Nipah Symptoms: Signs, Diagnosis, Treatment and Prevention

Nipah symptoms are initially same as symptoms of any flu. The Nipah virus has a long history of infection and death in humans and animals. Since its outbreak in 1998 Malaysia, it has infected over 700 humans with more than 520 deaths.

• The majority of the outbreak has occurred in Malaysia, Bangladesh, India, and Singapore.
• Highest mortality was recorded in Bangladesh and has been nearly an annual infection since 2001.
• Nipah virus disease is considered as zoonotic disease as it spreads from animals like bat, pig, etc. to humans. 
• This infection was first appeared in domestic pigs in Malaysia and Singapore between 1998 to 1999.
• It causes nuerologic and respiratory disease.

Key words: Nipah virus, Symptoms, Diagnosis, Treatment, Prevention, Disease, Infection, Endemic, Zoonotic.

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What is Nipah Virus?

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Nipah virus belongs to the family of negative-stranded RNA viruses called Paramyxoviridae and is derived from the genus Henipavirus.

• It is an infectious and zoonotic virus, commonly circulating among fruit bats, but it has been infecting animals and people.
• It spreads through direct contact with infected people and sources.
• Bats are the primary carriers and farm pigs are intermediate carriers before transmitting the virus to humans.
• The typical sources of transmission to humans are unprotected exposure to secretions or tissue of sick pigs and consumption of fruits contaminated with the saliva of infected fruit bats.
• Malaysian foxes are found to be potential carriers of the virus.
• Though the infection rate is low for the Nipah virus, it has caused a large number of deaths and infected a wide range of animals, the mortality rate is estimated to be 40% to 75%. 
• In the 2018 annual report WHO and R&D blueprint reviewed that there is an urgent need for accelerated research and development for the Nipah virus.

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Symptoms of Nipah Virus 

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The interval from infection of Nipah virus to onset of the symptoms, which is known as the incubation period, is found to range from 4 to 14 days. In some extreme cases, the interval is reported to be 45 days. The Nipah virus symptoms in humans can range from being asymptomatic, that is no sign of infection to fatal inflammation in the brain. Some common symptoms of the disease caused by the Nipah virus are:

• The patients develop mild to severe respiratory tract infections
• Atypical pneumonia 
• Fever, sometimes with chill and convulsion
• Myalgia(muscle pain) and muscle stiffness 
• Drowsiness and dizziness 
• Vomiting and sore throat
• Altered consciousness
• Acute to fatal encephalitis(inflammation of the brain)

In some severe cases of Nipah virus infection, encephalitis and seizures occur in some patients and they lapse into a coma within 24 to 48 hrs. Though most patients who survive encephalitis fully recover, some develop chronic neurologic illnesses. Besides, about 20% of the patients develop neurological consequences like seizures and personality disorders. 

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Diagnosis of Nipah Virus

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The signs and symptoms of the Nipah virus are similar to that of a febrile disease, which causes major distress in early detection of the infection and prevention of the outbreak. The nonspecific symptoms have been endemic in Southeast Asia. Further, the quality, quantity, timing, and time required to transfer the clinical samples to a laboratory can affect the accuracy of the laboratory results.

The diagnosis of Nipah virus infection can be done by examining the clinical history of the patient during the acute and convalescent phases of the infection.

• The main diagnosis test is conducted through RT-PCR or Real-time Polymerase Chain Reaction by sampling throat and nasal swabs, cerebrospinal fluid, urine, and blood.
• After recovery, the test for antibodies is done through ELISA or enzyme-linked immunosorbent assay.
• The other tests for detection of the Nipah virus are done by the methods of immunofluorescence assay, histopathology, and virus isolation and neutralization.

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Treatment for Nipah Virus Infections

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Currently, there are no drugs or vaccines available for the treatment of the infection caused by the Nipah virus. The treatment is limited to extensive care units, treatment of symptoms, resting, and being hydrated during the infection.

However, monoclonal antibody therapies are currently under development and are being evaluated as a treatment method for Nipah virus infections.

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Prevention of Nipah Virus

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Yet there is no licensed treatment of Nipah virus infections, the WHO and other public health organizations have formulated methods to prevent the outbreak and transmission of the disease. The prevention stratagies are based on the experience gained during the past disease outbreaks. 

• Routinely cleaning and disinfecting the animal premises with appropriate disinfectants can help in curbing the infections
• If an outbreak is suspected then the animal premises should be shut immediately, restricting the animal movement to prevent transmission.
• An unexposed and proper incarnation of the carcasses and if needed culling to be practiced to prevent human transmission.
• Reducing the disease transmission from bats to humans by receding their access to dates and fruits for human consumption.
• This can be achieved by employing protective covers like bamboo sap skirts over the date saps.
• Dates should be boiled and fruits should be washed and peeled thoroughly before consumption.
• To reduce the animal to human transmission, farmworkers should be wearing protective clothing when handling sick animals or their tissues.
• They should avoid contact with infected pigs as much as possible.
• In the area where fruit bats are feasible, protection of pig feeds and pig shed against fruit bats are to be considered.
• While handling infected patients, unprotected direct contact should be avoided.
• The healthcare workers need to wear proper gear(gloves, gown, and facemask) and wash hands frequently during handling bodily samples of the infected patients.

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Things to Remember

• Nipah virus is a negative-stranded RNA virus from the genus Henipavirus and family of Paramyxoviridae virus.
• It is a zoonotic virus, spread from animals to animals, animals to humans, and human to human.
• Fruit bats, pigs, and Malaysian foxes are carriers of the Nipah virus.
• Infection transmits through exposure to secretions or tissue of sick pigs and consumption of fruits contaminated with the saliva of infected fruit bats.
• The Nipah virus symptoms in humans can be asymptomatic.
• The incubation period for the disease ranges from 4 to 14 days and the patients can develop mild to severe respiratory tract infections.
• Fever, vomiting, sore throat, myalgia, drowsiness, and dizziness are common symptoms of the disease.
• Diagnosis of the infection can be done via RT-PCR and after recovery, the test for antibodies is done through ELISA.
• There is as such no drug or treatment for the disease and the best method is the prevention of the infection. 

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