Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever (≥37.5°C)
- flu-like symptoms
- paraesthesias
- hyperaesthesias
- severe persistent headache
- dizziness
- ocular pain
- gait disturbances
- ataxia
- diplopia
- agitation
- meningismus
- muscle weakness (paresis)
- persistent hiccups
- dyspnoea
- ascending or acute flaccid paralysis
- vesicular lesions
Other diagnostic factors
- nausea/vomiting
- conjunctivitis
- rash
- lymphadenitis
- lymphangitis
- abdominal pain
Risk factors
- occupational exposure
- travel to countries with free-roaming macaques
- keeping macaques as pets
- exposure to non-macaque species that have been housed with macaques
Diagnostic investigations
Investigations to consider
- viral culture
- brain MRI
- brain CT
- CSF tests
- EEG
- brainstem auditory evoked responses
- somatosensory evoked potentials
- laboratory testing of animal specimen
Treatment algorithm
Contributors
Authors
Richard Whitley, MD
Professor of Pediatrics
Professor of Microbiology, Medicine, and Neurosurgery
University of Alabama
Birmingham
AL
Disclosures
RW is a retired Board Member for Gilead Sciences, Inc., and a current member of Scientific Advisory Boards or Data Management Committees for Clear Creek Biosciences, Merck, Virios Therapeutics, Visby Medical, Evrys BioSciences, Enochian Biosciences, and Leyden Laboratories.
Acknowledgements
Professor Richard Whitley would like to gratefully acknowledge Dr D. Scott Schmid, Dr Jeffrey I. Cohen, and Dr Louisa E. Chapman, previous contributors to this topic, and Dr Julia K. Hilliard for her contributions to this topic. Unfortunately, we have been made aware that Dr Louisa E. Chapman is now deceased.
Disclosures
JKH, JIC, and LEC are the authors of several references cited in this topic. DSS declared that he had no competing interests. The views included in this topic are those of the authors (DSS and JIC) and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Institutes of Health.
Peer reviewers
Anna Maria Geretti, MD, PhD, FRCPath
Professor of Virology and Infectious Diseases
University of Liverpool
Liverpool
UK
Disclosures
AMG declares that she has no competing interests.
Deanna Saylor, MD, MHS
Assistant Professor of Neurology
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
DS has received research funding from the National Institutes of Health, the World Federation of Neurology, and the Johns Hopkins Center for AIDS Research.
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