Herpes B virus encephalomyelitis

Herpes B virus encephalomyelitis is an occupational hazard for workers who handle macaque monkeys (bites, scratches, or eye exposure from fomites).The case-fatality rate is about 80% in untreated patients. Macaque monkeys are the natural hosts for this virus.

CASES/YEAR
1 (US); 20 (Global)
CATEGORY
Zoonoses
AGENT TYPE
Viruses
OTHER NAMES
Herpesviral encephalitis, simian B; B virus; Simian B disease; Encephalomyelitis due to cercopithecine herpesvirus 1;
ACUITY
Acute-Severe
INCUBATION
3 days to 3 weeks; [CCDM]
INITIAL SYMPTOMS
Fever, headache, and localized skin vesicles; [CCDM] Some patients present with flu symptoms followed by encephalitis. May have paresthesias and weakness in extremity bitten by monkey; [PPID, p. 1905]
PRECAUTIONS
See "National B Virus Resource Center" website.
COMMENTS
Macaque monkeys are the natural hosts for this virus, and rhesus monkeys (Macaca mulatta) have 30-80% seropositive rates. "On a given day, approximately 2% of seropositive rhesus monkeys shed B virus, but shedding increases during periods of stress (e.g., shipping and handling)." B virus ascending encephalomyelitis is an occupational hazard for workers who handle macaque monkeys (bites, scratches, or eye exposure from fomites).The case-fatality rate is about 80% in untreated patients. [CCDM, p. 281-2] Patients may have vesicles at the bite site with regional lymphadenopathy. Other symptoms are sinusitis, conjunctivitis, hiccups, abdominal pain, stiff neck, dysphagia, dysarthria, ataxia, seizure, and coma. Vesicles may appear at the wound site. About 50 cases human B virus infection have been reported with about 26 well-documented. [PPID, p. 1904-5]
DIAGNOSTIC
Serology; Culture; PCR; [CCDM] See "National B Virus Resource Center" website.
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • >myalgia
  • E dysphagia
  • G abdominal pain
  • G nausea, vomiting
  • H lymphadenopathy
  • N headache
  • N lethargy
  • N muscle weakness
  • N paresthesia
  • N seizure
  • N stiff neck
  • O conjunctivitis, acute
  • S entry wound with lymph nodes
  • S skin blister or vesicles
  • *cranial neuropathy
  • *encephalitis
  • *myelitis
  • *paralysis
  • *stupor, coma
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva), Animal Bite
SOURCE
Animal Excreta
RESERVOIR
Monkeys
RISK FACTORS
  • Handle infected macaque monkeys
  • Work in a medical or research lab
DRUG LINK
CDC: B Virus First Aid and Treatment
REFERENCES FOR CASES/YEAR
1. (US) Guesstimate: 1/year;
2. (Global) Guesstimate: 20/year;