What is the treatment approach for a patient suspected of having Nipah virus infection?

Nipah Virus Infection Treatment

For patients with suspected Nipah virus infection, treatment is strictly supportive care with immediate isolation, intensive monitoring, and early intubation when respiratory failure threatens—there are no approved antiviral therapies, and management focuses on preventing mortality through aggressive critical care and infection control. 1, 2

Immediate Isolation and Infection Control

Isolate the patient immediately in a single, well-ventilated room with the door closed, or maintain at least 1 meter distance from other patients if a single room is unavailable. 1

• Healthcare workers must wear N95 respirators when entering the room—this is non-negotiable given the 50% person-to-person transmission rate. 1, 2
• Clean and disinfect all surfaces with 500 mg/L chlorine-containing disinfectant frequently. 1
• Healthcare workers must use full airborne precautions including N-95 respirators, gowns, aprons, and face shields when caring for suspected or confirmed cases. 2
• Family members and caregivers must wear N95 masks and avoid sharing any personal items. 1

Respiratory Support Strategy

Provide oxygen therapy immediately for any respiratory distress or hypoxemia, starting with nasal cannula at 5 L/min and titrating to maintain adequate oxygen saturation. 1

Do not delay intubation by attempting prolonged trials of non-invasive ventilation (NIV) or high-flow nasal oxygen (HFNO)—proceed to early intubation if respiratory failure is imminent. 1, 2 Treatment failure rates with NIV are high in severe viral infections, and delaying intubation increases mortality while putting healthcare workers at unnecessary risk during emergency intubation. 2

• If NIV or HFNO is attempted in carefully selected patients with mild respiratory distress, it must be done only in an ICU setting with strict airborne precautions, proper interface fitting, and a low threshold for proceeding to intubation if no improvement occurs within 1-2 hours. 2
• The American Thoracic Society recommends early intubation and invasive mechanical ventilation in patients with severe hypoxemia rather than delaying with non-invasive ventilation. 2

Critical Care Monitoring

Admit any patient with encephalitis or declining consciousness to the ICU immediately. 1

• Monitor heart rate, oxygen saturation, respiratory rate, and blood pressure continuously. 1
• Check body temperature at least every 4 hours. 1
• Dynamically monitor vital signs, neurological status, water-electrolyte balance, acid-base balance, and organ function continuously. 2
• Monitor for complications including acute respiratory distress syndrome, septic shock, stress ulcers, and deep vein thrombosis. 2
• Use continuous EEG monitoring to detect subclinical seizure activity, particularly if myoclonic jerks are present. 2

Neurological Management

Provide aggressive anticonvulsant therapy for myoclonic seizures and status epilepticus. 2 Myoclonic jerks with characteristic 1:1 relationship to EEG periodic complexes indicate severe CNS involvement and are poor prognostic signs. 2

• Dystonia, areflexia, and hypotonia are additional poor prognostic neurological signs requiring intensive monitoring. 2

Diagnostic Confirmation

Handle all specimens with biosafety level 4 precautions and perform RT-PCR testing from respiratory specimens in the acute phase. 1, 3

• Perform herpes simplex PCR on all CSF specimens to rule out treatable causes of encephalitis. 2
• Healthcare workers must avoid direct contact with patient secretions, especially oral and respiratory discharges. 1

Antiviral Considerations

Ribavirin can be considered for Nipah virus encephalitis, though evidence for efficacy is limited (C-III recommendation from the Infectious Diseases Society of America). 2, 4, 3 Currently, there are no approved drugs or vaccines specific for NiV infection. 5, 4, 6

• Other experimental options include HR2-based fusion inhibitors, convalescent plasma, monoclonal antibodies (m102.4), and favipiravir, but these lack robust clinical evidence. 4, 3

Supportive Care

Provide high-protein, high-vitamin, carbohydrate-containing diets for patients who can tolerate oral intake. 2

• For critically ill patients, dynamically assess nutritional risks and provide enteral nutrition as soon as possible; if enteral nutrition is not feasible, initiate parenteral nutrition promptly to meet energy requirements. 2
• Ensure adequate hydration throughout treatment. 7

Psychological Support

Provide psychological and humanistic care, especially for awake patients, using techniques like mindfulness-based stress reduction to relieve anxiety and panic. 2

• Positively encourage patients and address their concerns promptly to reduce fear and anxiety. 2

Critical Pitfalls to Avoid

• Do not delay intubation: Prolonged trials of NIV or HFNO increase mortality and put staff at risk during emergency intubation. 2
• Do not discharge patients without comprehensive follow-up plans: Neurological sequelae may emerge later, requiring long-term monitoring. 2
• Do not underestimate transmission risk: The 50% person-to-person transmission rate demands strict adherence to airborne precautions at all times. 2