Herpes B virus
Background
- Cercopithecine herpesvirus 1 (commonly referred to as B virus)
- Zoonotic Endemic in Macaque Monkeys-mild symptoms like blisters
- Fatal Encephalomyelitis in Humans: 80% fetal without treatment
- Most common transmission by bite, but very few cases
- Consider in Patients with Exposure, especial penetrating bites, to Macaque Monkeys in the wild or research
Clinical Features
- Vesicular Herpetic Lesions
- Nonspecific Flu-like Illness
- Lymphadenitis
- Site of inoculation - pain, numbness, itching
- CNS - poor coordination, respiratory depression
- Encephalitis - late stage of the disease
Differential Diagnosis
Diagnostic Evaluation
- Clinical
- PCR specificity and sensitivity at nearly 100% for serologic
- PCR wound samples less reliable
- All symptomatic should be tested
Management
- Asymptomatic Prophylaxis Treatment
- Treat if high risk for transmission:
- Penetrating (especially head, neck, torso)
- Fluid on mucosa
- Blistering Monkey
- Discuss with patient
- Treat if high risk for transmission:
- Treatment
- <20 minutes clean and irrigate
- Prophylaxis:
- 14 day course of PO Valacyclovir 1gm three times daily
((14 day course of PO Acyclovir 800mg five times daily
- All non-CNS symptomatic: Admit and treat
- Acyclovir IV 12.5-15 mg/kg every eight hours OR
- Ganciclovir IV 5mg/kg every 12 hours
- All CNS Symptomatic Admit and treat
- ganciclovir IV 5mg/kg every 12 hours
- Rabies Treatment
Disposition
- Asymptomatic Discharge
- Symptomatic Admit
See Also
External Links
References
- B Virus (herpes B, monkey B virus, herpesvirus simiae, and herpesvirus B). Centers for Disease Control and Prevention Web site. http://www.cdc.gov/herpesbvirus/ Page last reviewed: July 18, 2014. Accessed April 3, 2015.
- Cohen JI, Davenport DS, Stewart JA, Deitchman S, Hilliard JK, Chapman LE; B Virus Working Group. Recommendations for prevention of and therapy for exposure to B virus (cercopithecine herpesvirus 1). Clin Infect Dis. 2002 Nov 15;35(10):1191-203. Epub 2002 Oct 17.