eMedicine Specialties > Infectious Diseases > Viral Infections

Herpes B: Differential Diagnoses & Workup

Author: Brian Hogan, MD, MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium
Coauthor(s): Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center; Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus; Robert O Deaner, PhD, Assistant Professor, Department of Psychology, Grand Valley State University
Contributor Information and Disclosures

Updated: Mar 24, 2009

Differential Diagnoses

Rabies

Other Problems to Be Considered

Herpes simplex encephalitis
Arthropod-associated meningoencephalitis

Workup

Laboratory Studies

  • Evaluation of the potential primate vector
    • To avoid delaying wound cleansing and forcing the virus deeper into the wound (even after wound cleansing), obtain the exposure-directed primate virus cultures from buccal mucosa (for saliva exposure), conjunctivae, and the urogenital area (for urine exposure). If a cage was involved, acquire swab cultures from the monkey that was most recently housed there.
    • Because herpes B is a class 4 pathogen, cultures should be performed only at a designated reference laboratory.
  • Serologic evaluation of the exposed patient
    • If frozen serum from the last 6 months is not available, acquire, freeze, and store a serum sample.
    • Obtain a follow-up serum sample approximately 3 weeks after exposure or after the onset of illness (as close to 3 wk as possible) to test with the initial specimen for herpes B virus seroconversion.
    • Perform serologies in a reference laboratory to minimize cross-reacting HSV antibodies. Although further research is required, newer recombinant DNA techniques may allow for differentiation of herpes B virus infection from HSV infection.2
    • Some human cases of herpes B virus infection have resulted in a slow or minimal rise in virus-specific antibody, confounding serological confirmation.
  • Polymerase chain reaction (PCR) technology may permit faster and more accurate assessment of both human and primate cases. Newer studies are aimed at developing a PCR test that is not only sensitive but also specific, allowing for differentiation from HSV.3

Other Tests

  • Veterinary evaluation of monkeys
    • The importance of evaluating the primate should be weighed against the potential of further injuries if the monkey must be recaptured without anesthesia.
    • After anesthesia, the monkey should be examined for oral lesions, genital lesions, or conjunctivitis.
    • High-risk exposure includes any injury associated with an ill, immunocompromised, or lesioned animal.
    • Remember that asymptomatic shedding of herpes B virus may occur and is more likely during breeding season or times of stress.
    • Serial serologies can be obtained from the primate because a rise suggests primary infection and a higher risk of viral shedding. Stable serologies do not predict shedding, which occurs in only 2-3% of cases.

More on Herpes B

Overview: Herpes B
Differential Diagnoses & Workup: Herpes B
Treatment & Medication: Herpes B
Follow-up: Herpes B
Multimedia: Herpes B
References
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References

  1. Cohen JI, Davenport DS, Stewart JA, et al. Recommendations for Prevention of and Therapy for Exposure to B Virus. Clin Infect Dis. Nov 2002;35:1191-203. [Medline]. [Full Text].

  2. 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].

  3. 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. May 2004;42(5):1869-74. [Medline].

  4. 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].

  5. 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. Jan 1999;57(1):47-56. [Medline].

  6. Bryan BL, Espana CD, Emmons RW, et al. Recovery from encephalomyelitis caused by Herpesvirus simiae. Report of a case. Arch Intern Med. Jun 1975;135(6):868-70. [Medline].

  7. Chellman GJ, Lukas VS, Eugui EM, et al. Activation of B virus (Herpesvirus simiae) in chronically immunosuppressed cynomolgus monkeys. Lab Anim Sci. Apr 1992;42(2):146-51. [Medline].

  8. Davenport DS, Johnson DR, Holmes GP, et al. Diagnosis and management of human B virus (Herpesvirus simiae) infections in Michigan. Clin Infect Dis. Jul 1994;19(1):33-41. [Medline].

  9. Fierer J, Bazely P, Braude AI. Herpes B virus encephalomyelitis presenting as ophthalmic zoster. A possible latent infection reactivated. Ann Intern Med. Aug 1973;79(2):225-8. [Medline].

  10. 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. Apr 1995;171(4):1031-4. [Medline].

  11. Hilliard JK, Weigler BJ. The existence of differing monkey B virus genotypes with possible implications for degree of virulence in humans. Lab Anim Sci. Feb 1999;49(1):10-1. [Medline].

  12. 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. Feb 1995;20(2):421-39. [Medline].

  13. Holmes GP, Hilliard JK, Klontz KC, et al. B virus (Herpesvirus simiae) infection in humans: epidemiologic investigation of a cluster. Ann Intern Med. Jun 1 1990;112(11):833-9. [Medline].

  14. Jainkittivong A, Langlais RP. Herpes B virus infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 1998;85(4):399-403. [Medline].

  15. 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].

  16. 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. Jan-Mar 1998;4(1):117-21. [Medline].

  17. Palmer AE. B virus, Herpesvirus simiae: historical perspective. J Med Primatol. 1987;16(2):99-130. [Medline].

  18. 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. Feb 2005;43(2):620-8. [Medline].

  19. Scinicariello F, Eberle R, Hilliard JK. Rapid detection of B virus (herpesvirus simiae) DNA by polymerase chain reaction. J Infect Dis. Sep 1993;168(3):747-50. [Medline].

  20. Weigler BJ. Biology of B virus in macaque and human hosts: a review. Clin Infect Dis. Feb 1992;14(2):555-67. [Medline].

  21. Weigler BJ, Scinicariello F, Hilliard JK. Risk of venereal B virus (cercopithecine herpesvirus 1) transmission in rhesus monkeys using molecular epidemiology. J Infect Dis. May 1995;171(5):1139-43. [Medline].

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Further Reading

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Keywords

herpes B virus, Cercopithecine herpesvirus 1, CHV-1, herpes B virus infection, herpes B infection, herpesvirus simiae, monkey B virus, herpes B encephalitis

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Contributor Information and Disclosures

Author

Brian Hogan, MD, MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium
Disclosure: eMedicine None None

Coauthor(s)

Jason F Okulicz, MD, Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center
Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Robert O Deaner, PhD, Assistant Professor, Department of Psychology, Grand Valley State University
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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