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Detection of specific IgM in dengue infection

Lam SK, Devi S, Pang T

Southeast Asian J Trop Med Public Health, 1987 Dec;18(4):532-8.
PMID: 3329413

A modification of the IgM-capture ELISA which can provide an early diagnosis for dengue infection is presented. The test is technically simple compared to HI and appears to be more sensitive. It has the advantage over HIT for the detection of specific IgM in that it is more sensitive and the reading of the result is not subjective. There is the possibility of the test being able to replace HI and HIT in the future.

Matched MeSH terms: Antibodies, Viral/analysis*
Cytomegalovirus infection in Penang: a serological survey

Madhavan HN, Ong KH, Anuar K

Southeast Asian J Trop Med Public Health, 1986 Jun;17(2):168-71.
PMID: 3024324

During 1984-1985, a total of 838 sera obtained from individuals of different age groups, mostly blood donors and those whose sera were received for VDRL tests and other serological investigations. The sera were titrated for complement fixing antibodies against cytomegalovirus (Ad169 strain). Three hundred and fifty two (41%) out of 838 sera showed significant antibody titre. The incidence of this virus infection varied form 26% in the age group of 11-20 years to 59% of those above 50 years of age. Geometric mean titre (GMT) was highest (22) in age groups of 11-20 years and those over 50 years indicating active viral infection in these two age groups. GMT was also significantly higher in females in all age groups except in the age group of 21-30 years and those above 50 years, indicating that active viral infection is more common in females.

Matched MeSH terms: Antibodies, Viral/analysis*
The prevalence of human cytomegalovirus seropositivity among blood donors at the Unit of Blood Transfusion Medicine, Hospital Universiti Sains Malaysia

Ahmed SA, Al-Joudi FS, Zaidah AW, Roshan TM, Rapiaah M, Abdullah YM, et al.

Southeast Asian J Trop Med Public Health, 2006 Mar;37(2):294-6.
PMID: 17124989

Human cytomegalovirus (HCMV) is a species-specific DNA virus of the Herpetoviridae family. After a primary infection, HCMV persists in a latent form most probably in bone marrow progenitor cells or in peripheral blood monocytes. The virus can reactivate to result in shedding of the virus leading to virus dissemination and new infections. Immunocompromized patients are the ones most vulnerable to serious diseases occasionally acquired in blood transfusions. In a human population, HCMV seropositivity increases steadily with age to become approximately 100% in adults. This study was performed to detect seropositivity among regular blood donors in The Hospital of the Universiti Sains Malaysia, in the state of Kelantan. Using an enzyme immunoassay, it was found that 97.6% of blood donors were HCMV-positive. HCMV is highly prevalent and may be endemic in Kelantan. Hence, long-term strategies are required for the reduction of disease dissemination, and to prevent the exposure of immunocompromized patients to the virus.

Matched MeSH terms: Antibodies, Viral/blood*
Fulltext IgM capture ELISA for detection of IgM antibodies to dengue virus: comparison of 2 formats using hemagglutinins and cell culture derived antigens

Cardosa MJ, Tio PH, Nimmannitya S, Nisalak A, Innis B

Southeast Asian J Trop Med Public Health, 1992 Dec;23(4):726-9.
PMID: 1298081

The highly sensitive AFRIMS format IgM capture ELISA for the diagnosis of dengue virus infections requires the use of mouse brain derived hemagglutinins and consequently also the use of 20% acetone extracted normal human serum to eliminate high background. These reagents are not always easily available and we have thus compared the AFRIMS format with another published format which uses cell culture derived antigens (culture fluid, CF, format) in order to determine if it is reasonable to use cell culture derived antigens in situations where hemagglutinins and normal human serum are difficult to obtain. The study shows that using AFRIMS results as the reference point, the CF format described here has a sensitivity of 90% and a specificity of 96%.

Matched MeSH terms: Antibodies, Viral/blood
Fulltext Poliomyelitis and measles serosurvey in northern Malaysia

Saraswathy TS, Sinniah M, Lee WS, Lye MS, Choo KE, Jusoh H

Southeast Asian J Trop Med Public Health, 1994 Sep;25(3):565-8.
PMID: 7777927

In 1990 the Institute for Medical Research carried out a serosurvey in the state of Kelantan to study the age stratified immune prevalence rates for measles and poliomyelitis. Our findings indicate that 981 out of 1,097 (89%) of the population screened had measles antibodies and more than 90% (366 out of 400) had antibodies to all three serotypes of poliovirus. The susceptible group for measles was infants below one year of age, of whom 53.3% (8/15) did not have measles antibody. Of 400 subjects, 125 (31.3%) who were either incompletely vaccinated or had not been vaccinated against poliomyelitis, had polio neutralizing antibodies to all three poliovirus serotypes, suggesting herd immunity in the population. No high risk age group could be identified for poliomyelitis.

Matched MeSH terms: Antibodies, Viral/analysis*
A case of human infection with Newcastle disease virus

Mustaffa-Babjee A, Ibrahim AL, Khim TS

Southeast Asian J Trop Med Public Health, 1976 Dec;7(4):622-4.
PMID: 1025751

A case of Newcastle disease virus infection in a female laboratory technician is reported for the first time in Malaysia. Infection was acquired by droplet infection of the eye while grinding infected chicken in the laboratory. The case was confirmed by isolation of Newcastle disease virus from an eye swab taken from the subject on the first day of clinical signs. A four-fold rise of haemagglutination-inhibition titre was shown when sera on the third day of infection and 15 days later were compared.

Matched MeSH terms: Antibodies, Viral/analysis
An outbreak of acute conjunctivitis caused by coxsackievirus A24 in Kuala-Lumpur, Malaysia, 1978

Tan DS, Yin-Murphy M, Kandiah S

Southeast Asian J Trop Med Public Health, 1980 Mar;11(1):24-7.
PMID: 6250226

An investigation of an outbreak of acute conjunctivitis in Kuala Lumpur from May to August 1978 was made. A total of 2,133 cases was involved, most of whom were adult Malay males of low income status from the surrounding villages and low-cost flats. The majority of cases had bilateral conjunctivitis with clear discharge. Pain and subconjunctival haemorrhage were not common and recovery, mostly without complications, occurred within 1 week. Eye scrapings and paired sera specimens were examined and the causal agent was found to be Coxsackievirus A24 (CA24).

Matched MeSH terms: Antibodies, Viral/analysis
Fulltext AuNP Coupled Rapid Flow-Through Dot-Blot Immuno-Assay for Enhanced Detection of SARS-CoV-2 Specific Nucleocapsid and Receptor Binding Domain IgG

Sil BK, Jamiruddin MR, Haq MA, Khondoker MU, Jahan N, Khandker SS, et al.

Int J Nanomedicine, 2021;16:4739-4753.
PMID: 34267520 DOI: 10.2147/IJN.S313140

BACKGROUND: Serological tests detecting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are widely used in seroprevalence studies and evaluating the efficacy of the vaccination program. Some of the widely used serological testing techniques are enzyme-linked immune-sorbent assay (ELISA), chemiluminescence immunoassay (CLIA), and lateral flow immunoassay (LFIA). However, these tests are plagued with low sensitivity or specificity, time-consuming, labor-intensive, and expensive. We developed a serological test implementing flow-through dot-blot assay (FT-DBA) for SARS-CoV-2 specific IgG detection, which provides enhanced sensitivity and specificity while being quick to perform and easy to use.
METHODS: SARS-CoV-2 antigens were immobilized on nitrocellulose membrane to capture human IgG, which was then detected with anti-human IgG conjugated gold nanoparticle (hIgG-AuNP). A total of 181 samples were analyzed in-house. Within which 35 were further evaluated in US FDA-approved CLIA Elecsys SARS-CoV-2 assay. The positive panel consisted of RT-qPCR positive samples from patients with both <14 days and >14 days from the onset of clinical symptoms. The negative panel contained samples collected from the pre-pandemic era dengue patients and healthy donors during the pandemic. Moreover, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FT-DBA were evaluated against RT-qPCR positive sera. However, the overall efficacies were assessed with sera that seroconverted against either nucleocapsid (NCP) or receptor-binding domain (RBD).
RESULTS: In-house ELISA selected a total of 81 true seropositive and 100 seronegative samples. The sensitivity of samples with <14 days using FT-DBA was 94.7%, increasing to 100% for samples >14 days. The overall detection sensitivity and specificity were 98.8% and 98%, respectively, whereas the overall PPV and NPV were 99.6% and 99%. Moreover, comparative analysis between in-house ELISA assays and FT-DBA revealed clinical agreement of Cohen's Kappa value of 0.944. The FT-DBA showed sensitivity and specificity of 100% when compared with commercial CLIA kits.
CONCLUSION: The assay can confirm past SARS-CoV-2 infection with high accuracy within 2 minutes compared to commercial CLIA or in-house ELISA. It can help track SARS-CoV-2 disease progression, population screening, and vaccination response. The ease of use of the assay without requiring any instruments while being semi-quantitative provides the avenue of its implementation in remote areas around the globe, where conventional serodiagnosis is not feasible.

Matched MeSH terms: Antibodies, Viral/blood
Prevalence of anti-HBc in Malaysian male blood donors and its correlation with DNA polymerase activity

Ton SH, Lopez CG, Hasnah H

Southeast Asian J Trop Med Public Health, 1979 Mar;10(1):1-6.
PMID: 483004

A study of Kuala Lumpur blood donors for HBsAG, anti-HBc and DNA polymeraes showed that 5.5% in the sample population was positive for HBsAG, 50.1% for anti-HBc and 10.1% for DNA polymerase activity. There was no significant difference of the HBsAG among the Malay, Chinese and Indian groups. However, a significant difference was observed for the anti-HBc and DNA polymerase activity between the Indian and the Malay/Chinese groups. Both analysis were significantly lower in the Indians but there was no significant difference between the Chinese and the Malays.

Matched MeSH terms: Antibodies, Viral/analysis*
Improved sensitivity of detection by avidin-biotin complex (ABC) immunocytochemistry in Epstein-Barr virus serology

Thoe SY, Sam CK, Cheng HM, Prasad U

J Med Virol, 1989 Dec;29(4):311-4.
PMID: 2559955

Serum antibodies against Epstein-Barr virus (EBV)-determined antigens have traditionally been titrated by the indirect immunofluorescence (IIF) technique. The avidin-biotin complex (ABC) immunocytochemical technique was used to determine the serum levels of IgA against EBV viral capsid antigen (IgA/VCA) and IgA against EBV early antigen (IgA/EA) in sera of 106 nasopharyngeal carcinoma (NPC) patients prior to treatment and 100 normal individuals. The sensitivity of the ABC technique is enhanced by an amplification of the antigen-antibody reaction, which involves the binding of the enzyme-linked ABC to the second biotinylated antibody. There was a good correlation (r = 0.9988) between ABC and IIF-determined IgA/VCA-positive titres, with the ABC technique being more sensitive than IIF in the detection of IgA/VCA in NPC sera: 94% (99/106) and 76% (80/106), respectively. The frequency of IgA/EA reactivity in NPC sera was also markedly increased by immunodetection with the ABC technique as compared with IIF technique: 63% (69/106) and 28% (30/106) respectively. Both the immunocytochemical techniques were equally specific in discriminating between elevated serum titres of IgA/VCA and IgA/EA in NPC sera from normal human sera.

Matched MeSH terms: Antibodies, Viral/immunology
Identification and characterization of neutralization epitopes at VP2 and VP1 of enterovirus A71

NikNadia N, Tan CW, Ong KC, Sam IC, Chan YF

J Med Virol, 2018 06;90(6):1164-1167.
PMID: 29457642 DOI: 10.1002/jmv.25061

Enterovirus A71 (EV-A71) neutralization escape mutants were generated with monoclonal antibody MAB979 (Millipore). The VP2-T141I and VP1-D14N substitutions were identified. Using reverse genetics, infectious clones with these substitutions were constructed and tested by neutralization assay with immune sera from mice and humans. The N-terminus VP1-14 is more important than EF loop VP2-141 in acute human infection, mainly because it recognised IgM present in acute infection. The N-terminus VP1 could be a useful target for diagnostics and therapeutic antibodies in acute infection.

Matched MeSH terms: Antibodies, Viral/immunology*
The resistance of meat chickens vaccinated by aerosol with a live V4 Newcastle disease virus vaccine in the field to challenge with a velogenic Newcastle disease virus

Bell IG, Nicholls PJ, Norman C, Ideris A, Cross GM

Aust Vet J, 1991 Mar;68(3):97-101.
PMID: 2043098

Meat chickens housed on a commercial broiler farm in Australia were vaccinated once at 10 to 11 days-of-age by aerosol with live V4 Newcastle disease virus (NDV) vaccine. Groups of vaccinated and unvaccinated birds were flown to Malaysia, where they were challenged with a virulent strain of NDV. Survival rates in vaccinated chickens challenged 7, 14, 21 or 31 d after vaccination were 0.47, 0.77, 0.97 and 0.92, respectively. All unvaccinated chickens died due to Newcastle disease (ND) following challenge. Chickens in Australia and Malaysia were bled and the serums tested for haemagglutination-inhibiting (HI) antibody to NDV. Many vaccinated birds with no detectable antibody, and all birds with a log2 titre of 2 or greater, survived challenge. The results showed that this V4 vaccine induced protective immunity in a significant proportion of chickens within 7 d of mass aerosol vaccination. This early immunity occurred in the absence of detectable circulating HI antibody. Non-HI antibody mediated immunity continued to provide protection up to 31 d after vaccination. Almost all vaccinated birds were protected within 3 w of vaccination. It is concluded that the V4 vaccine is efficacious and could be useful during an outbreak of virulent ND in Australia.

Matched MeSH terms: Antibodies, Viral/blood
Fulltext The dengue disquisition: A low-cost public housing conundrum in Klang Valley, Malaysia

AbuBakar N, Behnke JM, Sahimin N, Kang X, Mohd Shahar SN, Lim YAL, et al.

PLoS One, 2025;20(1):e0317349.
PMID: 39820186 DOI: 10.1371/journal.pone.0317349

Dengue remains the most rapidly advancing vector-borne disease in the world, and while the disease burden is predominantly in low-to-middle-income countries, the association with poverty remains in question. Consequently, a study was undertaken to evaluate the prevalence of anti-dengue antibodies among individuals residing in the People's Housing Program (PPR), a government-sponsored low-cost housing initiative targeting low-income earners. This type of public housing often faces challenges, including substandard housing facilities. Therefore this study took into consideration several social determinants of health, including the economic, environmental, and social conditions that contribute towards dengue transmission. The research was conducted over a period of 18 months across 14 PPRs in Klang Valley, Malaysia. Overall seroprevalence of anti-dengue immunoglobulin G (IgG) was 78.2% (CL: 72.5-83.1) among the 436 residents who participated in the study, while seroprevalence of anti-dengue IgM was 0.9% (CL: 0.2-3.2). Log-linear statistical models with the presence/absence of anti-dengue IgG and individual factors showed significant associations of anti-dengue IgG with age, income, location, and waste bin conditions, but ethnicity was just at the wrong side of the cut-off for significance. However, a multifactorial model, in which all relevant factors were taken into account, showed that location and ethnicity were the key risk factors. For anti-dengue IgM, the only significant association was with the presence of stagnant water bodies around the compounds. Findings from this study highlight an acute need for improvements in the environmental and societal health of those residing in PPRs in locations that are particularly at risk, and continuous community empowerment to ensure that the preventive measures taken to eradicate dengue are locally sustainable.

Matched MeSH terms: Antibodies, Viral/blood
Application of streptavidin mass spectrometric immunoassay tips for immunoaffinity based antibody phage display panning

Chin CF, Ler LW, Choong YS, Ong EB, Ismail A, Tye GJ, et al.

J Microbiol Methods, 2016 Jan;120:6-14.
PMID: 26581498 DOI: 10.1016/j.mimet.2015.11.007

Antibody phage display panning involves the enrichment of antibodies against specific targets by affinity. In recent years, several new methods for panning have been introduced to accommodate the growing application of antibody phage display. The present work is concerned with the application of streptavidin mass spectrometry immunoassay (MSIA™) Disposable Automation Research Tips (D.A.R.T's®) for antibody phage display. The system was initially designed to isolate antigens by affinity selection for mass spectrometry analysis. The streptavidin MSIA™ D.A.R.T's® system allows for easy attachment of biotinylated target antigens on the solid surface for presentation to the phage library. As proof-of-concept, a domain antibody library was passed through the tips attached with the Hemolysin E antigen. After binding and washing, the bound phages were eluted via standard acid dissociation and the phages were rescued for subsequent panning rounds. Polyclonal enrichment was observed for three rounds of panning with five monoclonal domain antibodies identified. The proposed method allows for a convenient, rapid and semi-automated alternative to conventional antibody panning strategies.

Matched MeSH terms: Antibodies, Viral/genetics; Antibodies, Viral/immunology; Antibodies, Viral/isolation & purification; Antibodies, Viral/chemistry
Fulltext Recombinant measles virus vaccine expressing the Nipah virus glycoprotein protects against lethal Nipah virus challenge

Yoneda M, Georges-Courbot MC, Ikeda F, Ishii M, Nagata N, Jacquot F, et al.

PLoS One, 2013;8(3):e58414.
PMID: 23516477 DOI: 10.1371/journal.pone.0058414

Nipah virus (NiV) is a member of the genus Henipavirus, which emerged in Malaysia in 1998. In pigs, infection resulted in a predominantly non-lethal respiratory disease; however, infection in humans resulted in over 100 deaths. Nipah virus has continued to re-emerge in Bangladesh and India, and person-to-person transmission appeared in the outbreak. Although a number of NiV vaccine studies have been reported, there are currently no vaccines or treatments licensed for human use. In this study, we have developed a recombinant measles virus (rMV) vaccine expressing NiV envelope glycoproteins (rMV-HL-G and rMV-Ed-G). Vaccinated hamsters were completely protected against NiV challenge, while the mortality of unvaccinated control hamsters was 90%. We trialed our vaccine in a non-human primate model, African green monkeys. Upon intraperitoneal infection with NiV, monkeys showed several clinical signs of disease including severe depression, reduced ability to move and decreased food ingestion and died at 7 days post infection (dpi). Intranasal and oral inoculation induced similar clinical illness in monkeys, evident around 9 dpi, and resulted in a moribund stage around 14 dpi. Two monkeys immunized subcutaneously with rMV-Ed-G showed no clinical illness prior to euthanasia after challenge with NiV. Viral RNA was not detected in any organ samples collected from vaccinated monkeys, and no pathological changes were found upon histopathological examination. From our findings, we propose that rMV-NiV-G is an appropriate NiV vaccine candidate for use in humans.

Matched MeSH terms: Antibodies, Viral/blood; Antibodies, Viral/immunology
Immunogenicity of a truncated enterovirus 71 VP1 protein fused to a Newcastle disease virus nucleocapsid protein fragment in mice

Ch'ng WC, Saw WT, Yusoff K, Shafee N

Acta Virol., 2011;55(3):227-33.
PMID: 21978156

Enterovirus 71 (EV71) is one of the viruses that cause hand, foot and mouth disease. Its viral capsid protein 1 (VP1), which contains many neutralization epitopes, is an ideal target for vaccine development. Recently, we reported the induction of a strong immune response in rabbits to a truncated VP1 fragment (Nt-VP1t) displayed on a recombinant Newcastle disease virus (NDV) capsid protein. Protective efficacy of this vaccine, however, can only be tested in mice, since all EV71 animal models thus far were developed in mouse systems. In this study, we evaluated the type of immune responses against the protein developed by adult BALB/c mice. Nt-VP1t protein induced high levels of VP1 IgG antibody production in mice. Purified VP1 antigen stimulated activation, proliferation and differentiation of splenocytes harvested from these mice. They also produced significant levels of IFN-γ, a Th1-related cytokine. Taken together, Nt-VP1t protein is a potent immunogen in adult mice and our findings provide the data needed for testing of its protective efficacy in mouse models of EV71 infections.

Matched MeSH terms: Antibodies, Viral/analysis; Antibodies, Viral/biosynthesis
Fulltext Investigation of a potential zoonotic transmission of orthoreovirus associated with acute influenza-like illness in an adult patient

Chua KB, Voon K, Yu M, Keniscope C, Abdul Rasid K, Wang LF

PLoS One, 2011;6(10):e25434.
PMID: 22022394 DOI: 10.1371/journal.pone.0025434

Bats are increasingly being recognized as important reservoir hosts for a large number of viruses, some of them can be highly virulent when they infect human and livestock animals. Among the new bat zoonotic viruses discovered in recent years, several reoviruses (respiratory enteric orphan viruses) were found to be able to cause acute respiratory infections in humans, which included Melaka and Kampar viruses discovered in Malaysia, all of them belong to the genus Orthoreovirus, family Reoviridae. In this report, we describe the isolation of a highly related virus from an adult patient who suffered acute respiratory illness in Malaysia. Although there was no direct evidence of bat origin, epidemiological study indicated the potential exposure of the patient to bats before the onset of disease. The current study further demonstrates that spillover events of different strains of related orthoreoviruses from bats to humans are occurring on a regular basis, which calls for more intensive and systematic surveillances to fully assess the true public health impact of these newly discovered bat-borne zoonotic reoviruses.

Matched MeSH terms: Antibodies, Viral/blood; Antibodies, Viral/immunology
A phage-displayed single chain variable fragment that interacts with hepatitis B core antigen: library construction, selection and diagnosis

Tan GH, Yusoff K, Seow HF, Tan WS

J Clin Virol, 2007 Jan;38(1):49-56.
PMID: 17074533

Phage display is an alternative method for constructing and selecting antibodies with desired specificity towards an antigen.

Matched MeSH terms: Antibodies, Viral/genetics*; Antibodies, Viral/immunology*
Fulltext Development of enhanced antibody response toward dual delivery of nano-adjuvant adsorbed human Enterovirus-71 vaccine encapsulated carrier

Saeed MI, Omar AR, Hussein MZ, Elkhidir IM, Sekawi Z

Hum Vaccin Immunother, 2015;11(10):2414-24.
PMID: 26186664 DOI: 10.1080/21645515.2015.1052918

This study introduces a new approach for enhancing immunity toward mucosal vaccines. HEV71 killed vaccine that is formulated with nanosize calcium phosphate adjuvant and encapsulated onto chitosan and alginate delivery carriers was examined for eliciting antibody responses in serum and saliva collected at weeks 0, 1, 3, 5, 7 and 9 for viral-specific IgA & IgG levels and viral neutralizing antibody titers. The antibody responses induced in rabbits by the different formulations delivered by a single (buccal) route were compared to those of dual immunization (intradermal / mucosal) and un-immunized control. Chitosan-loaded vaccine adjuvant induced elevated IgA antibody, while Alginate-adjuvant irreversible bonding sequestered the vaccine and markedly reduced immunogenicity. The induced mucosal and parenteral antibody profiles appeared in an inverse manner of enhanced mucosal IgA antibody accompanied by lower systemic IgG following a single oral immunization route. The combined intradermal and oral dual-immunized group developed an elevated salivary IgA, systemic IgG, and virus neutralizing response. A reduced salivary neutralizing antibody titer was observed and attributed to the continual secretion exchanges in saliva. Designing a successful mucosal delivery formulation needs to take into account the vaccine delivery site, dosage, adjuvant and carrier particle size, charge, and the reversibility of component interactions. The dual immunization seems superior and is a important approach for modulating the antibody response and boosting mucosal protection against HEV71 and similar pathogens based on their transmission mode, tissue tropism and shedding sites. Finally, the study has highlighted the significant role of dual immunization for simultaneous inducing and modulating the systemic and mucosal immune responses to EV71.

Matched MeSH terms: Antibodies, Viral/analysis*; Antibodies, Viral/blood
Fulltext Clinical features of Nipah virus encephalitis among pig farmers in Malaysia

Goh KJ, Tan CT, Chew NK, Tan PS, Kamarulzaman A, Sarji SA, et al.

N Engl J Med, 2000 Apr 27;342(17):1229-35.
PMID: 10781618 DOI: 10.1056/NEJM200004273421701

BACKGROUND: Between September 1998 and June 1999, there was an outbreak of severe viral encephalitis due to Nipah virus, a newly discovered paramyxovirus, in Malaysia.
METHODS: We studied the clinical features of the patients with Nipah virus encephalitis who were admitted to a medical center in Kuala Lumpur. The case definition was based on epidemiologic, clinical, cerebrospinal fluid, and neuroimaging findings.
RESULTS: Ninety-four patients with Nipah virus infection were seen from February to June 1999 (mean age, 37 years; ratio of male patients to female patients, 4.5 to 1). Ninety-three percent had had direct contact with pigs, usually in the two weeks before the onset of illness, suggesting that there was direct viral transmission from pigs to humans and a short incubation period. The main presenting features were fever, headache, dizziness, and vomiting. Fifty-two patients (55 percent) had a reduced level of consciousness and prominent brain-stem dysfunction. Distinctive clinical signs included segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia and thus suggest the involvement of the brain stem and the upper cervical spinal cord. The initial cerebrospinal fluid findings were abnormal in 75 percent of patients. Antibodies against Hendra virus were detected in serum or cerebrospinal fluid in 76 percent of 83 patients tested. Thirty patients (32 percent) died after rapid deterioration in their condition. An abnormal doll's-eye reflex and tachycardia were factors associated with a poor prognosis. Death was probably due to severe brain-stem involvement. Neurologic relapse occurred after initially mild disease in three patients. Fifty patients (53 percent) recovered fully, and 14 (15 percent) had persistent neurologic deficits.
CONCLUSIONS: Nipah virus causes a severe, rapidly progressive encephalitis with a high mortality rate and features that suggest involvement of the brain stem. The infection is associated with recent contact with pigs.

Matched MeSH terms: Antibodies, Viral/blood; Antibodies, Viral/cerebrospinal fluid

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