Long-term neurological and functional outcome in Nipah virus infection.
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.
Sejvar
James J
JJ
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
Hossain
Jahangir
J
Saha
Sankar Kama
SK
Gurley
Emily S
ES
Banu
Shakila
S
Hamadani
Jena D
JD
Faiz
Mohammed Abdul
MA
Siddiqui
F M
FM
Mohammad
Quazi Deen
QD
Mollah
Abid Hossain
AH
Uddin
Rafique
R
Alam
Rajibul
R
Rahman
Ridwanur
R
Tan
Chong Tin
CT
Bellini
William
W
Rota
Paul
P
Breiman
Robert F
RF
Luby
Stephen P
SP
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
D007074:Immunoglobulin G