified NiV infection survivors. We performed neurologic evaluations and brain magnetic resonance imaging (MRI).
  
  
  RESULTS
  Twelve (55%) subjects were male; median age was 14.5 years (range 6-50). Seventeen (77%) survived encephalitis, and 5 survived febrile illness. All but 1 subject had disabling fatigue, with a median duration of 5 months (range, 8 days-8 months). Seven encephalitis patients (32% overall), but none with febrile illness had persistent neurologic dysfunction, including static encephalopathy (n = 4), ocular motor palsies (2), cervical dystonia (2), focal weakness (2), and facial paralysis (1). Four cases had delayed-onset neurologic abnormalities months after acute illness. Behavioral abnormalities were reported by caregivers of over 50% of subjects under age 16. MRI abnormalities were present in 15, and included multifocal hyperintensities, cerebral atrophy, and confluent cortical and subcortical signal changes.
  
  
  CONCLUSIONS
  Although delayed progression to neurologic illness following Nipah fever was not observed, persistent fatigue and functional impairment was frequent. Neurologic sequelae were frequent following Nipah encephalitis. Neurologic dysfunction may persist for years after acute infection, and new neurologic dysfunction may develop after acute illness. Survivors of NiV infection may experience substantial long-term neurologic and functional morbidity.
authors: Divisions of Viral and Rickettsial Diseases and Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta GA 30333, USA. zea3@cdc.gov
authors: James J
authors: JJ
authors: Sejvar
authors: Jahangir
authors: J
authors: Hossain
authors: Sankar Kama
authors: SK
authors: Saha
authors: Emily S
authors: ES
authors: Gurley
authors: Shakila
authors: S
authors: Banu
authors: Jena D
authors: JD
authors: Hamadani
authors: Mohammed Abdul
authors: MA
authors: Faiz
authors: F M
authors: FM
authors: Siddiqui
authors: Quazi Deen
authors: QD
authors: Mohammad
authors: Abid Hossain
authors: AH
authors: Mollah
authors: Rafique
authors: R
authors: Uddin
authors: Rajibul
authors: R
authors: Alam
authors: Ridwanur
authors: R
authors: Rahman
authors: Chong Tin
authors: CT
authors: Tan
authors: William
authors: W
authors: Bellini
authors: Paul
authors: P
authors: Rota
authors: Robert F
authors: RF
authors: Breiman
authors: Stephen P
authors: SP
authors: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D001921:Brain / Q000473:pathology; D002675:Child, Preschool; D018450:Disease Progression; D004569:Electroencephalography; D004660:Encephalitis / Q000473:pathology / Q000503:physiopathology; D004797:Enzyme-Linked Immunosorbent Assay; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D045464:Henipavirus Infections / Q000134:cerebrospinal fluid / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009460:Neurologic Examination; D045405:Nipah Virus; D012008:Recurrence; D020133:Reverse Transcriptase Polymerase Chain Reaction; D011795:Surveys and Questionnaires; D017741:Survivors
chemical_list: D007074:Immunoglobulin G