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1/7. Fatal encephalitis due to nipah virus among pig-farmers in malaysia.

    BACKGROUND: Between February and April, 1999, an outbreak of viral encephalitis occurred among pig-farmers in malaysia. We report findings for the first three patients who died. methods: Samples of tissue were taken at necropsy. Blood and cerebrospinal-fluid (CSF) samples taken before death were cultured for viruses, and tested for antibodies to viruses. FINDINGS: The three pig-farmers presented with fever, headache, and altered level of consciousness. myoclonus was present in two patients. There were signs of brainstem dysfunction with hypertension and tachycardia. Rapid deterioration led to irreversible hypotension and death. A virus causing syncytial formation of vero cells was cultured from the CSF of two patients after 5 days; the virus stained positively with antibodies against hendra virus by indirect immunofluorescence. IgM capture ELISA showed that all three patients had IgM antibodies in CSF against Hendra viral antigens. Necropsy showed widespread microinfarction in the central nervous system and other organs resulting from vasculitis-induced thrombosis. There was no clinical evidence of pulmonary involvement. inclusion bodies likely to be of viral origin were noted in neurons near vasculitic blood vessels. INTERPRETATION: The causative agent was a previously undescribed paramyxovirus related to the hendra virus. Close contact with infected pigs may be the source of the viral transmission. Clinically and epidemiologically the infection is distinct from infection by the hendra virus. We propose that this Hendra-like virus was the cause of the outbreak of encephalitis in malaysia.
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2/7. Parainfluenza virus respiratory infection after bone marrow transplantation.

    BACKGROUND. pneumonia complicates about half of all bone marrow transplantations, and in about a third of the cases no specific cause is identified. Although parainfluenza virus is a common cause of respiratory infection in normal children, its role in transplant recipients is unknown. methods. We describe the incidence and clinical course of parainfluenza infection among the 1253 recipients of bone marrow transplants at our center from 1974 through 1990. We performed viral cultures on all such recipients who had manifestations of a viral infection or fever without apparent cause. RESULTS. Among the 1253 patients, we found 27 (2.2 percent) who had parainfluenza virus infection as demonstrated by culture (12 of 580 adults and 15 of 673 children). Eight of these patients had only upper respiratory tract involvement, all of whom had positive nasopharyngeal cultures. Of the remaining 19, 8 had symptoms of both upper and lower respiratory tract involvement, and 11 had only lower respiratory involvement, of whom only 6 had positive nasopharyngeal cultures. Four required bronchoalveolar lavage for diagnosis. A median of nine days elapsed from the onset of symptoms until the culture became positive, and overall only 33 of 118 cultures obtained were positive. Respiratory failure developed in 6 of the 19 patients with lower respiratory tract involvement, and all died. CONCLUSIONS. Parainfluenza virus is a cause of serious lower respiratory tract involvement in both adults and children who undergo bone marrow transplantation. Given the insensitivity of current culturing techniques, it may be underdiagnosed.
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3/7. Dual infection with pneumocystis carinii and respiratory viruses complicating bone marrow transplantation.

    pneumonia due to dual infection with pneumocystis carinii and respiratory viruses is a rare but formidable complication of bone marrow transplantation. We report here two cases of viral infections complicating P. carinii pneumonia in bone marrow transplant recipients who, at the time of infection, were not taking P. carinii prophylaxis. Both patients died following the pneumonia. Potential factors contributing to the dual infection included graft-versus-host disease, high-dose steroids and cyclosporin A. P. carinii prophylaxis should be continued for 12 months, or longer in bone marrow transplant recipients requiring prolonged immunosuppressive therapy. As specific antiviral therapy becomes available for some respiratory viral infections, performing regular viral surveillance cultures and responding with active early treatment may help improve the outcome in these immunocompromised patients.
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4/7. Human metapneumovirus rna in encephalitis patient.

    We describe a fatal case of encephalitis that might be correlated with primary human metapneumovirus (HMPV) encephalitis. Postmortem HMPV rna was detected in brain and lung tissue samples from the patient. Furthermore, HMPV rna was found in culture fluids from cells coincubated with lung tissue.
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5/7. supraglottitis in three young infants.

    Three case histories of young infants with supraglottitis are presented. At this age, supraglottitis rarely occurs. Atypical features, as compared to older children, include a viral prodrome, lack of fever, stomatitis, and negative blood cultures. Although viral supraglottitis has been previously reported, this is the first report of epiglottitis associated with parainfluenza virus.
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6/7. meningitis due to parainfluenza virus type 3: report of two cases and review.

    We report the cases of two infants with meningitis due to parainfluenza virus type 3. This is the first time that documented clinical and laboratory details have been reported for a 1-month-old infant with meningitis due to parainfluenza virus type 3 (our second case). We reviewed the literature and determined that CNS involvement by parainfluenza virus type 3 appears rare. Clinicians should be aware that parainfluenza virus type 3, one of the most common causes of viral respiratory infection in infancy, can also produce infection of the CNS and that hemadsorption testing of CSF specimens submitted for viral culture is necessary for detecting these paramyxoviruses.
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7/7. Infections due to parainfluenza virus type 4 in children.

    Parainfluenza viruses are a major cause of hospitalization for respiratory illness in children. The spectrum of clinical illness associated with infection due to parainfluenza type 4 virus has not been well defined. It is technically difficult to isolate the virus in tissue culture, and because illness is generally reported to be mild, in many cases, patients may not seek medical attention. We describe a series of 10 children with parainfluenza type 4 virus infection who were seen at the Montreal Children's Hospital between 1988 and 1992. There were five males and five females whose average age was 29.7 months. infection was associated with symptoms of bronchiolitis or pneumonia in 5 children, paroxysmal coughing in 3 infants, apnea in 1 newborn, and aseptic meningitis in 1 child. hospitalization was required for 8 of the 10 children. It appears that infection with parainfluenza type 4 virus may be more common than previously recognized, and it may be associated with more severe infections.
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