Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever (≥37.5°C)
- flu-like symptoms
- paraesthesias
- hyperaesthesias
- severe persistent headache
- disorientation
- dizziness
- ocular pain
- gait disturbances
- ataxia
- diplopia
- agitation
- meningismus
- muscle weakness (paresis)
- persistent hiccups
- dyspnoea
- ascending or acute flaccid paralysis
- vesicular lesions
Other diagnostic factors
- nausea/vomiting
- conjunctivitis
- rash
- lymphadenitis
- lymphangitis
- abdominal pain
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
Diagnostic investigations
1st investigations to order
- serology
- polymerase chain reaction (PCR)
Investigations to consider
- viral culture
- brain MRI
- brain CT
- cerebrospinal fluid (CSF) tests
- electroencephalogram (EEG)
- brainstem auditory evoked responses
- somatosensory evoked potentials
- laboratory testing of animal specimen
Treatment algorithm
potential exposure
confirmed infection and/or symptomatic
Contributors
Authors
Richard Whitley, MD
Professor of Pediatrics
Professor of Microbiology, Medicine, and Neurosurgery
University of Alabama
Birmingham, AL
Disclosures
RW has previously received compensation from Leyden Laboratories, Dogwood Therapeutics, and Visby Medical (not related to herpes B virus infection). He currently has two grants from the National Institutes of Health related to the study of long COVID-19 and chikungunya.
Acknowledgements
Professor Richard Whitley would like to gratefully acknowledge Dr D. Scott Schmid, Dr Jeffrey I. Cohen, and the late Dr Louisa E. Chapman, previous contributors to this topic, and Dr Julia K. Hilliard for her contributions to this topic.
Disclosures
DSS, JIC, LEC, and JKH declared that they 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
Liverpool
UK
Disclosures
AMG declares that she has no competing interests.
Deanna Saylor, MD, MHS
Assistant Professor of Neurology
Johns Hopkins University School of Medicine
Baltimore, MD
Disclosures
DS has received research funding from the National Institutes of Health, the World Federation of Neurology, and the Johns Hopkins Center for AIDS Research.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Cohen JI, Davenport DS, Stewart JA, et al. Recommendations for prevention of and therapy for exposure to B virus (cercopithecine herpesvirus 1). Clin Infect Dis. 2002 Nov 15;35(10):1191-203.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Herpes simplex encephalitis
- Herpes zoster encephalitis
- West Nile virus
More DifferentialsGuidelines
- Patient care for B virus
- Recommendations for prevention of and therapy for exposure to B virus (Cercopithecine Herpesvirus 1)
More Guidelines
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