Nipah Virus, Its Symptoms, and Treatment


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Evidence Based - Facts Checked

This content is medically reviewed by Dr. Sharwari Dabhade Dua and written by Puneet Utreja

Last Medical Review Date - 4th October 2020



Table of Contents

The advent of new diseases is no surprise in today's time. With an exponential rise in drug resistance, overpopulation, and failure to mitigate prevalent diseases, the arrival of a potential hazardous disease seems inevitable.

Nipah Virus, which may seem innocuous to a layman, is a cause for concern. The virus is a zoonotic virus, which means it is transmitted from animal to human. The host of this virus is a family of bats known as Pteropodidae and pigs. These bats and pigs have the potential of transmitting the virus to animals on farms, thereby infecting the animals and, subsequently, the humans attending them1Aditi, & Shariff, M. (2019, January)  'Nipah virus infection: A review'  Source-PubMed

Where Was the First Case of Nipah Virus Reported?

The outbreaks so far have occurred in Malaysia, Singapore, and South Asia2Aditi, & Shariff, M. (2019, January)  'Nipah virus infection: A review'  Source-PubMedThe first outbreak of this disease was reported in Malaysia in the year 1998-99.

Discovered in Kampung Sungai Nipah, Malaysia, it got its name from the place of discovery.

In 2004, an outbreak of Nipah virus was identified in Bangladesh. This outbreak occurred due to the consumption of contaminated fruits or fruit juices by the locals of Bangladesh.

Recently the virus spread to India in the year 2018 and caused several casualties. The infection source was the same as that of Bangladesh and Malaysia, i.e., 'the consumption of contaminated fruits and fruit juices.'

Dr. John Epstein3Source states that Nipah virus is a deadly virus and is relatively unknown, which is an apt way to describe this emerging disease. The potency of this virus is not to be underestimated.

What is Nipah Virus?

Nipah Virus is an RNA virus, which is non-segmented and belongs to Henipavirus's genus, which has five species, including the Nipah Virus. The abbreviation for this virus is NiV.4Aditi, & Shariff, M. (2019, January)  'Nipah virus infection: A review'  Source-PubMed

Structure of Nipah Virus

Knowledge regarding the virus's genome and structure always allow scientists to establish a link to curtail its spread. The virus is variable in shape, and its diameter can range from 40 to 600 nm. Its membrane is made of lipids, which lies over the shell of the matrix protein. This virus comprises of a single RNA strand that is tightly adherent to a nucleocapsid protein. It also is associated with large proteins as well as phosphoproteins. The ability to replicate itself comes from these proteins5Rockx, B., Winegar, R., & Freiberga, A. N. (2012) Recent progress in henipavirus research: Molecular biology, genetic diversity, animal models  Source

Its membrane has proteins that serve as points of attachments. It has an F protein trimer and a G protein tetramer. The G protein helps attach the virus to a host cell when in contact with one. Ephrin-B2 mediates its attachment. X-Ray Crystallography has proved this attachment. The F protein aims to fuse both the virus and humans' membranes, thus allowing entry for the virion into the host cell. It also has a destructive potential to cause adjacent cells to fuse and result in large syncytia.

Is Nipah Virus Dangerous? 

Nipah has been identified as a budding disease as the discovery of this disease is recent. Despite its recent outbreaks in minor numbers, WHO considers it a cause for concern due to the virus's possibility of infecting numerous animals and humans. Its transmission isn't the sole cause of concern; its impact on the health of the individual infected is detrimental. It can either be asymptomatic or can lead to encephalitis.

Nipah virus is a vector-borne RNA virus that attacks the respiratory system primarily and travels to the brain through septicemia or viremia to be more specific. Once the infection spreads in the brain, it can cross the blood-brain barrier due to its small size and result in encephalitis, proving to be a lethal consequence of the disease6Wong, K. T., Shieh, W., Kumar, S., Norain, K., Abdullah, W., Guarner, J., . . . Nipah Virus Pathology Working Group. (2002, December) 'Nipah virus infection: Pathology and pathogenesis of an emerging paramyxoviral zoonosis'  Source 7Aditi, & Shariff, M. (2019, January)  'Nipah virus infection: A review'  Source-PubMed

Nipah virus has been known to claim several human lives in Malaysia in its initial outbreak, followed by Bangladesh in 2004 and India in 2018.

In India, the virus has claimed lives in Northern Kerala, precisely four districts or regions, viz. Kozhikode, Malappuram, Waynad, and Kannur. The casualties also included a hospital nurse who died after acquiring the infection, catering to the infected individuals in a local hospital in one of these four districts8Source

Nipah virus has several clinical presentations in individuals, which is why it is regarded as a 'Blueprint priority disease'9Source-WHO, which indicates the danger the disease implies. It can thereby be concluded that the Nipah virus is dangerous.

Quick Note - What is the Blueprint priority list?

WHO devised a list that determines which diseases need to be researched on priority basis. The diseases are prioritized based on various factors like lack of treatment options and increased risk for fatality. Conditions that become endemic in certain regions in a short period of time, add to the list. COVID-19 is another such example for the Blueprint Priority List.

How Does A Human Get Infected with Nipah Virus?

Nipah virus is transmitted by the secretions, urine, and the saliva of bats (which belong to Pteropodidae) and pigs. The bats are the primary hosts of the virus and do not get infected by it. The virus co-exists in a state of harmony with the somatic bat cells and is infective for humans10Singh, R. K., Dhama, K., Chakraborty, S., Tiwari, R., Natesan, S., Khandia, R., . . . Mourya, D. T. (2019, December). 'Nipah virus: Epidemiology, pathology, immunobiology and advances in diagnosis, vaccine designing and control strategies - a comprehensive review' Source

The intermediate hosts are pigs that get the infection by ingesting contaminated or soiled fruits or other liquids contaminated by bat's urine or saliva. A mild infection may develop in pig following the transmission of the Nipah virus; however, the infection is not fatal.

Humans are the secondary hosts of the virus. They catch the infection by ingesting contaminated fruits or fruit juices or human to human transmission through inhalation of aerosols and direct contact with secretions containing the viral toxins. Transplacental transmission, i.e., from mother to fetus, is also possible in this case11Dimitrov, D. S., & Wang, L. (2007, September 15). 'In Utero Transmission of Nipah Virus: Role Played by Pregnancy and Vertical Transmission in Henipavirus Epidemiology'  Source

The virus can also be transmitted by ingesting undercooked meat, entirely or partially infected by the virus12Ang, B. S., Lim, T. C., & Wang, L. (2018, May 25) 'Nipah Virus Infection'  Source

The consumption of date palm juice is a red flag against the transmission of viruses and should be banned in endemic areas13Luby, S. P. (n.d.). 'TRANSMISSION OF HUMAN INFECTION WITH NIPAH VIRUS'  Source

Symptoms of Nipah Virus

Nipah virus can present in multiple forms in human beings. From being asymptomatic, Nipah can prove to be a life-threatening condition. Asymptomatic infections are usually sub-clinical infections, managed by the body's immune system, and do not develop enough to produce symptoms14Parashar UD;Sunn LM;Ong F;Mounts AW;Arif MT;Ksiazek TG;Kamaluddin MA;Mustafa AN;Kaur H;Ding LM;Othman G;Radzi HM;Kitsutani PT;Stockton PC;Arokiasamy J;Gary HE;Anderson LJ;. (2000). 'Case-control study of risk factors for human infection with a new zoonotic paramyxovirus, Nipah virus, during a 1998-1999 outbreak of severe encephalitis in Malaysia'  Source-PubMed

The second most common presentation seen in most cases is in the form of the simple flu or influenza 15Ang, B. S., Lim, T. C., & Wang, L. (2018, May 25. 'Nipah Virus Infection'  Source-PubMed which produces influenza type symptoms:-

  • Fever
  • Headache
  • Running nose
  • Weakness (lethargy)
  • Muscle pain or myalgia
  • Sore throat
  • Nausea
  • Vomiting

If the infection remains untreated until this phase, it becomes complicated and results into upper respiratory tract infection16Ang, B. S., Lim, T. C., & Wang, L. (2018, May 25. 'Nipah Virus Infection'  Source-PubMed

  • Fever
  • Headache
  • Dyspnea
  • Tachypnea
  • Wheezing
  • Weakness (lethargy)
  • Muscle pain or myalgia
  • Cough
  • Chest pain
  • Blocked or stuffed nose

The above mentioned conditions may appear due to the development of atypical pneumonia or acute respiratory distress syndrome.

If the infection remains untreated or fails to respond to medicines, it progresses to its last form of presentation and presents as encephalitis17Goh KJ;Tan CT;Chew NK;Tan PS;Kamarulzaman A;Sarji SA;Wong KT;Abdullah BJ;Chua KB;Lam SK;. (2000) 'Clinical features of Nipah virus encephalitis among pig farmers in Malaysia'  Source-PubMed. The following are the symptoms:-
  • Headache
  • Fever
  • Dizziness
  • Drowsiness
  • Altered mental state
  • Neurological deficits
  • Confusion
  • Seizures
  • Coma (within 24-48 of the infection)

The cause of death in the Nipah virus is usually encephalitic coma.

Diagnosis of Nipah Virus

The following are the two tests that are used to detect18Source-WHO the presence of Nipah Virus in the human body:-

  • ELISA Test (Enzyme-Linked Immunosorbent Assay)
  • RT-PCR Test (Real-Time Polymerase Chain Reaction)

Treatment of Nipah Virus

The incubation period of the virus is about 4-14 days19Source-WHO. This plays a vital role in determining the treatment and prevention plan for infected patients.

Quick Note - What is Incubation Period

The incubation period is defined as the number of days between the start of an infection and the day when you actually start showing symptoms.

There is no drug or treatment plan to treat Nipah virus20Source-WHO. The best method of treatment is first by locating the disease and controlling its spread and transmission.

Treatment of the influenza-like symptoms controls the disease during its initial stage and prevents fatal complications. Treating acute respiratory tract infections is also seen to be helpful in several cases21Soman Pillai, V., Krishna, G., & Valiya Veettil, M. (2020, April 20). 'Nipah Virus: Past Outbreaks and Future Containment'  Source-PubMed

Some patients have also seen to respond well to the usual treatment offered for encephalitis. The relapse rate is low, and full recovery has been observed in patients treated for encephalitis; however, there aren't many studies that can confirm the efficacy of this regime of treatment for now.

However, certain patients also present neurological disorders like seizures and personality changes, for which they need to be put on rivotril, clonpam, clonazepam-R, valium, dastat, diazemuls, dipam zarontin, neurontin, lamictal and risperidal and zyprexa respectively.

Prevention of Nipah Virus

The disease's prevention can be done by controlling the spread of the disease's infection and transmission.

  • Maintain personal hygiene
  • Avoid close contact with infected individuals
  • Wear NH-95 grade masks at all times in an endemic area
  • Avoid consuming fruits and fruit juices during the time of the pandemic
  • Do not keep pigs as pets
  • Stay away from fruit bats
  • Ensure the meat you eat in properly cooked

How to Prevent the Next Outbreak of Nipah Virus

Since there is no vaccine available for Nipah, the best way to curtail this virus's spread is to regularly disinfect the farms of fruits infected with bat saliva or droppings of pig or bats. Public health agencies shall play an essential role in identifying and disinfecting such areas and conducting regular surveillance of such sites to prevent the outbreak22Source-WHO

References

  1. 1
    Aditi, & Shariff, M. (2019, January).
    Nipah virus infection: A review.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518547/
  2. 2
    Rockx, B., Winegar, R., & Freiberga, A. N. (2012).
    Recent progress in henipavirus research: Molecular biology, genetic diversity, animal models.
    Retrieved October 4, 2020, from https://doi.org/10.1016/j.antiviral.2012.05.008
  3. 3
    https://www.publichealth.columbia.edu/research/center-infection-and-immunity/jonathan-h-epstein-dvm-mph
  4. 4
    Wong, K. T., Shieh, W., Kumar, S., Norain, K., Abdullah, W., Guarner, J., . . . Nipah Virus Pathology Working Group. (2002, December).
    Nipah virus infection: Pathology and pathogenesis of an emerging paramyxoviral zoonosis.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850894/
  5. 5
    https://www.bbc.com/news/world-asia-india-44207740
  6. 6
    https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts
  7. 7
    Singh, R. K., Dhama, K., Chakraborty, S., Tiwari, R., Natesan, S., Khandia, R., . . . Mourya, D. T. (2019, December). Nipah virus: Epidemiology, pathology, immunobiology and advances in diagnosis, vaccine designing and control strategies - a comprehensive review.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830995/
  8. 8
    Dimitrov, D. S., & Wang, L. (2007, September 15). In Utero Transmission of Nipah Virus: Role Played by Pregnancy and Vertical Transmission in Henipavirus Epidemiology.
    Retrieved October 4, 2020, from https://academic.oup.com/jid/article/196/6/807/2191776
  9. 9
    Ang, B. S., Lim, T. C., & Wang, L. (2018, May 25).
    Nipah Virus Infection.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971524/
  10. 10
    Luby, S. P. (n.d.).
    TRANSMISSION OF HUMAN INFECTION WITH NIPAH VIRUS.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK114486
  11. 11
    Parashar UD;Sunn LM;Ong F;Mounts AW;Arif MT;Ksiazek TG;Kamaluddin MA;Mustafa AN;Kaur H;Ding LM;Othman G;Radzi HM;Kitsutani PT;Stockton PC;Arokiasamy J;Gary HE;Anderson LJ;. (2000).
    Case-control study of risk factors for human infection with a new zoonotic paramyxovirus, Nipah virus, during a 1998-1999 outbreak of severe encephalitis in Malaysia.
    Retrieved October 4, 2020, from https://pubmed.ncbi.nlm.nih.gov/10823779/
  12. 12
    Goh KJ;Tan CT;Chew NK;Tan PS;Kamarulzaman A;Sarji SA;Wong KT;Abdullah BJ;Chua KB;Lam SK;. (2000). Clinical features of Nipah virus encephalitis among pig farmers in Malaysia.
    Retrieved October 4, 2020, from https://pubmed.ncbi.nlm.nih.gov/10781618/
  13. 13
    Soman Pillai, V., Krishna, G., & Valiya Veettil, M. (2020, April 20).
    Nipah Virus: Past Outbreaks and Future Containment.
    Retrieved October 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232522

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This content is only for educational purpose and should not be considered as a substitute for your Physician's/Doctor's clinical judgement

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