Macacine alphaherpesvirus 1 - Revision history

Aidan: /* Clinical Manifestations */

2020-08-05T13:46:21Z

Clinical Manifestations

← Older revision		Revision as of 13:46, 5 August 2020
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	** Asymptomatic or similar presentation to HSV in the monkey		** Asymptomatic or similar presentation to HSV in the monkey
	** Seroprevalence reaches 100% in some populations of macaques		** Seroprevalence reaches 100% in some populations of macaques
	* Incubation period 5 to 21 days (range 2 days to 5 weeks)		* Incubation period [[Usual incubation period::5 to 21 days]] (range [[Incubation period range::2 days to 5 weeks]])
	* Three clinical forms:		* Three clinical forms:
	** Flu-like illness followed by CNS symptoms		** Flu-like illness followed by CNS symptoms

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-17T22:16:38Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 22:16, 17 July 2020
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	* Virus replicates locally at the site of inoculation, then spreads from peripheral nerves to spinal cord to brainstem to brain		* Virus replicates locally at the site of inoculation, then spreads from peripheral nerves to spinal cord to brainstem to brain

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Typically via bite or scratch of macaque monkey		* Typically via bite or scratch of macaque monkey

Aidan: /* Initial management */

2019-10-17T13:54:18Z

Initial management

← Older revision		Revision as of 13:54, 17 October 2019
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	** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)		** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)
	* Consider sending wound swab and baseline serology		* Consider sending wound swab and baseline serology
			** CDC recommends ''against'' routine swabbing
	** Contact the lab, especially if you will be sending PCR		** Contact the lab, especially if you will be sending PCR

Aidan: /* Initial management */ fixed link

2019-10-15T13:56:10Z

Initial management: fixed link

← Older revision		Revision as of 13:56, 15 October 2019
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	* Local wound irrigation, flushing for 15 minutes		* Local wound irrigation, flushing for 15 minutes
	* Assess risk:		* Assess risk:
	** Source of exposure: must be a [http://~~www2~~.gsu.edu/~~~wwwvir~~/VirusInfo/macaque.html macaque], as there are no other known hosts. Captive macaques have up to 100% seropositivity, depending on age.		** Source of exposure: must be a [http://biotech.gsu.edu/virology/VirusInfo/macaque.html macaque], as there are no other known hosts. Captive macaques have up to 100% seropositivity, depending on age.
	** First aid: risk decreases with flushing for 15 minutes		** First aid: risk decreases with flushing for 15 minutes
	** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)		** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)

Aidan: /* History */ added citation

2019-10-15T13:52:33Z

History: added citation

← Older revision		Revision as of 13:52, 15 October 2019
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	=== History ===		=== History ===
	* First ~~diagnosed in a researcher~~ in 1933, named 'B' for ~~his~~ ~~last~~ ~~name~~ initial		* First described in 1933[[CiteRef::gay1933is]], named 'B' for the first patient's initial

	=== Microbiology ===		=== Microbiology ===

Aidan: /* Postexposure prophylaxis */ typo in link

2019-10-15T13:51:16Z

Postexposure prophylaxis: typo in link

← Older revision		Revision as of 13:51, 15 October 2019
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	* Recommended for everyone with skin or mucosal exposure to a captive macaque, and there was inadequate cleaning (deep puncture bites are assumed to not be adequately cleaned)		* Recommended for everyone with skin or mucosal exposure to a captive macaque, and there was inadequate cleaning (deep puncture bites are assumed to not be adequately cleaned)
	** Should be started within hours		** Should be started within hours
	** First-line treatment: [[Is treated by:valacyclovir]] 1 g po tid		** First-line treatment: [[Is treated by::valacyclovir]] 1 g po tid
	** Alternatives: [[Is treated by::acyclovir]] 800 mg po 5 times daily, or [[Is treated by::famciclovir]] 500 mg po 5 times daily		** Alternatives: [[Is treated by::acyclovir]] 800 mg po 5 times daily, or [[Is treated by::famciclovir]] 500 mg po 5 times daily
	** Continue for 2 weeks (some recommend up to 5 weeks, the longest known incubation period)		** Continue for 2 weeks (some recommend up to 5 weeks, the longest known incubation period)

Aidan: /* Treatment of diagnosed infection */ capitalization

2019-10-15T13:51:06Z

Treatment of diagnosed infection: capitalization

← Older revision		Revision as of 13:51, 15 October 2019
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	=== Treatment of diagnosed infection ===		=== Treatment of diagnosed infection ===
	* [[Is treated by::~~acyclovir~~]] 12.5 to 15 mg/kg IV q8h		* [[Is treated by::Acyclovir]] 12.5 to 15 mg/kg IV q8h
	* Alternative: [[Is treated by::ganciclovir]] 5 mg/kg IV q12h		* Alternative: [[Is treated by::ganciclovir]] 5 mg/kg IV q12h
	* Duration at least 2 weeks and until resolution of symptoms and 2 negative cultures		* Duration at least 2 weeks and until resolution of symptoms and 2 negative cultures

Aidan: /* Clinical Presentation */

2019-10-15T13:46:22Z

Clinical Presentation

← Older revision		Revision as of 13:46, 15 October 2019
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	** Local symptoms (itching, tingling, numbness, or pain) at the inoculation site, with or without vesicular rash and regional lymphadenopathy		** Local symptoms (itching, tingling, numbness, or pain) at the inoculation site, with or without vesicular rash and regional lymphadenopathy
	** Peripheral or central nervous system symptoms, with meningismus, vomiting, confusion, cranial nerve palsies		** Peripheral or central nervous system symptoms, with meningismus, vomiting, confusion, cranial nerve palsies
			** There has been a single case of reactivation 10 years after last macaque exposure[[CiteRef::fierer1973he]]
	* Eventually progresses to global encephalitis, seizures, paralysis, and respiratory failure		* Eventually progresses to global encephalitis, seizures, paralysis, and respiratory failure
	* Mortality 70% if untreated		* Mortality 70-80% if untreated

	== Diagnosis ==		== Diagnosis ==

Aidan: /* Management */

2019-10-15T13:39:43Z

Management

← Older revision		Revision as of 13:39, 15 October 2019
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	== Management ==		== Management ==

	* Initial management		=== Initial management ===
	** Local wound irrigation, flushing for 15 minutes		* Local wound irrigation, flushing for 15 minutes
	** Assess risk:		* Assess risk:
	*** Source of exposure: must be a [http://www2.gsu.edu/~wwwvir/VirusInfo/macaque.html macaque], as there are no other known hosts. Captive macaques have up to 100% seropositivity, depending on age.		** Source of exposure: must be a [http://www2.gsu.edu/~wwwvir/VirusInfo/macaque.html macaque], as there are no other known hosts. Captive macaques have up to 100% seropositivity, depending on age.
	*** First aid: risk decreases with flushing for 15 minutes		** First aid: risk decreases with flushing for 15 minutes
	*** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)		** Type of wound: risk is higher with deeper wounds (e.g. bites) and larger area, as well as with high-risk areas (head, neck, or torso)
	** Consider sending wound swab and baseline serology		* Consider sending wound swab and baseline serology
	*** Contact the lab, especially if you will be sending PCR		** Contact the lab, especially if you will be sending PCR

⚫	* ~~'''Postexposure prophylaxis''' is recommended~~ for everyone with skin or mucosal exposure to a captive macaque, and there was inadequate cleaning (deep puncture bites are assumed to not be adequately cleaned)
			=== Treatment of diagnosed infection ===
			* [[Is treated by::acyclovir]] 12.5 to 15 mg/kg IV q8h
			* Alternative: [[Is treated by::ganciclovir]] 5 mg/kg IV q12h
			* Duration at least 2 weeks and until resolution of symptoms and 2 negative cultures

			=== Postexposure prophylaxis ===
		⚫	* Recommended for everyone with skin or mucosal exposure to a captive macaque, and there was inadequate cleaning (deep puncture bites are assumed to not be adequately cleaned)
	** Should be started within hours		** Should be started within hours
	** First-line treatment: [[Is treated by:valacyclovir]] 1 g po tid		** First-line treatment: [[Is treated by:valacyclovir]] 1 g po tid

Aidan: /* Background */ added epidemiology

2019-10-15T13:36:15Z

Background: added epidemiology

← Older revision		Revision as of 13:36, 15 October 2019
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	=== History ===		=== History ===
	* First diagnosed in a researcher in 1933		* First diagnosed in a researcher in 1933, named 'B' for his last name initial

	=== Microbiology ===		=== Microbiology ===
	* Double-stranded DNA virus		* Double-stranded DNA virus
	* Alphaherpesvirus, in the same family as [[HSV]]		* Alphaherpesvirus, in the same family as [[HSV]]

			=== Epidemiology ===
			* 50 documented cases worldwide, in people who handle macaques or their lab samples

	=== Pathophysiology ===		=== Pathophysiology ===