exudates and Encephalitis

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998. Clinical presentation ranges from asymptomatic infection to fatal encephalitis. Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India. In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission. Bats are the main reservoir for this virus, which can cause disease in humans and animals. There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

Topics: Abattoirs; Animals; Bangladesh; Chiroptera; Disease Outbreaks; Disease Reservoirs; Encephalitis; Henipavirus Infections; History, 20th Century; History, 21st Century; Humans; India; Malaysia; Nipah Virus; Phoeniceae; Singapore; Swine

Acute necrotising encephalopathy of childhood (ANEC) is an uncommon disease with characteristic clinical and imaging findings. We present two cases of ANEC secondary to Respiratory Syncytial Virus (RSV) and mycoplasma infections. An eight-month-old boy presented with features of gastroenteritis but soon developed multiple episodes of seizures. Blood and CSF cultures were negative but nasopharyngeal aspirate immunofluorescence was positive for RSV. A nine-year-old girl presented with abnormal behaviour following two days of prodromal symptoms. Her serological markers implicated mycoplasma (IgM titre 1: 640). CT brain of both patients showed bilateral symmetrical thalamic hypodensities, while MRI revealed more extensive white matter involvements.

Topics: Acute Disease; Child; Encephalitis; Female; Gait Disorders, Neurologic; Humans; Infant; Magnetic Resonance Imaging; Malaysia; Male; Mycoplasma Infections; Neuroimaging; Respiratory Syncytial Virus Infections

Henipaviruses are implicated in severe and frequently fatal pneumonia and encephalitis in humans. There are no approved vaccines or treatments available for human use, and testing of candidates requires the use of well-characterized animal models that mimic human disease. We performed a comprehensive and statistically-powered evaluation of the African green monkey model to define parameters critical to disease progression and the extent to which they correlate with human disease. African green monkeys were inoculated by the intratracheal route with 2.5 × 10(4) plaque forming units of the Malaysia strain of Nipah virus. Physiological data captured using telemetry implants and assessed in conjunction with clinical pathology were consistent with shock, and histopathology confirmed widespread tissue involvement associated with systemic vasculitis in animals that succumbed to acute disease. In addition, relapse encephalitis was identified in 100% of animals that survived beyond the acute disease phase. Our data suggest that disease progression in the African green monkey is comparable to the variable outcome of Nipah virus infection in humans.

Topics: Animals; Chlorocebus aethiops; Communicable Diseases; Disease Models, Animal; Disease Progression; Encephalitis; Henipavirus Infections; Malaysia; Nipah Virus

To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent.. A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment.. There was good inter-observer agreement on using the new score to identify likely dependency (Kappa = 0.942 for Malaysian children; Kappa = 0.786 for Indian children) and good intra-observer agreement (Kappa = 1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (Kappa = 0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India.. The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment.

Topics: Adolescent; Child; Child, Preschool; Disability Evaluation; Disabled Persons; Encephalitis; Female; Humans; India; Malaysia; Male; Pilot Projects; Severity of Illness Index; Surveys and Questionnaires

Emerging infectious diseases involving zoonosis have become important global health problems. The 1998 outbreak of severe febrile encephalitis among pig farmers in Malaysia caused by a newly emergent paramyxovirus, Nipah virus, is a good example. This disease has the potential to spread to other countries through infected animals and can cause considerable economic loss. The clinical presentation includes segmental myoclonus, areflexia, hypertension, and tachycardia, and histologic evidence includes endothelial damage and vasculitis of the brain and other major organs. Magnetic resonance imaging has demonstrated the presence of discrete high-signal-intensity lesions disseminated throughout the brain. Nipah virus causes syncytial formation in Vero cells and is antigenically related to Hendra virus. The Island flying fox (Pteropus hypomelanus; the fruit bat) is a likely reservoir of this virus. The outbreak in Malaysia was controlled through the culling of >1 million pigs.

Topics: Animals; Chiroptera; Chlorocebus aethiops; Disease Outbreaks; Disease Reservoirs; Encephalitis; Malaysia; Paramyxoviridae Infections; Paramyxovirinae; Vero Cells

A pilot epidemiologic study of all cases of Reye and Reye-like syndromes was undertaken at 8 representative major hospitals in Peninsular Malaya from January 1st to December 31st 1986. The cases were classified as definitive Reye's syndrome, clinical Reye's syndrome and encephalo-hepatopathies. Less than 50% of cases reviewed fulfilled the National Center for Disease Control criteria for clinical Reye's syndrome. Causes of Reye-like syndromes/encephalo-hepatopathies included fulminant hepatitis, Japanese B encephalitis, dengue, septicaemia, and complex febrile fits. It was not possible to differentiate clinical Reye's syndrome from the other encephalo-hepatopathies by either the clinical features (except for jaundice) or biochemical parameters. Liver biopsy is necessary for a definitive diagnosis of Reye's syndrome in Malaysia, because of the high prevalence of Reye-like diseases. The mortality rate in the 2 groups of patients is similar. Ingestion of salicylates was not found to be significantly associated with Reye and Reye-like syndromes in this study.

Topics: Diagnosis, Differential; Encephalitis; Female; Humans; Infant; Liver Diseases; Malaysia; Male; Pilot Projects; Prospective Studies; Reye Syndrome

Topics: Animals; Arbovirus Infections; Borneo; Culicidae; Encephalitis; Encephalitis, Arbovirus; Insect Vectors; Malaysia

Topics: Animals; Culicidae; Dengue; Encephalitis; Encephalitis, Japanese; Humans; Malaysia; Rural Population; Yellow Fever

Topics: Encephalitis; Encephalitis Virus, Japanese; Encephalitis, Japanese; Humans; Incidence; Malaysia

Topics: Animals; Antibodies; Antigens; Culicidae; Encephalitis; Encephalitis Virus, Japanese; Encephalitis, Japanese; Horses; Malaysia; Viruses

Topics: Animals; Culicidae; Encephalitis; Encephalitis Virus, Japanese; Encephalitis Viruses; Encephalitis, Japanese; Malaysia; Viruses

Topics: Animals; Encephalitis; Encephalomyelitis; Encephalomyelitis, Equine; Equidae; Horse Diseases; Horses; Malaysia

Topics: Animals; Biometry; Culicidae; Encephalitis; Encephalitis, Japanese; Horses; Humans; Malaysia; Viruses

Topics: Animals; Culicidae; Encephalitis; Encephalitis, Japanese; Humans; Malaysia