Limits...
Human Hendra virus encephalitis associated with equine outbreak, Australia, 2008.

Playford EG, McCall B, Smith G, Slinko V, Allen G, Smith I, Moore F, Taylor C, Kung YH, Field H - Emerging Infect. Dis. (2010)

Bottom Line: Both patients were given ribavirin.Basal serum and cerebrospinal fluid levels were 10-13 mg/L after intravenous administration and 6 mg/L after oral administration (isolate 90% inhibitory concentration 64 mg/L).An isolate from this outbreak showed genetic heterogeneity with isolates from a concurrent, but geographically remote, outbreak and from previous outbreaks.

View Article: PubMed Central - PubMed

Affiliation: Pathology Queensland, Brisbane, Queensland, Australia.

ABSTRACT
A recent Hendra virus outbreak at a veterinary clinic in Brisbane, Queensland, Australia, involved 5 equine and 2 human infections. In contrast to previous outbreaks, infected horses had predominantly encephalitic, rather than respiratory, signs. After an incubation period of 9-16 days, influenza-like illnesses developed in the 2 persons before progressing to encephalitis; 1 died. Both patients were given ribavirin. Basal serum and cerebrospinal fluid levels were 10-13 mg/L after intravenous administration and 6 mg/L after oral administration (isolate 90% inhibitory concentration 64 mg/L). Both patients were exposed to infected horses, 1 during the late incubation period in a horse. The attack rate for veterinary clinic staff exposed to infected horses was 10%. An isolate from this outbreak showed genetic heterogeneity with isolates from a concurrent, but geographically remote, outbreak and from previous outbreaks. Emergence of Hendra virus is a serious medical, veterinary, and public health challenge.

Show MeSH

Related in: MedlinePlus

Magnetic resonance imaging scans of the brains of 2 patients with Hendra virus encephalitis, Australia, 2008. A) Patient 1 on day 18 of illness, showing cortical and subcortical hyperintense foci. B) Patient 2 on day 25 of illness, showing hyperintense foci in the left precentral gyrus (arrowhead).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2957996&req=5

Figure 1: Magnetic resonance imaging scans of the brains of 2 patients with Hendra virus encephalitis, Australia, 2008. A) Patient 1 on day 18 of illness, showing cortical and subcortical hyperintense foci. B) Patient 2 on day 25 of illness, showing hyperintense foci in the left precentral gyrus (arrowhead).

Mentions: Over the next 4 days (to day 10) progressive neurologic signs and high-grade fever developed, culminating in a generalized partial tonic-clonic seizure. During the next 4 weeks, the patient required mechanical ventilation, remained febrile, and despite control of seizure activity and minimal sedation, remained deeply unconscious with minimally reactive pupils. Treatment with ribavirin was stopped after 12 days of therapy when the patient’s hemoglobin level decreased to 76 g/L. Serial MRI showed marked progression with innumerable cortical, subcortical, and brainstem hyperintense foci on T2 flair images with matching diffusion restriction, and leptomeningeal enhancement (Figure 1, panel A). Serial EEGs showed an absence of a stable background rhythm, slow wave activity with periodic sharp discharges, and a right-sided epileptogenic focus. CSF on day 28 had a leukocyte count of 84 × 106 cells/L, a protein level of 650 mg/L, and a glucose level of 4.3 mmol/L; Hendra virus RNA was not detected by RT-PCR. He died on day 40 of illness. A postmortem examination was not performed because a risk assessment conducted by Queensland Health concluded that an examination could not be performed in Queensland.


Human Hendra virus encephalitis associated with equine outbreak, Australia, 2008.

Playford EG, McCall B, Smith G, Slinko V, Allen G, Smith I, Moore F, Taylor C, Kung YH, Field H - Emerging Infect. Dis. (2010)

Magnetic resonance imaging scans of the brains of 2 patients with Hendra virus encephalitis, Australia, 2008. A) Patient 1 on day 18 of illness, showing cortical and subcortical hyperintense foci. B) Patient 2 on day 25 of illness, showing hyperintense foci in the left precentral gyrus (arrowhead).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2957996&req=5

Figure 1: Magnetic resonance imaging scans of the brains of 2 patients with Hendra virus encephalitis, Australia, 2008. A) Patient 1 on day 18 of illness, showing cortical and subcortical hyperintense foci. B) Patient 2 on day 25 of illness, showing hyperintense foci in the left precentral gyrus (arrowhead).
Mentions: Over the next 4 days (to day 10) progressive neurologic signs and high-grade fever developed, culminating in a generalized partial tonic-clonic seizure. During the next 4 weeks, the patient required mechanical ventilation, remained febrile, and despite control of seizure activity and minimal sedation, remained deeply unconscious with minimally reactive pupils. Treatment with ribavirin was stopped after 12 days of therapy when the patient’s hemoglobin level decreased to 76 g/L. Serial MRI showed marked progression with innumerable cortical, subcortical, and brainstem hyperintense foci on T2 flair images with matching diffusion restriction, and leptomeningeal enhancement (Figure 1, panel A). Serial EEGs showed an absence of a stable background rhythm, slow wave activity with periodic sharp discharges, and a right-sided epileptogenic focus. CSF on day 28 had a leukocyte count of 84 × 106 cells/L, a protein level of 650 mg/L, and a glucose level of 4.3 mmol/L; Hendra virus RNA was not detected by RT-PCR. He died on day 40 of illness. A postmortem examination was not performed because a risk assessment conducted by Queensland Health concluded that an examination could not be performed in Queensland.

Bottom Line: Both patients were given ribavirin.Basal serum and cerebrospinal fluid levels were 10-13 mg/L after intravenous administration and 6 mg/L after oral administration (isolate 90% inhibitory concentration 64 mg/L).An isolate from this outbreak showed genetic heterogeneity with isolates from a concurrent, but geographically remote, outbreak and from previous outbreaks.

View Article: PubMed Central - PubMed

Affiliation: Pathology Queensland, Brisbane, Queensland, Australia.

ABSTRACT
A recent Hendra virus outbreak at a veterinary clinic in Brisbane, Queensland, Australia, involved 5 equine and 2 human infections. In contrast to previous outbreaks, infected horses had predominantly encephalitic, rather than respiratory, signs. After an incubation period of 9-16 days, influenza-like illnesses developed in the 2 persons before progressing to encephalitis; 1 died. Both patients were given ribavirin. Basal serum and cerebrospinal fluid levels were 10-13 mg/L after intravenous administration and 6 mg/L after oral administration (isolate 90% inhibitory concentration 64 mg/L). Both patients were exposed to infected horses, 1 during the late incubation period in a horse. The attack rate for veterinary clinic staff exposed to infected horses was 10%. An isolate from this outbreak showed genetic heterogeneity with isolates from a concurrent, but geographically remote, outbreak and from previous outbreaks. Emergence of Hendra virus is a serious medical, veterinary, and public health challenge.

Show MeSH
Related in: MedlinePlus