Nipah virus infection: Pathology and pathogenesis of an emerging paramyxoviral zoonosis

Kum Thong Wong, Wun Ju Shieh, Shalini Kumar, Karim Norain, Wahidah Abdullah, Jeannette Guarner, Cynthia S. Goldsmith, Kaw Bing Chua, Sai Kit Lam, Chong Tin Tan, Khean Jin Goh, Heng Thay Chong, Rani Jusoh, Pierre E. Rollin, Thomas G. Ksiazek, Sherif R. Zaki, Jeanine Bartlett, Tara Ferebee-Harris, Patricia Greer, Lisa M. HarperJeltley Montague, Tim Morken, Chalanda Smith, Sharifah Safoorah Syed Alwee, Thuaibah Hashim, Khairul Azman Ibrahim, Fauziah Kassim, Lily Manoramah, George Paul, Norraha Abdul Rahman, Kalyani Supramaniam, Thayaparan Tarmizi, Nor Yatizah, Mohc Yatim, Rosna Yunus, Suryati Yusuf

Research output: Contribution to journalArticlepeer-review

246 Scopus citations


In 1998, an outbreak of acute encephalitis with high mortality rates among pig handlers in Malaysia led to the discovery of a novel paramyxovirus named Nipah virus. A multidisciplinary investigation that included epidemiology, microbiology, molecular biology, and pathology was pivotal in the discovery of this new human infection. Clinical and autopsy findings were derived from a series of 32 fatal human cases of Nipah virus infection. Diagnosis was established in all cases by a combination of immunohistochemistry (IHC) and serology. Routine histological stains, IHC, and electron microscopy were used to examine autopsy tissues. The main histopathological findings included a systemic vasculitis with extensive thrombosis and parenchymal necrosis, particularly in the central nervous system. Endothelial cell damage, necrosis, and syncytial giant cell formation were seen in affected vessels. Characteristic viral inclusions were seen by light and electron microscopy. IHC analysis showed widespread presence of Nipah virus antigens in endothelial and smooth muscle cells of blood vessels. Abundant viral antigens were also seen in various parenchymal cells, particularly in neurons. Infection of endothelial cells and neurons as well as vasculitis and thrombosis seem to be critical to the pathogenesis of this new human disease.

Original languageEnglish (US)
Pages (from-to)2153-2167
Number of pages15
JournalAmerican Journal of Pathology
Issue number6
StatePublished - Dec 1 2002
Externally publishedYes

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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