Clinical presentation of nipah virus infection in Bangladesh.
BACKGROUND
In Bangladesh, 4 outbreaks of Nipah virus infection were identified during the period 2001-2004.


METHODS
We characterized the clinical features of Nipah virus-infected individuals affected by these outbreaks. We classified patients as having confirmed cases of Nipah virus infection if they had antibodies reactive with Nipah virus antigen. Patients were considered to have probable cases of Nipah virus infection if they had symptoms consistent with Nipah virus infection during the same time and in the same community as patients with confirmed cases.


RESULTS
We identified 92 patients with Nipah virus infection, 67 (73%) of whom died. Although all age groups were affected, 2 outbreaks principally affected young persons (median age, 12 years); 62% of the affected persons were male. Fever, altered mental status, headache, cough, respiratory difficulty, vomiting, and convulsions were the most common signs and symptoms; clinical and radiographic features of acute respiratory distress syndrome of Nipah illness were identified during the fourth outbreak. Among those who died, death occurred a median of 6 days (range, 2-36 days) after the onset of illness. Patients who died were more likely than survivors to have a temperature >37.8 degrees C, altered mental status, difficulty breathing, and abnormal plantar reflexes. Among patients with Nipah virus infection who had well-defined exposure to another patient infected with Nipah virus, the median incubation period was 9 days (range, 6-11 days).


CONCLUSIONS
Nipah virus infection produced rapidly progressive severe illness affecting the central nervous and respiratory systems. Clinical characteristics of Nipah virus infection in Bangladesh, including a severe respiratory component, appear distinct from clinical characteristics reported during earlier outbreaks in other countries.
Hossain
M Jahangir
MJ
International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. jhossain@icddrb.org
Gurley
Emily S
ES
Montgomery
Joel M
JM
Bell
Michael
M
Carroll
Darin S
DS
Hsu
Vincent P
VP
Formenty
P
P
Croisier
A
A
Bertherat
E
E
Faiz
M A
MA
Azad
Abul Kalam
AK
Islam
Rafiqul
R
Molla
M Abdur Rahim
MA
Ksiazek
Thomas G
TG
Rota
Paul A
PA
Comer
James A
JA
Rollin
Pierre E
PE
Luby
Stephen P
SP
Breiman
Robert F
RF
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D045464:Henipavirus Infections / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045405:Nipah Virus / Q000276:immunology / Q000302:isolation & purification; D013902:Radiography, Thoracic; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D012698:Serologic Tests; D013997:Time Factors
D000914:Antibodies, Viral