SYNOPSISIn regions to which T. marneffei infection is endemic, serologicsurveillance for patients receiving targeted therapymight be useful in the early diagnosis of T. marneffei infection,as in the case of AIDS patients (19). In non-endemicregions, such as the United States, clinicians should bevigilant of this infrequent infection in at-risk hematologypatients who have resided in or are returning from diseaseendemicareas.This study was partly supported by donations from the HuiHoy and Chow Sin Lan Charity Fund Limited; the Health andMedical Research Fund (ref. no. 13121342) and HKM-15-M07(commissioned study) of the Food and Health Bureau of HongKong Special Administrative Region Government; the StrategicResearch Theme Fund, The University of Hong Kong; and aCroucher Senior Medical Research Fellowship.Dr. Jasper F.W. Chan is a clinical assistant professor in theDepartment of Microbiology, The University of Hong Kong,Hong Kong, China. His research interests include emerginginfectious diseases and opportunistic infections in immunocompromisedhosts.References1. Vanittanakom N, Cooper CR Jr, Fisher MC, Sirisanthana T.Penicillium marneffei infection and recent advances in theepidemiology and molecular biology aspects. Clin Microbiol Rev.2006;19:95–110. http://dx.doi.org/10.1128/CMR.19.1.95-110.20062. Samson RA, Yilmaz N, Houbraken J, Spierenburg H, Seifert KA,Peterson SW, et al. Phylogeny and nomenclature of the genusTalaromyces and taxa accomodated in Penicillium subgenusBiverticillium. Stud Mycol. 2011;70:159–83. http://dx.doi.org/10.3114/sim.2011.70.043. Tang BS, Chan JF, Chen M, Tsang OT, Mok MY, Lai RW, et al.Disseminated penicilliosis, recurrent bacteremic nontyphoidalsalmonellosis, and burkholderiosis associated with acquiredimmunodeficiency due to autoantibody against gamma interferon.Clin Vaccine Immunol. 2010;17:1132–8. http://dx.doi.org/10.1128/CVI.00053-104. Chan JF, Trendell-Smith NJ, Chan JC, Hung IF, Tang BS,Cheng VC, et al. Reactive and infective dermatoses associatedwith adult-onset immunodeficiency due to anti-interferon-gammaautoantibody: Sweet’s syndrome and beyond. Dermatology.2013;226:157–66. http://dx.doi.org/10.1159/0003471125. Lee PP, Chan KW, Lee TL, Ho MH, Chen XY, Li CH, et al.Penicilliosis in children without HIV infection – are theyimmunodeficient? Clin Infect Dis. 2012;54:e8–19. http://dx.doi.org/10.1093/cid/cir7546. Lee PP, Mao H, Yang W, Chan KW, Ho MH, Lee TL, et al.Penicillium marneffei infection and impaired IFN-g immunity inhumans with autosomal-dominant gain-of-phosphorylation STAT1mutations. J Allergy Clin Immunol. 2014;133:8948–6.e5.7. Wong SS, Woo PC, Yuen KY. Candida tropicalis and Penicilliummarneffei mixed fungaemia in a patient with Waldenstrom’smacroglobulinaemia. Eur J Clin Microbiol Infect Dis.2001;20:132–5. http://dx.doi.org/10.1007/PL000112438. Woo PC, Lau SK, Lau CC, Chong KT, Hui WT, Wong SS, et al.Penicillium marneffei fungaemia in an allogeneic bone marrowtransplant recipient. Bone Marrow Transplant. 2005;35:831–3.http://dx.doi.org/10.1038/sj.bmt.17048959. Cheng VC, Chan JF, Ngan AH, To KK, Leung SY, Tsoi HW,et al. Outbreak of intestinal infection due to Rhizopus microsporus.J Clin Microbiol. 2009;47:2834–43. http://dx.doi.org/10.1128/JCM.00908-0910. Yuen KY, Woo PC, Ip MS, Liang RH, Chiu EK, Siau H, et al.Stage-specific manifestation of infection and impaired moldinfections in bone marrow transplant recipients: risk factors andclinical significance of positive concentrated smears. Clin InfectDis. 1997;25:37–42. http://dx.doi.org/10.1086/51449211. Wong SS, Wong KH, Hui WT, Lee SS, Lo JY, Cao L, et al.Differences in clinical and laboratory diagnostic characteristics ofpenicilliosis marneffei in human immunodeficiency virus (HIV)-and non-HIV-infected patients. J Clin Microbiol. 2001;39:4535–40.http://dx.doi.org/10.1128/JCM.39.12.4535-4540.200112. Yuen KY, Wong SS, Tsang DN, Chau PY. Serodiagnosis ofPenicillium marneffei infection. Lancet. 1994;344:444–5.http://dx.doi.org/10.1016/S0140-6736(94)91771-X13. Wu TC, Chan JW, Ng CK, Tsang DN, Lee MP, Li PC. Clinicalpresentations and outcomes of Penicillium marneffei infections: aseries from 1994 to 2004. Hong Kong Med J. 2008; 14:103–9 .14. Dang VD, Hilgenberg E, Ries S, Shen P, Fillatreau S. From theregulatory functions of B cells to the identification of cytokineproducingplasma cell subsets. Curr Opin Immunol. 2014;28:77–83. http://dx.doi.org/10.1016/j.coi.2014.02.00915. Anolik JH, Friedberg JW, Zheng B, Barnard J, Owen T, Cushing E,et al. B cell reconstitution after rituximab treatment of lymphomarecapitulates B cell ontogeny. Clin Immunol. 2007;122:139–45.http://dx.doi.org/10.1016/j.clim.2006.08.00916. Wysham NG, Sullivan DR, Allada G. An opportunistic infectionassociated with ruxolitinib, a novel janus kinase 1,2 inhibitor.Chest. 2013;143:1478–9. http://dx.doi.org/10.1378/chest.12-160417. Hopman RK, Lawrence SJ, Oh ST. Disseminated tuberculosisassociated with ruxolitinib. Leukemia. 2014;28:1750–1.http://dx.doi.org/10.1038/leu.2014.10418. Teo M, O’Connor TM, O’Reilly SP, Power DG. Sorafenib-inducedtuberculosis reactivation. Onkologie. 2012;35:514–6.http://dx.doi.org/10.1159/00034182919. Wang YF, Xu HF, Han ZG, Zeng L, Liang CY, Chen XJ, et al.Serological surveillance for Penicillium marneffei infection inHIV-infected patients during 2004−2011 in Guangzhou, China.Clin Microbiol Infect. 2014;Dec 26:pii:S1198-743X(14)00167-0.[Epub ahead of print].Address for correspondence: Patrick C.Y. Woo, State Key Laboratoryof Emerging Infectious Diseases, Department of Microbiology, CarolYu Centre for Infection, The University of Hong Kong, UniversityPathology Bldg, Queen Mary Hospital Compound, Pokfulam Rd, HongKong, China; email: pcywoo@hku.hk1106 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015
Macacine Herpesvirus 1 inLong-Tailed Macaques,Malaysia, 2009–2011RESEARCHMei-Ho Lee, Melinda K. Rostal, Tom Hughes, Frankie Sitam, Chee-Yen Lee, Jeffrine Japning,Mallory E. Harden, Anthony Griffiths, Misliah Basir, Nathan D. Wolfe, Jonathan H. Epstein, Peter DaszakMacacine herpesvirus 1 (MaHV1; B virus) naturally infectsmacaques (Macaca spp.) and can cause fatal encephalitisin humans. In Peninsular Malaysia, wild macaques areabundant, and translocation is used to mitigate human–macaque conflict. Most adult macaques are infected withMaHV1, although the risk for transmission to persons whohandle them during capture and translocation is unknown.We investigated MaHV1 shedding among 392 long-tailedmacaques (M. fascicularis) after capture and translocationby the Department of Wildlife and National Parks in PeninsularMalaysia, during 2009–2011. For detection of MaHV1DNA, PCR was performed on urogenital and oropharyngealswab samples. Overall, 39% of macaques were sheddingMaHV1 DNA; rates of DNA detection did not differ betweensample types. This study demonstrates that MaHV1 wasshed by a substantial proportion of macaques after captureand transport and suggests that persons handlingmacaques under these circumstances might be at risk forexposure to MaHV1.Macacine herpesvirus 1 (MaHV1; also known as B virus)is a zoonotic pathogen that is enzootic amongmacaque (Macaca spp.) populations throughout Asia (1,2).MaHV1 is an α-herpesvirus related to human herpes simplexviruses (HSV) 1 and 2 (3,4) and to herpesviruses thatinfect other nonhuman primates such as baboons (5). LikeHSV infection in humans, MaHV1 infection in macaquescan clinically appear as vesicular lesions on the mucousmembranes of the buccal cavity and genital area (6,7).However, macaques without clinically apparent lesions canstill shed MaHV1 (6).Transmission of MaHV1 can occur transcutaneously(via bites) or permucosally (via exposure to macaque bodyAuthor affiliations: EcoHealth Alliance, New York, New York, USA(M-.H. Lee, M.K. Rostal, T. Hughes, C.-Y. Lee, J.H. Epstein,P. Daszak); Department of Wildlife and National Parks PeninsularMalaysia, Kuala Lumpur, Malaysia (F. Sitam, J. Japning, M. Basir);Texas Biomedical Research Institute, San Antonio, Texas, USA(M.E. Harden, A. Griffiths); Metabiota, San Francisco, California,USA (N.D. Wolfe)DOI: http://dx.doi.org/10.3201/eid2107.140162fluids) (8,9). Among humans, ≈40 cases of MaHV1 encephalitishave been reported; all patients were laboratoryworkers who had come in contact with rhesus macaques(M. mulatta) only or with rhesus macaques and long-tailedmacaques (M. fascicularis) or their tissues in the researchenvironment (2,3). For these patients, signs and symptomsof MaHV1 infection included skin ulcers and lesions at thesite of injury, influenza-like illness, and infection of the peripheraland central nervous systems (which can developinto brainstem encephalomyelitis and death) (7,9). Themortality rate for humans with untreated MaHV1 infectionis >70% (7). This high case-fatality rate has led to strictregulations for handling macaques and macaque clinicalsamples in laboratories and resulted in the designation ofMaHV1 as a Biosafety Level 4 (BSL-4) pathogen and, untilrecently, a select agent (2,7,9).In macaques, MaHV1 frequently remains latent in thetrigeminal and lumbosacral ganglia; however, in responseto stress, it can be asymptomatically reactivated and shed insaliva and urogenital excretions (10). Macaques typicallyacquire MaHV1 at sexual maturity (11); previous studieshave found IgG against MaHV1 in up to 100% of sexuallymature wild or laboratory long-tailed and rhesus macaques(11,12). As with other viral infections, the presenceof IgG indicates previous exposure or infection but doesnot indicate active virus shedding. During active infection,MaHV1 DNA can be detected in saliva or urogenitalsamples by use of PCR. Virus culture is also possible but isnot routinely performed because doing so safely requires aBSL-4 laboratory (11). Using PCR as a diagnostic methodhas advantages over culture in that it can be performed underBSL-2 conditions, it produces results more rapidly, andits sensitivity and specificity are higher (13,14).Little is known about the shedding rate of MaHV1 inmacaques outside the laboratory setting, the frequency oftransmission to humans, or the incidence of MaHV1 encephalitisamong humans (particularly those with frequentcontact with macaques). In Asia, at least 50% of cases ofencephalitis are never diagnosed to the point of causativeagent identification (15). Understanding the ecology ofMaHV1 among macaques is essential for understandingEmerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015 1107
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