Herpes B virus infection

Last reviewed: 28 Feb 2023
Last updated: 23 Mar 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • fever (≥37.5°C)
  • flu-like symptoms
  • paraesthesias
  • hyperaesthesias
  • severe persistent headache
  • dizziness
  • ocular pain
  • gait disturbances
  • ataxia
  • diplopia
  • agitation
  • meningismus
  • muscle weakness (paresis)
  • persistent hiccups
  • dyspnoea
  • ascending or acute flaccid paralysis
  • vesicular lesions
More key diagnostic factors

Other diagnostic factors

  • nausea/vomiting
  • conjunctivitis
  • rash
  • lymphadenitis
  • lymphangitis
  • abdominal pain
Other diagnostic factors

Risk factors

  • occupational exposure
  • travel to countries with free-roaming macaques
  • keeping macaques as pets
  • exposure to non-macaque species that have been housed with macaques
More risk factors

Diagnostic investigations

1st investigations to order

  • serology
  • polymerase chain reaction (PCR)
More 1st investigations to order

Investigations to consider

  • viral culture
  • brain MRI
  • brain CT
  • CSF tests
  • EEG
  • brainstem auditory evoked responses
  • somatosensory evoked potentials
  • laboratory testing of animal specimen
More investigations to consider

Treatment algorithm


potential exposure


confirmed infection and/or symptomatic



Richard Whitley, MD

Professor of Pediatrics

Professor of Microbiology, Medicine, and Neurosurgery

University of Alabama




RW is a retired Board Member for Gilead Sciences, Inc., and a current member of Scientific Advisory Boards or Data Management Committees for Clear Creek Biosciences, Merck, Virios Therapeutics, Visby Medical, Evrys BioSciences, Enochian Biosciences, and Leyden Laboratories.


Professor Richard Whitley would like to gratefully acknowledge Dr D. Scott Schmid, Dr Jeffrey I. Cohen, and Dr Louisa E. Chapman, previous contributors to this topic, and Dr Julia K. Hilliard for her contributions to this topic. Unfortunately, we have been made aware that Dr Louisa E. Chapman is now deceased.


JKH, JIC, and LEC are the authors of several references cited in this topic. DSS declared that he had no competing interests. The views included in this topic are those of the authors (DSS and JIC) and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Institutes of Health.

Peer reviewers

Anna Maria Geretti, MD, PhD, FRCPath

Professor of Virology and Infectious Diseases

University of Liverpool




AMG declares that she has no competing interests.

Deanna Saylor, MD, MHS

Assistant Professor of Neurology

Johns Hopkins University School of Medicine




DS has received research funding from the National Institutes of Health, the World Federation of Neurology, and the Johns Hopkins Center for AIDS Research.

  • Herpes B virus infection images
  • Differentials

    • Herpes simplex encephalitis
    • Herpes zoster encephalitis
    • West Nile virus
    More Differentials
  • Guidelines

    • Health information for international travel (Yellow Book): B virus
    • Recommendations for prevention of and therapy for exposure to B virus (Cercopithecine Herpesvirus 1)
    More Guidelines
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