Clinical features of nipah virus encephalitis among pig farmers in Malaysia.
Clinical features of nipah virus encephalitis among pig farmers in Malaysia.
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DOI：
10.1056/nejm200004273421701
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发表时间：
2000-04-27
影响因子：
158.5
通讯作者：
Lam, SK
中科院分区：
文献类型：
--
作者：
Goh, KJ;Tan, CT;Lam, SK
背景资料：1998年9月至1999年6月，马来西亚发生了一起由新发现的副粘病毒尼帕病毒引起的严重病毒性脑炎。方法：我们研究了吉隆坡一家医疗中心收治的尼帕病毒性脑炎患者的临床特征。病例定义是基于流行病学，临床，脑脊液，神经影像学findings.Results：94例尼帕病毒感染的患者被认为是从1999年2月至6月（平均年龄，37岁;男性患者与女性患者的比例，4.5比1）。93%的人与猪有过直接接触，通常是在发病前两周，这表明病毒从猪直接传播给人，潜伏期很短。主要表现为发热、头痛、头晕和呕吐。52名患者（55%）意识水平降低，脑干功能障碍突出。独特的临床体征包括节段性肌阵挛、反射消失和张力减退、高血压和心动过速，因此提示脑干和上颈脊髓受累。75%的患者的初始脑脊液检查结果异常。在83名接受检测的患者中，76%的人在血清或脑脊液中检测到亨德拉病毒抗体。30名患者（32%）在病情迅速恶化后死亡。异常娃娃眼反射和心动过速是预后不良的相关因素。死亡可能是由于严重的脑干受累。三名患者在最初轻度疾病后发生神经系统复发。50例患者（53%）完全康复，14例（15%）有持续的神经功能缺损。结论：尼帕病毒引起严重的，迅速进行性脑炎，死亡率高，功能提示脑干受累。这种感染与最近与猪的接触有关。（N Engl J Med 2000;342：1229-35.）(C)2000年，马萨诸塞州医学会。
Background: Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia.Methods: We studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings.Results: Ninety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits.Conclusions: Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs. (N Engl J Med 2000;342:1229-35.) (C) 2000, Massachusetts Medical Society.