You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

..
  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.



Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Password
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.09.1401   (build 62b8f0e)
Select Language


Select Region

Send us your feedback

E-mail
Message
This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email feedback@visualdx.com with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.

OK

Share This Page

Thank You!

We have sent an e-mail with a link to the current page.

OK

E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.

OK

Image Contributors

Individuals

  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Mary J. Spencer MD, FAAP
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD


Organizations

  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Potentially life-threatening emergency
Herpes B virus infection
Print
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Herpes B virus infection

Print Images (1)
Contributors: Tara Babu MD, Mukesh Patel MD
Other Resources UpToDate PubMed

Synopsis

Herpes B virus is also known as Cercopithecine herpesvirus 1, herpesvirus simiae, B virus, and Macacine herpesvirus 1. The term "B virus" will be used in this discussion. Infection typically causes an asymptomatic herpes simplex virus-like infection in its natural primate host, Asian macaques. Transmission of B virus to humans can result in a fatal encephalomyelitis.

All species of macaques may carry B virus, including colonies exported from Asia to other parts of the world and those in zoos or research facilities. The virus has been most commonly isolated from rhesus macaques (Macaca mulatta) and cynomolgus monkeys (Macaca fascicularis). Other infected species include the pig-tailed macaque (Macaca nemestrina), bonnet macaque (Macaca radiata), Japanese macaque (Macaca fuscata), stump-tailed macaque (Macaca arctoides), and Taiwan macaque (Macaca cyclopis).

Animals spread B virus through oral and genital secretions. The virus can be stored in sensory ganglia and reactivate in monkeys, resulting in viral shedding. Humans are infected when exposed to oral, genital, or ocular secretions from an infected monkey, usually via a bite or scratch. Humans have also been infected when exposed to infected tissue and infected fomites (eg, needlestick or cages). Inhalation of aerosolized infected material can lead to infection. Human-to-human transmission due to direct contact of a monkey bite wound from the index patient has been reported. Non-macaque monkeys can acquire B virus from macaques if housed in close proximity and can develop symptomatic disease that is transmissible to humans.

Herpes B virus infection in humans is uncommon, with only several dozen cases reported since 1933. The incubation period for B virus in humans typically ranges from several days to 5 weeks after exposure. Reactivation of disease, years after monkey exposure, has occurred.

Several clinical manifestations of B virus have been described in humans and can overlap with each other. 1) Vesicular or ulcerative lesions at the site of exposure, pain, and regional lymphadenopathy. 2) Flu-like illness consisting of fever, headache, and myalgias followed by neurologic symptoms of numbness, paresthesias, and central nervous system (CNS) symptoms. 3) CNS symptoms vary with the region of brain or spinal cord that is affected but include headache, cranial nerve abnormalities, meningoencephalitis, ascending flaccid paralysis, hyperesthesias, coma, seizures, dysarthria, and dysphagia. Asymptomatic infection with herpes B virus has not been proven to occur. Death follows CNS infection, usually from respiratory failure due to ascending paralysis.

Persons with the highest risk for B virus infection include veterinarians and biomedical laboratory workers who have contact with macaques, and those who work with monkey cell cultures.

Codes

ICD10CM:
B00.4  – Herpesviral encephalitis

SNOMEDCT:
284595000 – Herpes B virus

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Rabies – The likelihood of rabies can be considered based on the source animal species, vaccination status of the animal and the human, and whether the animal exhibited symptoms or not. Non-human primates can develop rabies following infection; it is usually symptomatic and rapidly fatal.
  • Other herpesvirus encephalitides – Herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) can all cause meningoencephalitis. HSV typically manifests as unilateral temporal lobe encephalitis. Polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) can differentiate the viruses. Cross-reactivity between herpes viruses and B virus can occur with antibody testing.
  • Enteroviral meningitis – Rash may be present; seasonal.
  • Japanese encephalitis – Travel to Asia and specifically rural areas, especially if not vaccinated.
  • St. Louis encephalitis
  • West Nile encephalitis (see also West Nile virus) – Fever, flaccid paralysis can occur; seasonal with most cases occurring in the summer.
  • Bacterial meningitis – Cerebrospinal fluid frequently with significant leukocytosis; gram stain may be revealing. Cultures frequently positive. Children, elderly individuals, and immunocompromised individuals are at higher risk of infection.
  • Eastern equine encephalitis
  • Human transmissible spongiform encephalopathies (eg, bovine spongiform encephalopathy) – Progressive dementia.
  • Poliovirus – Exposure to endemic areas and a history of incomplete vaccination. Flaccid paralysis can occur.
  • Brain abscess – Focal neurological signs and symptoms more likely; encephalitis not typical. Imaging can reveal focal lesions.
  • Monkeypox – Can present with vesicle around bite wound and later disseminated vesicles that resemble smallpox. Although discovered in monkeys, it is typically associated with Gambian rats, prairie dogs, and African squirrels. CNS manifestations are uncommon.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 12/08/2014
Copyright © 2018 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Herpes B virus infection
Print 1 Images
Herpes B virus infection : Chills, Fever, Headache, Monkey exposure, Vesicle, Myalgia
Copyright © 2018 VisualDx®. All rights reserved.