Herpes B Clinical Presentation
- Author: Sowmya Nanjappa, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more...
Following potential exposure to herpes B virus in humans, the wound and the at-risk individual should be monitored because of the potential for severe infection, a protocol involving the exposing primate (see Lab Studies). An incubation period of 2-30 days has been described, with progression of symptoms over 7-10 days.
Early symptoms (variably present) may include the following:
Pain or pruritus at exposure site
Vesicles or ulcers at or near exposure site
Intermediate symptoms (variably present) may include the following:
Numbness or paraesthesias at or near exposure site
Nausea and/or abdominal pain
Late manifestations may include the following:
Alteration of mentation
Focal neurological symptoms
Findings of herpes B virus infection primarily include progressive neurologic deterioration that suggests a multifocal hemorrhagic encephalitis or encephalomyelitis. This finding contrasts with the temporal lobe localization of herpes simplex encephalitis. The progression of signs and symptoms may be modified by early antiviral therapy. Asymptomatic human herpes B virus infection is rare, if not nonexistent. Typical physical signs include the following:
Confusion progressing to coma
Brain stem findings, which may include the following: Diplopia, dysarthria, dysphagia, cerebellar signs (including ataxia), cranial nerve palsies
Signs of meningoencephalomyelitis, which may include the following: Seizures, hemiparesis or hemiplegia, progressive ascending paralysis, transverse myelitis
Non–central nervous system signs, which may include the following: conjunctivitis or chorioretinitis, sinusitis
Information regarding the epidemiology and transmission of herpes B virus in primates is vital in order to understand how to prevent this high-mortality infection.
Macaques transmit the herpes B virus to each other through oral, ocular, or genital contact of mucous membranes or lesioned skin. The herpes B virus can be shed asymptomatically, including through bodily fluids (eg, semen, mother's milk, saliva, perhaps even in aerosol form). The animal stools could also conceivably transmit the herpes B virus. In captive macaques, transmission may often occur during routine colony management protocols involving tube sharing, common instrumentation, or contaminated gloves. Animals usually become infected as juveniles, at the onset of sexual activity; however, younger animals can become infected through contact with another virus-shedding animal. For example, a nursing mother has repeated opportunities to transmit herpes B virus in buccal or conjunctival fluids to a nursing infant during grooming.
Conclusively determining transmission pathways may not be possible because most human cases of herpes B virus infection involve individuals who regularly work with monkeys, thus providing many potential means of exposure. Suspected transmission modes include monkey bites, monkey scratches, or cage scratches; direct contamination of a preexisting wound with macaque saliva; respiratory exposure to aerosol macaque saliva; mucosal splash exposure; cuts sustained from culture bottles containing macaque kidney cells; needle-stick injuries following needle use in macaques; and cleaning a rhesus macaque skull without gloves. In addition, one apparent case of human-to-human herpes B virus transmission involved a woman with dermatitis on her finger; she touched her husband's herpetiform lesion (resulting from a monkey bite).
Given the myriad potential transmission pathways and abundance of macaques in contact with people, the fact that relatively few documented cases of B virus infection occur in humans may seem surprising. Nevertheless, although most macaques test positive for herpes B virus antibodies, only a small percentage (ie, 0-2%) shed the virus at any given time. In most animals, the human B virus is latent in the trigeminal ganglia and becomes reactivated only when the macaque experiences psychological stress, pharmacological stress, or diminished immunocompetence.
The widely observed pattern of increasing frequency with age suggests that horizontal transmission is far more common than vertical transmission (ie, mother to offspring). Whether this horizontal transmission occurs most commonly via oral or genital contact, including sexual behavior, is unresolved.
Fan Q, Amen M, Harden M, Severini A, Griffiths A, Longnecker R. Herpes B virus utilizes human nectin-1 but not HVEM or PILRa for cell-cell fusion and virus entry. J Virol. 2012 Apr. 86(8):4468-76. [Medline]. [Full Text].
Du T, Zhou G, Roizman B. Modulation of reactivation of latent herpes simplex virus 1 in ganglionic organ cultures by p300/CBP and STAT3. Proc Natl Acad Sci U S A. 2013 Jul 9. 110(28):E2621-8. [Medline]. [Full Text].
Fujima, A, Ochiai Y, Saito A, et al. Discrimination of Antibody to Herpes B Virus from Antibody to Herpes Simplex Virus Types 1 and 2 in Human and Macaque Sera. J Clin Microbiol. Jan 2008. 46(1):56-61. [Medline]. [Full Text].
Oya C, Ochiai Y, Taniuchi Y, Takano T, Ueda F, Yoshikawa Y, et al. Specific detection and identification of herpes B virus by a PCR-microplate hybridization assay. J Clin Microbiol. 2004 May. 42(5):1869-74. [Medline].
Focher F, Lossani A, Verri A, et al. Sensitivity of Monkey B Virus (Cercopithecine herpesvirus 1) to Antiviral Drugs: Role of Thymidine Kinase in Antiviral Activities of Substrate Analogs and Acyclonucleosides. Antimicrob. Agents Chemother. Jun 2007. 51(6):2028-2024. [Medline]. [Full Text].
Bennett AM, Slomka MJ, Brown DW, et al. Protection against herpes B virus infection in rabbits with a recombinant vaccinia virus expressing glycoprotein D. J Med Virol. 1999 Jan. 57(1):47-56. [Medline].
Bryan BL, Espana CD, Emmons RW, et al. Recovery from encephalomyelitis caused by Herpesvirus simiae. Report of a case. Arch Intern Med. 1975 Jun. 135(6):868-70. [Medline].
Chellman GJ, Lukas VS, Eugui EM, et al. Activation of B virus (Herpesvirus simiae) in chronically immunosuppressed cynomolgus monkeys. Lab Anim Sci. 1992 Apr. 42(2):146-51. [Medline].
Davenport DS, Johnson DR, Holmes GP, et al. Diagnosis and management of human B virus (Herpesvirus simiae) infections in Michigan. Clin Infect Dis. 1994 Jul. 19(1):33-41. [Medline].
Fierer J, Bazely P, Braude AI. Herpes B virus encephalomyelitis presenting as ophthalmic zoster. A possible latent infection reactivated. Ann Intern Med. 1973 Aug. 79(2):225-8. [Medline].
Freifeld AG, Hilliard J, Southers J, et al. A controlled seroprevalence survey of primate handlers for evidence of asymptomatic herpes B virus infection. J Infect Dis. 1995 Apr. 171(4):1031-4. [Medline].
Hilliard JK, Weigler BJ. The existence of differing monkey B virus genotypes with possible implications for degree of virulence in humans. Lab Anim Sci. 1999 Feb. 49(1):10-1. [Medline].
Holmes GP, Chapman LE, Stewart JA, et al. Guidelines for the prevention and treatment of B-virus infections in exposed persons. The B virus Working Group. Clin Infect Dis. 1995 Feb. 20(2):421-39. [Medline].
Holmes GP, Hilliard JK, Klontz KC, et al. B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster. Ann Intern Med. 1990 Jun 1. 112(11):833-9. [Medline].
Jainkittivong A, Langlais RP. Herpes B virus infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Apr. 85(4):399-403. [Medline].
Kessler MJ, Hilliard JK. Seroprevalence of B virus (Herpesvirus simiae) antibodies in a naturally formed group of rhesus macaques. J Med Primatol. 1990. 19(2):155-60. [Medline].
Ostrowski SR, Leslie MJ, Parrott T, Abelt S, Piercy PE. B-virus from pet macaque monkeys: an emerging threat in the United States?. Emerg Infect Dis. 1998 Jan-Mar. 4(1):117-21. [Medline].
Palmer AE. B virus, Herpesvirus simiae: historical perspective. J Med Primatol. 1987. 16(2):99-130. [Medline].
Perelygina L, Patrusheva I, Hombaiah S, Zurkuhlen H, Wildes MJ, Patrushev N, et al. Production of herpes B virus recombinant glycoproteins and evaluation of their diagnostic potential. J Clin Microbiol. 2005 Feb. 43(2):620-8. [Medline].
Scinicariello F, Eberle R, Hilliard JK. Rapid detection of B virus (herpesvirus simiae) DNA by polymerase chain reaction. J Infect Dis. 1993 Sep. 168(3):747-50. [Medline].
Weigler BJ. Biology of B virus in macaque and human hosts: a review. Clin Infect Dis. 1992 Feb. 14(2):555-67. [Medline].
Weigler BJ, Scinicariello F, Hilliard JK. Risk of venereal B virus (cercopithecine herpesvirus 1) transmission in rhesus monkeys using molecular epidemiology. J Infect Dis. 1995 May. 171(5):1139-43. [Medline].