Epidemiologic Notes and Reports
B Virus Infections in Humans -- Michigan
In June 1989, two men were admitted to a Kalamazoo, Michigan,
hospital
with B virus (Herpesvirus simiae) infection. Both men worked at an
animal research facility with rhesus (Macaca mulatta) and
cynomolgus
(Macaca fascicularis) monkeys.
Patient 1, a 23-year-old, had worked at the facility for 2 years.
Since April, he had sustained monkey bites to hands and arms, and
one
bite to the chest wall. On June 10, pain and numbness developed on
the
right side of his back and then spread locally. Over the next 2
days,
dysesthesia developed in the lower limbs, along with generalized
weakness, dizziness, difficulty in swallowing, and copious oral
secretions. On June 13, the patient collapsed and had a respiratory
arrest. Examination at the hospital revealed bilateral
conjunctivitis,
depressed gag reflex, right-sided weakness, and small vesicular
lesions
on the right side of his chest; his cerebrospinal fluid (CSF) had a
neutrophilic pleocytosis and an elevated protein level. He was
mechanically ventilated and given high-dose intravenous acyclovir
(15
mg/kg every 8 h). Magnetic resonance imaging (MRI) showed
abnormalities
of the thalamus, midbrain, pons, and upper spinal cord. B virus was
cultured from the vesicular chest lesions. Total paralysis and coma
rapidly ensued, and he died on June 20.
Patient 2, a 20-year-old, had worked at the research facility
from May
22 to June 2. On approximately May 30, a monkey bit the man's right
thumb. On June 15, he had fever and chills. Subsequent symptoms
included severe headaches, myalgia, difficulty in urinating,
paresthesia, and dizziness. When admitted to the hospital on June
20,
the patient had a temperature of 104 F and his CSF contained
numerous
lymphocytes. Treatment with intravenous acyclovir (15 mg/kg every 8
h)
was begun. Western blot of his CSF was consistent with B virus IgM
and
IgG antibodies. Culture of a biopsy specimen from the healed bite
wound
was inconclusive; further virologic studies are pending. On June
23,
his treatment was changed to intravenous ganciclovir (5 mg/kg every
12
h). MRI scans showed subtle defects in the thalamus and midbrain.
As of
July 5, Patient 2 remained clinically stable, without fever or
headache
and with decreasing paresthesia.
Active surveillance has been instituted for approximately 135
current
or former employees of the research facility who have had contact
with
monkeys or monkey tissue since mid-April. In addition, persons who
are
likely to have had contact with body fluids from either patient
during
the week before onset of symptoms are being monitored for evidence
of B
virus infection.
Reported by: DS Davenport, MD, SC Ross, MD; GA Stoltman, PhD,
Kalamazoo
County Health Dept, Kalamazoo; BA Kintner, DVM, HB McGee, MPH, WN
Hall,
MD, GR Anderson, DVM, KR Wilcox Jr, MD, State Epidemiologist,
Michigan
Dept of Public Health. JK Hilliard, PhD, Southwest Foundation for
Biomedical Research, San Antonio, Texas. Div of Viral Diseases,
Center
for Infectious Diseases; Div of Field Svcs, Epidemiology Program
Office, CDC.
Editorial Note
Editorial Note: B virus infection is common and relatively benign
in
Old World monkeys such as rhesus and cynomolgus; however, this
virus is
highly pathogenic in humans (1). The two cases in Michigan are the
first symptomatic human cases reported since 1987. A cluster of
four
cases in Florida in 1987 (2) prompted CDC to convene a working
group to
formulate new guidelines for the prevention of B virus infection in
monkey handlers (3).
In efforts to adhere to these guidelines, training of all persons
who
handle monkeys or monkey tissues is particularly important. Such
training must include the following: prevention of monkey-inflicted
wounds, appropriate care of such wounds when they occur, signs and
symptoms that might indicate human infection with B virus, and
recognition of the severity of such infection.
References
1.Palmer AE. B virus, Herpesvirus simiae: historical perspective. J
Med Primatol 1987;16: 99-130.
2.CDC. B-virus infection in humans--Pensacola, Florida. MMWR
1987;36:289-90,295-6.
3.CDC. Guidelines for prevention of Herpesvirus simiae (B virus)
infection in monkey handlers. MMWR 1987;36:680-82,687-9.
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