Nipah virus disease: A rare and intractable disease

Nipah virus (NiV) is an RNA virus that belongs to the class of Paramyxoviridae and Henipavirus genus, which also consists of the Hendra virus (HeV) as well as the Cedar virus. Since its 1998 discovery in Malaysia, the NiV virus has been linked to multiple epidemics throughout South and Southeast Asia. Due to its potential to start outbreaks, NiV is a priority pathogen according to the WHO. NiV is a zoonotic illness, and the Pteropus fruit bat serves as its reservoir. From there, pigs and later humans are likely to contract the disease. NiV is categorized as a disease with a biological safety level 4 (BSL 4) because there is no vaccine or viable therapy for it. 

Etiology:

An example of a paramyxovirus is the Nipah virus, which is a member of the Henipavirus genus, Paramyxovirinae subfamily, Paramyxoviridae family, and Mononegavirales order. A single-stranded, enclosed, negative-sense RNA virus is called NiV. The Pteropus fruit bat serves as the virus' reservoir host, and the virus's half-life in bat urine is 18 hours. Consuming contaminated food, coming into contact with infected human or animal bodily fluids, and exposure to droplets or aerosols are the three main ways that NiV is spread. Being in close contact with an infected individual is one of the risk factors for contracting the virus. 

Epidemiology:

The first case of NiV infection was reported near the city of Ipoh in Perak, Malaysia, in 1998. NiV received its name from the Sungai Nipah town after being originally isolated from a patient's cerebrospinal fluid (CSF) in March 1999. In 1999, another outbreak involving 11 cases and one death occurred in Singapore.
The epidemiology of NiV changed in Bangladesh, beginning with an epidemic of encephalitis in Meherpur in 2001.
In 2001, an encephalitis outbreak was detected in Siliguri, West Bengal, India, which borders Bangladesh.

Evaluation:

 • Leukopenia, thrombocytopenia, and elevated levels of alanine aminotransferase and aspartate aminotransferase are commonly seen
 • Most patients' CSF examination revealed an increased WBC count, protein level, or both
 • In encephalitis, the EEG reveals bilateral temporal periodic complexes of sharp and slow waves that occur every 1 or 2 seconds
 • Only a few patients exhibit leptomeningeal or parenchymal lesion enhancement
 • Culture and PCR can detect the Nipah virus in urine and respiratory secretions
 • Real-time RT-PCR is more sensitive than traditional methods
 • Serology is not beneficial for treating acute infections, although it is useful for epidemiologic investigations

Treatment:

 • Ribavirin – is an antiviral that is effective against the respiratory syncytial virus
 • Potential treatment alternatives include acyclovir, chloroquine, and ephrin-B2
 • Supportive care – rest, hydration, and treatment of specific symptoms
 • NSAIDs – acetaminophen, and ibuprofen to relieve pain and fever.
 • Antiemetics to control nausea and vomiting
 • Dextromethorphan, Dexamethasone, Ipratropium, or salbutamol inhalers or nebulizers to improve respiratory symptoms
 • Anti-seizure medications to alleviate seizures associated with acute encephalitis 
 • The monoclonal antibody m102.4 is in clinical studies and is being used on an  individual basis.