Outbreak of Nipah-virus infection among abattoir workers in Singapore
Outbreak of Nipah-virus infection among abattoir workers in Singapore
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DOI：
10.1016/s0140-6736(99)04379-2
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发表时间：
1999-10-09
期刊：
影响因子：
168.9
通讯作者：
Ksiazek, TG
中科院分区：
文献类型：
--
作者：
Paton, NI;Leo, YS;Ksiazek, TG
背景 1999年3月，新加坡一家屠宰场的工人爆发了脑炎和肺炎疫情。我们描述了这些患者的临床表现和调查结果。方法通过对病例记录进行系统回顾来收集临床和实验室数据。使用 IgM 捕获 ELISA 检测血清和脑脊液 (CSF) 样本中针对尼帕病毒的 IgM 抗体，对一名死亡患者的脑脊液和组织样本进行逆转录酶 PCR。结果根据血清中 IgM 升高，确认 11 名患者患有急性尼帕病毒感染。通过逆转录酶 PCR 在死亡患者的脑脊液和组织中鉴定出尼帕病毒。患者均为男性，中位年龄 44 岁。最常见的症状是发烧、头痛和嗜睡。八名患者出现脑炎体征（意识水平下降或局灶性神经系统体征）。三名患者出现非典型肺炎，但一名患者后来出现幻觉，脑脊液检查有脑炎证据。异常实验室检查结果包括低淋巴细胞计数（9 名患者）、低血小板计数、低血清钠和高天冬氨酸氨基转移酶浓度（各在 5 名患者中观察到）。八名患者的脑脊液蛋白含量较高，七名患者的白细胞计数较高。胸部X光检查显示八名患者有轻度间质阴影。磁共振成像（MRI）显示所有接受扫描的八名患者的皮质白色标记中信号强度增加的焦点区域。 9名脑炎患者接受了静脉注射阿昔洛韦的经验性治疗，其中8名存活下来。 解释 尼帕病毒感染引起脑炎疾病，其特征性局灶性区域在MRI上可见强度增加，肺部受累也很常见，因此该疾病可能表现为非典型肺炎。
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, acid the disease may present as an atypical pneumonia.