Nipah Virus Infection: From Spillover to the ICU — Virology, Pathophysiology, Clinical Syndromes, Diagnostics, and Infection Prevention

Nipah virus (NiV) is a zoonotic henipavirus associated with sporadic outbreaks and high case
fatality. In clinical practice, the main threat is not only individual severity—often characterized by
encephalitis and/or severe respiratory failure—but also the potential for healthcare-associated
transmission when early suspicion and infection prevention and control (IPC) measures are
delayed. This narrative review connects key aspects of NiV biology with bedside decision-making
in emergency and critical care settings. We emphasize the mechanistic entry axis (G glycoprotein
binding to ephrin-B2/B3 receptors followed by F-mediated membrane fusion) as a unifying
framework that explains tissue tropism for endothelium and the central nervous system, and that
also informs investigational countermeasures (neutralizing antibodies and vaccines targeting
entry). We summarize transmission pathways (bat-to-human, animal-to-human, and person-to
person), typical incubation and symptom patterns, diagnostic approaches (RT-PCR and serology)
and biosafety considerations, and practical management centered on high-quality supportive
critical care and strict IPC. Finally, we briefly review the current landscape of therapeutic and
vaccine research, highlighting that no licensed specific treatment or vaccine exists to date.