Is cough a symptom of Nipah virus infection, particularly in older adults with underlying medical conditions such as chronic obstructive pulmonary disease (COPD) or heart failure?

Is Cough a Symptom of Nipah Virus Infection?

Yes, cough is a common and prominent symptom of Nipah virus infection, occurring in the majority of patients and representing one of the key clinical features of this severe zoonotic disease. 1

Clinical Presentation of Nipah Virus

Cough ranks among the most frequently reported symptoms in Nipah virus infection, appearing alongside fever, altered mental status, headache, respiratory difficulty, vomiting, and convulsions. 1 In the Bangladesh outbreaks during 2001-2004, cough was documented as one of the most common presenting signs in patients with confirmed Nipah virus infection. 1

Respiratory Manifestations

• Respiratory involvement is substantial in Nipah virus infection, with clinical and radiographic features of acute respiratory distress syndrome (ARDS) identified during documented outbreaks. 1
• The clinical presentation ranges from asymptomatic infection to fatal encephalitis, with severe respiratory disease being a hallmark feature. 2
• Nipah virus causes severe neurological AND respiratory disease, distinguishing it from purely neurological infections. 3, 4

High-Risk Populations

Older adults with underlying conditions like COPD or heart failure face particularly elevated risk when infected with Nipah virus, as the severe respiratory component can rapidly progress to respiratory failure. 1 Patients who died from Nipah virus infection were significantly more likely to have difficulty breathing compared to survivors. 1

Disease Severity and Progression

• The mortality rate for Nipah virus infection is extremely high at 73% based on Bangladesh outbreak data. 1
• Among fatal cases, death occurred a median of 6 days (range 2-36 days) after illness onset. 1
• Patients who died were more likely to present with fever >37.8°C, altered mental status, difficulty breathing, and abnormal plantar reflexes. 1

Geographic and Transmission Considerations

• Outbreaks have occurred in Malaysia, Singapore, Bangladesh, India, and the Philippines. 3, 2
• Human-to-human transmission is common in Bangladesh, occurring through close contact with clinically-unwell patients or their infectious secretions. 5
• The median incubation period is 9 days (range 6-11 days) among patients with well-defined exposure. 1

Clinical Pitfalls

The respiratory symptoms of Nipah virus, including cough, can initially mimic common respiratory infections, potentially delaying diagnosis and implementation of critical infection control measures. 4 Rapid diagnosis is essential to contain outbreaks, as the virus is highly infectious and spreads through infected animals or people. 4

There are currently no effective therapeutics available, making supportive care and prevention the mainstays of management. 2 This underscores the critical importance of early recognition based on clinical features like cough in endemic areas or following potential exposure.