Nipah Virus and Zika Virus

Nipah Virus

The Nipah Virus belongs to the Family Paramyxovirus and the genus Henipa virus or Hendra virus (Hev). It occurs naturally in bats, pigs, horses, or dogs.

The current Death rate associated with Nipah Virus is 40-70%. The incubation period of the disease is 4 – 14 days.

The first case of the Nipah virus was reported in Malaysia, mainly among people who worked in Pig farms.

The Initial report of the Nipah virus was from a village in Malaysia, and then it spread to other parts of the World, like India, Bangladesh, etc. The source of the virus is fruits contaminated with the droppings or saliva of Pteropus/ Flying Fox (BAT). Nipah Virus is a negative single-stranded RNA virus.

Modes of Transmission of Nipah Virus

• It can be transmitted through Pigs, mainly to farm workers
• It is also found in the Saliva-contaminated fruits
• The transmission of the Nipah virus is Man-to-man transmission.
• Nipah virus is a Category C Bioterrorism agent.

Clinical manifestation of Nipah virus

• Fever: A moderate to High-Grade fever is the most common clinical feature of Nipah virus infection
• Headache
• Dizziness and vertigo
• Altered sensorium is an initial symptom that is seen on day 1 of illness.
• The progression of the disease is very fast, and it rapidly worsens in about 4 days.
• Other symptoms reported:
  • Myoclonic jerk
  • Seizures
  • Hallucinations
  • Abnormal doll eye Reflexes
• Respiratory symptoms:
  • Respiratory distress
  • Cough
  • ARDS
•  Neurological illness can also set in where the GCS <8.

Work Up of Nipah Virus

• Serum IgM captures E.I.A from Nipah virus or Hendra virus,
  • IgG indirect E.I.A for Nipah virus/ Hendra virus
• Lumbar puncture: CSF Reverse Transcriptase PCR
• MRI head: Punctuate hyperdensities (due to vasculitis manifestation of disease microinfarction in the brain.)

Management of the Nipah Virus

• There is no vaccine for Nipah Virus.
• There is no treatment for Nipah Virus, but symptomatic treatment can be given for specific ailments.
• Some improvement in patients is observed with the usage of
  • Ribavirin
  • M 102.4: currently in Phase 1 trial
• Monoclonal Ab against Henipa virus G protein: used to prevent further damage to the brain by blocking the receptor engagement.

Zika Virus

Zika Virus is a single-stranded RNA virus that belongs to the Family “Flavivirus.”

The Cases were reported first in 2016. It was reported In Rio (Brazil) that children born in 2016 had microcephaly. Microcephaly is a neurological sequel, which implies that the mother must suffer from Zika Virus infection.

There is an Increased incidence of GBS in people exposed to Zika virus infection. The Incubation period of Zika Virus is 3-12 days. The Fever can last between 2-7 days.

The Transmission of Zika Virus is through Aedes Aegypti. This mosquito is present at more than 2000 m altitude. There is also a risk of Sexual transmission (man to man).

Clinical features of Zika Virus

• Fever
• Retro orbital pain: pain behind the eyes
• Arthralgia: pain in mainly small joints of hands)
• Rashes on the Palms, chest, and trunk can also be present throughout the fever.
• Conjunctivitis
• It is a self-limiting illness.

Clinical Features of Zika Virus in Infant 

• Microcephaly: Head circumference < -3 SD
• Abnormal foveal reflex
• Macular atrophy
• Hypoplasia of optic nerve head
• Incidence of GBS increases

Work-up of Zika Virus

• Investigation of choice: Urine Assay: Urine Triplex PCR (rRT – PCR) (Combination of Real-time and Reverse Transcriptase PCR)
• Blood sample: RT – PCR
• ELISA IgM Zika (demonstrated only if > 7 days)
• Pregnant Female
  • Serial USG: microcephaly
  • Amniocentesis

Treatment of Zika Virus

• There is no definite management.
• No Vaccine

Frequently Asked Questions:

Q: Where can punctuate hyperdensities on the MRI head be seen, and in which disease?

Answer: Nipah Virus

Q: What is the Incubation Period of the Nipah Virus?

Answer: 4-14 Days

Q: What is the Incubation Period of the Zika Virus?

Answer: 3-12 Days

Q: Is there any vaccination for the Zika Virus?

Answer: No

Q: What is the best method for confirming the presence of the Zika virus?

Answer: Urine Assay: Urine Triplex PCR (rRT – PCR), which is a Combination of Real-time and Reverse Transcriptase PCR. 

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