Case history
Case history
A 29-year-old male animal handler is bitten by an apparently healthy macaque. The bite wound is immediately rinsed under tap water for a few minutes with soap. He develops a local and general infection (staphylococcus and streptococcus) the next day, which is treated with antibiotics. He then develops intermittent low grade fever over the next 10 days, which is followed by symptoms of central nervous system (CNS) involvement, including paralysis of the lower extremities and paraesthesia. The paralysis ascends to 1 inch above the nipple line. A temperature of 40.2°C is recorded on day 12 following the bite. MRI and CT scan do not reveal lesions on the brain or spinal cord.
Other presentations
There have been about 50 documented cases of B virus infection published to date, 21 of whom have been fatal.[4] Thus, limited numbers preclude solid data about typical presentation, particularly for early signs and symptoms. Patients may present with herpetic lesions at the site of exposure, which then progresses to CNS disease. Other presentations include dysaesthesias at the exposure site, which may evolve into ascending paralysis or CNS disease. In one case report, a patient presented with herpetic lesions associated with the ophthalmic nerve suggestive of reactivation disease. Various patients have presented in the initial stage of disease with some combination of generalised flu-like symptoms, fever, vesicles proximal to the exposure site, or conjunctivitis. Subsequent neurological involvement can manifest with dizziness, weakness, dyspnoea, severe persistent headache, and, with advancing disease, ascending paralysis and attending complications. Most surviving patients suffer from life-long moderate-to-severe neurological impairments.
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