A report of 4 patients with Nipah encephalitis from Rajbari district, Bangladesh in the January 2004 outbreak

Abstract

This is a report of 4 patients with Nipah encephalitis during the January outbreak in Bangladesh. The patients were from Rajbari district. The age was from 13 years to 35 years. Two of the patients were housewives and the other 2 were brothers. The patients presented with acute onset of fever, headache impaired consciousness, and seizure in one patient. On examination, all the patients were comatosed with hyporeflexia and hypotonia were seen in 3 patients. Cerebrospinal fluid was abnormal in one patient. MR imaging of brain showed confluent high signal lesions involving both gray and white matter. IgM and IgG antibodies to Nipah virus were positive in the serum and cerebrospinal fluid of all the 4 patients. There was one death. Two patients recovered with residual neurological signs, and the other patient recovered completely. In conclusion, Nipah virus causes a fatal encephalitis in Bangladesh with MR imaging features different from the Malaysian outbreak.