Case history
Case history #1
A 21-year-old university student attends the accident and emergency department with a 2-day history of fever, headache, and dry cough. He has recently returned from visiting his family in Nilphamari, Bangladesh for the Christmas holidays. Further history reveals he took malaria prophylaxis and used DEET (N,N-diethyl-3-methylbenzamide) spray religiously. On examination, he is febrile (38.6°C [101.4°F]), tachycardic (pulse 120 bpm), and hypertensive (BP 160/100 mmHg). He looks unwell and is confused. Routine blood tests reveal a transaminitis and thrombocytopenia, but are otherwise unremarkable. CXR is normal. CT head reveals no abnormality, with no evidence of cerebral oedema or mass lesion. A lumbar puncture is performed, which shows raised lymphocyte count, raised protein, and normal glucose. He is treated empirically for herpes simplex virus encephalitis with intravenous aciclovir and referred to the infectious disease specialist. Both serum and cerebrospinal fluid (CSF) are sent for both Hendra virus (HeV) and Nipah virus (NiV) serology as well as reverse transcription-polymerase chain reaction for NiV (as presentation seems to fit with Japanese encephalitis or NiV infections) after discussion with the local virology laboratory. Over the next 24 hours, the patient’s conscious level deteriorates and he is transferred to the intensive care unit where he is intubated and ventilated. He is isolated in a side room; strict barrier nursing practices are used, with personal protective equipment worn by all staff. An MRI brain is performed, which shows widespread hyperintense discrete lesions in white matter. In 48 hours, the patient’s NiV serology results are phoned through: NiV IgM is positive on serum and CSF.
Case history #2
A 49-year-old equine veterinarian in Brisbane attends her GP with a 4-day history of headache, fever, and myalgia. On examination, she is febrile (temperature 38.2°C [100.8°F]), but observations are otherwise unremarkable. She has no obvious localising signs. She is alert and orientated. Neurological examination is normal. Two weeks later, blood is tested for IgM against HeV with a positive result.
Use of this content is subject to our disclaimer