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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.


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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