Macacine alphaherpesvirus 1: Difference between revisions
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=== History === |
=== History === |
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* First |
* First described in 1933[[CiteRef::gay1933is]], named 'B' for the first patient's initial |
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=== Microbiology === |
=== Microbiology === |
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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 |
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== Clinical |
== Clinical Manifestations == |
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* Typically via bite or scratch of macaque monkey |
* Typically via bite or scratch of macaque monkey |
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** Asymptomatic or similar presentation to HSV in the monkey |
** Asymptomatic or similar presentation to HSV in the monkey |
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** Seroprevalence reaches 100% in some populations of macaques |
** Seroprevalence reaches 100% in some populations of macaques |
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* 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]]) |
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* Three clinical forms: |
* Three clinical forms: |
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** Flu-like illness followed by CNS symptoms |
** Flu-like illness followed by CNS symptoms |
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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 |
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** 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 |
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** There has been a single case of reactivation 10 years after last macaque exposure[[CiteRef::fierer1973he]] |
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* Eventually progresses to global encephalitis, seizures, paralysis, and respiratory failure |
* Eventually progresses to global encephalitis, seizures, paralysis, and respiratory failure |
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* Mortality 70% if untreated |
* Mortality 70-80% if untreated |
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== Diagnosis == |
== Diagnosis == |
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== Management == |
== Management == |
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=== Initial management === |
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* Local wound irrigation, flushing for 15 minutes |
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* Assess risk: |
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** 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. |
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** First aid: risk decreases with flushing for 15 minutes |
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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) |
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* Consider sending wound swab and baseline serology |
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** CDC recommends ''against'' routine swabbing |
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** Contact the lab, especially if you will be sending PCR |
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=== Treatment of diagnosed infection === |
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* [[Is treated by::Acyclovir]] 12.5 to 15 mg/kg IV q8h |
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* Alternative: [[Is treated by::ganciclovir]] 5 mg/kg IV q12h |
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* Duration at least 2 weeks and until resolution of symptoms and 2 negative cultures |
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=== Postexposure prophylaxis === |
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** Should be started within hours |
** Should be started within hours |
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** First-line treatment: [[Is treated by:valacyclovir]] 1 g po tid |
** First-line treatment: [[Is treated by::valacyclovir]] 1 g po tid |
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** 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 |
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** 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) |
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Latest revision as of 13:46, 5 August 2020
Background
- Also known as macacine herpesvirus 1, macacine alphaherpesvirus 1, cercopithecine herpesvirus 1, CHV-1), herpes B virus, monkey B virus, herpesvirus simiae and herpesvirus B
History
- First described in 19331, named 'B' for the first patient's initial
Microbiology
- Double-stranded DNA virus
- Alphaherpesvirus, in the same family as HSV
Epidemiology
- 50 documented cases worldwide, in people who handle macaques or their lab samples
Pathophysiology
- Virus replicates locally at the site of inoculation, then spreads from peripheral nerves to spinal cord to brainstem to brain
Clinical Manifestations
- Typically via bite or scratch of macaque monkey
- Asymptomatic or similar presentation to HSV in the monkey
- Seroprevalence reaches 100% in some populations of macaques
- Incubation period 5 to 21 days (range 2 days to 5 weeks)
- Three clinical forms:
- Flu-like illness followed by CNS symptoms
- 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
- There has been a single case of reactivation 10 years after last macaque exposure2
- Eventually progresses to global encephalitis, seizures, paralysis, and respiratory failure
- Mortality 70-80% if untreated
Diagnosis
- Serology, with acute and convalescent (3 to 6 weeks) titres, looking for a 4-fold rise
- Seroconversion may be delayed if on acyclovir, so should be repeated at 12 weeks
- Done at NML or sent out to Georgia State University
- Viral culture is possible but not done routinely
- PCR is available for swab, tissue, blood, and CSF
- Sent out to Georgia State University
- In autopsy, send right and left trigeminal ganglia or the sacral dorsal root ganglia
Management
Initial management
- Local wound irrigation, flushing for 15 minutes
- Assess risk:
- Source of exposure: must be a 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
- 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
- CDC recommends against routine swabbing
- Contact the lab, especially if you will be sending PCR
Treatment of diagnosed infection
- Acyclovir 12.5 to 15 mg/kg IV q8h
- Alternative: 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
- First-line treatment: valacyclovir 1 g po tid
- Alternatives: acyclovir 800 mg po 5 times daily, or famciclovir 500 mg po 5 times daily
- Continue for 2 weeks (some recommend up to 5 weeks, the longest known incubation period)
References
- ^ F. P. Gay, M. Holden. Isolation of a Herpes Virus from Several Cases of Epidemic Encephalitis.. Experimental Biology and Medicine. 1933;30(8):1051-1053. doi:10.3181/00379727-30-6788.
- ^ Joshua Fierer. Herpes B Virus Encephalomyelitis Presenting as Ophthalmic Zoster. Annals of Internal Medicine. 1973;79(2):225. doi:10.7326/0003-4819-79-2-225.
