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Infections among Contacts of Patients with Nipah Virus, India

机译：印度NIPAH病毒患者联系人之间的感染

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To the Editor: Kumar et al. recently reported 3 asymptomatic, seropositive persons with Nipah virus (NiV) among 279 contacts of 18 NiV-infected patients (1). In the 1998–1999 NiV outbreak in Malaysia, asymptomatic, seropositive persons, most of whom were farm workers and soldiers involved in pig culling, also were identified (2,3). Furthermore, some additional cases might not have been detected among patients who had mild, nonencephalitic symptoms (e.g., fever, influenza-like illness). Up to 16% of asymptomatic, seropositive persons exhibited lesions in their brain magnetic resonance imaging (MRI) scans, albeit a slightly smaller number than in patients with acute NiV encephalitis (2). These discrete, small highsignal lesions in the cerebrum were best seen on fluidattenuated inversion recovery images (2). In another study, a seropositive nurse who was exposed only to patients also had similar brain lesions visible on an MRI scan, suggesting person-to-person transmission (4). Whether late-onset NiV encephalitis (i.e., encephalitis in an asymptomatic or mildly symptomatic person) would develop in any of these persons, especially those with brain lesions visible on MRI scan, is unknown. In another cohort, approximately 5% of asymptomatic or mildly symptomatic persons (5) had febrile encephalitis characterized by headache, seizures, focal neurologic signs, and cerebrospinal fluid pleocytosis, a set of symptoms and signs distinct from acute NiV encephalitis. In patients who survived acute NiV encephalitis, a clinicopathologically similar relapsing encephalitis has also been reported (5). The death rate was ≈20% during the clinical course of late-onset/relapsing NiV encephalitis.
机译：到编辑：Kumar等人。最近报告了18名核育感染患者的279例患者（1）的279例患者中存在3种患有NIPAH病毒（NIV）的无症状的血清阳性人。在1998 - 1999年的NIV爆发马来西亚，无症状，血清阳性人，其中大多数是参与猪剔除的农业工人和士兵，也被识别（2,3）。此外，在具有轻度，非血际症状的患者中可能没有检测到一些额外的病例（例如，发烧，流感的疾病）。高达16％的无症状，血清阳性的人在其脑磁共振成像（MRI）扫描中表现出病变，尽管数量略小于急性NIV脑炎（2）的患者。在流体反转恢复图像（2）上最佳地看到大脑中的离散，脑中的小次次畸变。在另一项研究中，仅对患者暴露的血清阳性护士也在MRI扫描上可见了类似的脑病变，表明人员传输（4）。在这些人中的任何一个中，是否会出现晚期核心脑炎（即，无症状或轻度症状的人），特别是那些在MRI扫描上可见的脑病变的脑病，是未知的。在另一个队列中，大约5％的无症状或轻微的症状人（5）具有发热性脑炎，其特征是头痛，癫痫发作，局灶性神经系统症状和脑脊髓液相传，一系列症状和与急性NIV脑炎不同的症状。在急性NIV脑炎的患者中，还报告了临床病理学上类似的复发性脑炎（5）。在晚期开始/复发NIV脑炎的临床过程中，死亡率为≈20％。

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