Human infection is rare, but often fatal; therefore, prompt management of likely exposure is critical to preventing disease progression.
Should be suspected when illness follows exposure to macaque monkeys or their body fluids or tissues. Immediate thorough cleansing of the exposed area combined with antiviral prophylaxis may prevent infection.
Untreated infection often leads to CNS disease and death, with a mortality rate of approximately 80%. Early and aggressive antiviral treatment may prevent death.
Herpes B virus infection in humans is caused by the zoonotic Macacine herpesvirus 1 (MHV-1), previously known as Cercopithecine herpesvirus 1 (CHV-1). It is mainly found in macaque monkeys and they appear to be its natural host. Of all the simplex herpesviruses identified in non-human primates, only B virus is known to be pathogenic for humans.
Infection in humans is usually caused by the bite or scratch from an infected animal, a percutaneous injury contaminated by macaque body fluids, or from mucosal or non-intact skin contact with infected body fluid or tissue (e.g., in a laboratory or animal handling facility).
Infection in humans is rare, but when it does occur it often presents with flu-like symptoms (fever, muscle aches, fatigue, and headache). Neurological symptoms usually develop, which result in fatal encephalomyelitis or severe neurological impairment if not treated early.
History and exam
- presence of risk factors
- fever (≥37.5°C)
- flu-like symptoms
- severe persistent headache
- ocular pain
- gait disturbances
- muscle weakness (paresis)
- persistent hiccups
- ascending or acute flaccid paralysis
- vesicular lesions
D. Scott Schmid, PhD
Centers for Disease Control and Prevention
DSS declares that he has no competing interests. The views included in this topic are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Institutes of Health.
Jeffrey I. Cohen, MD
Chief, Laboratory of Infectious Diseases
Chief, Medical Virology Section
National Institutes of Health
JIC is the author of a reference cited in this monograph. The views included in this topic are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Institutes of Health.
Dr D. Scott Schmid and Dr Jeffrey I. Cohen would like to gratefully acknowledge Dr Louisa E. Chapman, a previous contributor 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 and LEC are the authors of several references cited in this topic.
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.
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