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1/9. Outbreak of Nipah-virus infection among abattoir workers in singapore.

    BACKGROUND: In March 1999, an outbreak of encephalitis and pneumonia occurred in workers at an abattoir in singapore. We describe the clinical presentation and the results of investigations in these patients. methods: Clinical and laboratory data were collected by systemic review of the case records. serum and cerebrospinal fluid (CSF) samples were tested for IgM antibodies to nipah virus with an IgM capture ELISA. Reverse-transcriptase PCR was done on the CSF and tissue samples from one patient who died. FINDINGS: Eleven patients were confirmed to have acute Nipah-virus infection based on raised IgM in serum. nipah virus was identified by reverse transcriptase PCR in the CSF and tissue of the patient who died. The patients were all men, with a median age of 44 years. The commonest presenting symptoms were fever, headache, and drowsiness. Eight patients presented with signs of encephalitis (decreased level of consciousness or focal neurological signs). Three patients presented with atypical pneumonia, but one later developed hallucinations and had evidence of encephalitis on CSF examination. Abnormal laboratory findings included a low lymphocyte count (nine patients), low platelet count, low serum sodium, and high aspartate aminostransferase concentration (each observed in five patients). The CSF protein was high in eight patients and white-blood-cell count was high in seven. Chest radiography showed mild interstitial shadowing in eight patients. magnetic resonance imaging (MRI) showed focal areas of increased signal intensity in the cortical white marker in all eight patients who were scanned. The nine patients with encephalitis received empirical treatment with intravenous aciclovir and eight survived. INTERPRETATION: infection with nipah virus caused an encephalitis illness with characteristic focal areas of increased intensity seen on MRI. lung involvement was also common, and the disease may present as an atypical pneumonia.
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ranking = 1
keywords = encephalitis
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2/9. 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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ranking = 1.2
keywords = encephalitis
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3/9. diagnosis of nipah virus encephalitis by electron microscopy of cerebrospinal fluid.

    BACKGROUND: between 1998 and 1999, an outbreak of potentially fatal viral encephalitis erupted among pig farm workers in West malaysia, and later spread to singapore where abattoir workers were afflicted. Although Japanese encephalitis virus was initially suspected, the predominant aetiologic agent was subsequently confirmed to be nipah virus, a novel paramyxovirus related to but distinct from hendra virus. OBJECTIVE: to describe a case of nipah virus encephalitis in a pig farm worker from malaysia. STUDY DESIGN: the clinical, laboratory and radiological findings of this patient were scrutinized. Special emphasis was placed on the electron microscopic analysis of the cerebrospinal fluid (CSF) specimen from this patient. RESULTS: the neurological deficits indicative of cerebellar involvement were supported by the magnetic resonance imaging that showed prominent cerebellar and brainstem lesions. CSF examination provided further evidence of viral encephalitis. Complement fixation and/or RT-PCR assays were negative for Japanese encephalitis, herpes simplex, measles and mumps viruses. ELISA for detecting IgM and IgG antibodies against Hendra viral antigens were equivocal for the CSF specimen, and tested initially negative for the first serum sample but subsequently positive for the repeat serum sample. Transmission electron microscopy of negatively-stained preparations of CSF revealed enveloped virus-like structures fringed with surface projections as well as nucleocapsids with distinctive helical and herringbone patterns, features consistent with those of other paramyxoviruses, including hendra virus. CONCLUSION: this case report reiterates the relevant and feasible role of diagnostic electron microscopy for identifying and/or classifying novel or emerging viral pathogens for which sufficiently specific and sensitive tests are lacking.
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ranking = 1.8
keywords = encephalitis
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4/9. Late presentation of nipah virus encephalitis and kinetics of the humoral immune response.

    nipah virus is a newly discovered paramyxovirus transmitted directly from pigs to humans. During a large encephalitis outbreak in malaysia and singapore in 1998-9, most patients presented acutely. A 12 year old child is described who developed encephalitis 4 months after exposure to the virus. She was diagnosed by a new indirect IgG enzyme linked immunosorbent assay (ELISA), which is also described. The late presentation and IgG subclass responses had similarities to subacute sclerosing panencephalitis. nipah virus should be considered in patients with encephalitis even months after their possible exposure.
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ranking = 1.6
keywords = encephalitis
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5/9. Nipah encephalitis outbreak in malaysia, clinical features in patients from Seremban.

    BACKGROUND: An outbreak of viral encephalitis occurred among pig industry workers in malaysia in September 1998 to April 1999. The encephalitis was attributed to a new paramyxovirus, nipah virus. This is a description of the clinical features of 103 patients treated in the Seremban Hospital with characterization of the prognostic factors. methods: Clinical case records and laboratory investigations were reviewed. The case definition was: patients from the outbreak area, direct contact or in close proximity with pigs, clinical or CSF features of encephalitis. RESULTS: The mean age was 38 years, 89% were male, 58% were ethnic Chinese, 78% were pig farm owners or hired workers. The mean incubation period was 10 days. The patients typically presented with nonspecific systemic symptoms of fever, headache, myalgia and sore throat. seizures and focal neurological signs were seen in 16% and 5% respectively. In the more severe cases, this was followed by drowsiness and deteriorating consciousness requiring ventilation in 61%. Autonomic disturbances and myoclonic jerks were common features. The mortality was high at 41%. Systolic hypertension, tachycardia and high fever were associated with poor outcome. On the other hand, 40% recovered fully. As for the other 19%, the residual neurological signs were mostly mild. CONCLUSION: nipah virus caused an encephalitis illness with short incubation period and high mortality. The prognosis for the survivors was good.
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ranking = 1.6
keywords = encephalitis
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6/9. Emerging viral infections in australia.

    hendra virus infection should be suspected in someone with close association with horses or bats who presents acutely with pneumonia or encephalitis (potentially after a prolonged incubation period). Australian bat lyssavirus infection should be suspected in a patient with a progressive neurological illness and a history of exposure to a bat. rabies vaccine and immunoglobulin should be strongly considered after a bite, scratch or mucous membrane exposure to a bat. Japanese encephalitis vaccine should be considered for people intending to reside in or visit endemic areas of southern or eastern asia for more than 30 days.
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ranking = 0.4
keywords = encephalitis
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7/9. 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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ranking = 1.2
keywords = encephalitis
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8/9. Prenatal ultrasonographic diagnosis of fetal hydrocephalus due to infection with parainfluenza virus type 3.

    Parainfluenza virus type 3 is one of the most common causes of respiratory infection in infants. No complications of pregnancy or fetal anomalies have been reported in association with parainfluenza virus infection. A pregnancy was terminated at 22 weeks' gestation due to ultrasonographic diagnosis of hydrocephalus. Pathological examination was consistent with viral encephalitis, ventriculitis and pneumonia. Serological investigation demonstrated a significant rise in maternal antibody titers for parainfluenza virus type 3. Parainfluenza virus type 3 may be associated with severe fetal infection in the first half of pregnancy. Serological studies for this virus should be considered in cases of fetal hydrocephalus.
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ranking = 0.2
keywords = encephalitis
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9/9. Zoonotic disease in australia caused by a novel member of the paramyxoviridae.

    Twenty-three horses and three humans in queensland, australia, were infected with a novel member of the paramyxoviridae family of viruses in two geographically distinct outbreaks. Two of the humans died-one died of rapid-onset respiratory illness, and the other died of encephalitis. The third infected human developed an influenza-like illness and made a complete recovery. All infected humans had close contact with sick horses. Since the two outbreaks occurred at sites 1,000 km apart and no known contact between the two groups of humans and horses occurred, extensive testing of animals and birds common to the two areas was conducted. fruit bats (Pteropus species) were found to carry a virus identical to that found in the infected humans and horses. Although there was no contact between the infected humans and the bats, some form of close contact between the horses and bats is the likely mode of infection.
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ranking = 0.2
keywords = encephalitis
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