Case Report: Late Reactivation of Herpes B Virus After a Monkey Bite: A Case of Severe Meningoencephalitis

Abstract

Macacine alphaherpesvirus 1, also known as herpes B virus (BV), is an alphaherpesvirus endemic to several macaque species, capable of causing zoonotic infections in humans, with high mortality rates. Evidence of reactivation in humans has rarely been reported. Here we depict a case of BV reactivation after 54 years, leading to severe meningoencephalitis. This case supports the use of antiviral prophylaxis in patients surviving a confirmed BV central nervous system infection. We sequenced DNA from BV obtained from the patient's cerebrospinal fluid. Phylogenetic analysis showed significant divergence in the clustering of this particular BV strain compared with other known BVs. Therefore, additional efforts are needed to obtain a broader sequence landscape from BVs circulating in monkeys.

Figure 1.

Brain magnetic resonance imaging (MRI) on day 2. (A) Brain MRI, DWI: hyperintense signals in the right inferior temporal gyrus and juxta insular. (B) Brain MRI, FLAIR: hyperintense signals in the same parts of the DWI sequences.

Figure 2.

Coverage of the metagenomic sequencing reads across the Macacine alphaherpesvirus 1 (McHV-1) isolate 7709642 genome.

Figure 3.

Phylogenetic relationship of herpes B virus. UL29 sequence from our isolate, the Clinique Saint-Pierre Ottignies 2020 isolate (McHV-1 CSPO 2020) was retrieved from the metagenomic sequencing data and aligned to selected herpes B virus (McHV-1) sequences, herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), leporid alphaherpesvirus 4 (LeHV-4), cercopithecine alphaherpesvirus 2 (CeHV-2), bovine alphaherpesvirus 2 (BoHV-2), and cytomegalovirus (CMV) as an outgroup. Gaps were removed and a phylogenetic tree was constructed.