Clinical Manifestations of NIPAH Virus Infected Patients Presenting to the Emergency Department

Abstract

Introduction: Nipah virus (NiV) infection is a newly emerging viral zoonosis that has a potential to cause severe disease in both animals and humans and with a risk of human to human transmission. An outbreak of NiV occurred in Kozhikode district of Kerala State in India in May 2018. Patients and methods: Twelve of the 19 cases involved in the outbreak were treated at the Emergency Medicine Department of Government Medical College, Kozhikode. The clinico-pathological and epidemiological features of these 12 cases are reported here. Results: The median age of the patients was 30 years and the male: female ratio was 1.4: 1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and nine out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. A combination of encephalitis and acute respiratory distress with or without myocarditis was the most common mode of presentation (66.7%). Administration of antiviral drugs such as acyclovir and oseltamivir did not alter the course of the disease, but ribavirin, which was tried in some of the patients, might have reduced the mortality by 20%. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing. Funding: No funding received for this study. Declaration of Interest: None. Ethical Approval: Received approval from Institutional Ethics Committee, Government Medical College, Kozhikode, Kerala, India.