406. Early Initiation of Therapy in Herpes B virus Infection
Session: Poster Abstract Session: Occupational Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
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  • Background:   Macacine herpes virus 1 (B virus) is endemic in macaques monkeys. Infected monkeys can have asymptomatic shedding of virus that can cause severe encephalitis in humans. We present a case of B virus infection in a researcher after sustaining a monkey scratch.

    Methods: Patient samples (blood, CSF, swabs of eyes and throat) were tested for B virus using Western Blot and PCR performed at the B virus Research and Resource Laboratory in Atlanta, GA. 

     Results:   After sustaining a scratch from a rhesus macaque, a researcher scrubbed the area for 5 minutes with 2% chlorhexidine gluconate but did not receive antiviral prophylaxis.  Five days later, he developed fever, myalgias, and diarrhea and a presumptive diagnosis of influenza was made by a primary care doctor. On day 10, a maculopapular, non-vesicular rash developed bilateral wrists and ankles (including the scratch area,) and the patient presented to occupational medicine for evaluation on day 11.  Although no neurological symptoms were present, the patient was admitted and started on intravenous ganciclovir.  Results of blood, CSF, and mucous membrane testing are shown in figure 1.  CSF analysis revealed 12 WBC per microliter (81% lymphs, 19% monos). Serum HSV IgG and IgM were negative. The case was reported to local public health authorities and, after repeated serological testing, a diagnosis of B virus was made.  The six macaques in the researcher's lab were tested for B virus on day 18. All were seronegative but one macaque had a positive PCR from oral secretions. The patient recovered completely but remains on indefinite suppressive therapy. 

     Conclusion: Robust training of research and veterinary staff on the management of scratch and bite exposures by non-human primates in addition to use of effective personal protective equipment are essential to preventing B virus infection in humans.  Because serological testing of macaques can result in false negatives, these data should not affect management of an exposed employee. However, early initiation of treatment with intravenous ganciclovir in a patient without central nervous system symptoms was successful in preventing progression of B virus.

    Jennifer Delacruz, MD, MS1, Julia Hilliard, PhD2, Massimo Pacilli, MS MPH3, Jean-Luc Benoit, MD, FACP4, Stephanie Black, MD, MSc3, Steven Lelyveld, MD5, Marek Niekrasz, DVM6, Jennifer Pisano, MD7, Alicia Siston, MPH8, Craig Wardrip, DVM, DACLAM6, Michelle Rohrman, APN9, Allison H. Bartlett, MD, MS10 and Emily Landon, MD11, (1)Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Hospitals, Chicago, IL, (2)Molecular Biotechnology, Georgia State university, Atlanta, GA, (3)Chicago Department of Public Health, Chicago, IL, (4)Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, (5)Pediatrics and Medicine, University of Chicago, Chicago, IL, (6)Veterinary Medicine, University of Chicago, Chicago, IL, (7)Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL, (8)Chicago Department of Public Health, chicago, IL, (9)University of Chicago, Chicago, IL, (10)Pediatrics, Baylor College of Medicine, Houston, TX, (11)Infectious Diseases & Global Health, University of Chicago, Chicago, IL

    Disclosures:

    J. Delacruz, None

    J. Hilliard, None

    M. Pacilli, None

    J. L. Benoit, None

    S. Black, None

    S. Lelyveld, None

    M. Niekrasz, None

    J. Pisano, None

    A. Siston, None

    C. Wardrip, None

    M. Rohrman, None

    A. H. Bartlett, None

    E. Landon, None

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