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This patient presented with herpes simplex lesions around her mouth due to the herpes simplex virus Type-1, (HSV1) pathogen. We believe in a holistic clinical approach, which involves first listening to patients concerns, then thoroughly diagnosing and explaining their individual treatment options. In 2007, we detected human herpes simplex virus type 1, which caused stomatitis, in a juvenile confiscated eastern lowland gorilla (Gorilla beringei graueri) that had a high degree of direct contact with human caretakers. A 2-year-old female Grauer’s gorilla, confiscated from poachers in Goma, Democratic Republic of the Congo, in November 2005, was group-housed in a facility with 6 other juvenile Grauer’s gorillas and 1 juvenile mountain gorilla (G.b.
Histologic examination of the biopsy sample showed variably thickened, ulcerated, nonkeratinizing, stratified squamous oral mucosae.
DNA was extracted from swab samples from this animal (8) and amplified by PCR using pan-herpesvirus–specific primers designed to the DNA polymerase gene (UL30) (9). To confirm our conclusion that the lesion was associated with HSV-1 infection, we used HSV-1–specific primers to amplify a region of UL30 (aa 134–246) outside of the amplicon defined by the pan-herpesvirus–specific primers.
On the basis of the results of the histopathologic features and molecular screening of the virus, we concluded that the stomatitis in this juvenile female Grauer’s gorilla confiscated from poachers in Goma, Democratic Republic of the Congo, was caused by HSV-1.
Our findings have major ramifications for the possible reintroduction of these confiscated gorillas into the wild (all remain in captivity) because such a management action might introduce a novel (human) pathogen to a naive population. Samples were imported into the United States by permission of the Convention on International Trade in Endangered Species. This report was made possible in part by National Center for Research Resources and Office of Research Infrastructure Programs support to the California National Primate Research Center, and by the US Agency for International Development Emerging Pandemic Threats PREDICT project; contents do not necessarily reflect the views of USAID or the US Government. Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Global trends in emerging infectious diseases.
Suggested citation for this article: Gilardi KVK, Oxford KL, Gardner-Roberts D, Kinani JF, Spelman L, Barry PA, et al. The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Herpes simplex virus type1 usually is the cause for oral lesions sometimes referred to as “cold sores”, “fever blisters” or more technically known as “recurrent herpes labialis”. Our findings confirm that pathogens can transfer between nonhuman primate hosts and humans. The close genetic relatedness of humans and nonhuman primates (NHPs) makes each uniquely susceptible to pathogens of the other (2). Vesicular stomatitis in a wild-caught juvenile Grauer’s gorilla (Gorilla beringei graueri).
Margins of ulcers showed marked epidermal swelling (intracellular edema, ballooning degeneration) and large numbers of epithelial syncytial cells, often with marginated chromatin and smudgy intranuclear inclusion bodies filling the nucleus (Figure 1, panel B.). Amplification was positive for the oral swab sample DNA with this second primer pair and for 3 human-isolated HSV-1 strains. Alphaherpesvirus exposure in wild gorillas in this region has been reported (10), but to our knowledge, human HSV infection in wild-born captive gorillas has not been detected with molecular techniques.
Screening wild Grauer’s gorillas and other gorilla populations for human HSV and other human pathogens will be critical to adequately assess the risk for reintroducing captive gorillas to wild populations of these endangered great apes.

Drayer Wildlife Health Center, School of Veterinary Medicine, University of California, Davis. We thank the Institut Congolais pour la Conservation de la Nature and the Rwanda Development Board (Antoine Mudakikwa) for permission to care for confiscated Grauer’s and mountain gorillas and the Dian Fossey Gorilla Fund for orphan gorilla management cooperation. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. All gorillas had daily direct contact with one another and with human caretakers who provided hands-on care. Inclusion bodies were present in individual cells in the stratum basalis and stratum spinosum adjacent to the ulcers. KJ396198) showed 99% identities with the DNA and protein sequences of HSV-1 UL30, and 94% and 95% identities (DNA and protein, respectively) to UL30 of HSV-2 (Table).
Sequence analysis of the amplicon demonstrated 100% and 89% sequence identity with HSV-1 and HSV-2, respectively (data not shown). From a global health standpoint, our finding of human HSV-1 in a gorilla proves once again that pathogens transfer among human and NHP hosts.
Her research interests include NHP medicine and conservation, zoonoses, marine wildlife and ecosystem health, and One Health. Bob Nordhausen assisted with electron microscopy, and Christopher Polage provided human herpesvirus isolates.
Use of trade names is for identification only and does not imply endorsement by any of the groups named above. In March 2007, 5 of the Grauer’s gorillas exhibited bouts of lethargy and anorexia and oral lesions. Using transmission electron microscopy, we observed virions consistent with herpesvirus in shape and size within the nucleus of syncytial cells and budding through the nuclear membrane (Figure 1, panel C.).
Because sequences from gorilla-specific herpesviruses have not been annotated, we performed a phylogenetic analysis of the amplicon from the gorilla swab sample using the UL30 genes from broadly representative isolates from the 3 herpesvirus subfamilies. Although of concern from a wildlife conservation standpoint (5), human-to-NHP transmission events substantiate the fact that pathogen sharing is bidirectional (6).
Three of the affected gorillas, including the gorilla from Goma, were chemically immobilized for examination. Histopathology and transmission electron microscopy findings were essentially identical to findings from human HSV-1 infections (7). The gorilla-derived DNA and protein (Figure 2, panels A and B) exhibited the strongest phylogenetic relationship with HSV-1. Serologic tests for HSV-1 on samples collected before the outbreak from other gorillas in the confiscated gorilla’s group showed that 2 clinically unaffected gorillas were seropositive for HSV-1, suggesting previous exposure to an alphaherpesvirus (12).
To provide further evidence for the potential for disease emergence at the human–NHP interface, we report a human herpes simplex virus type 1 (HSV-1) infection in an eastern lowland gorilla (Grauer’s gorilla, Gorilla beringei graueri). All 3 gorillas exhibited multiple clear fluid-filled vesicles up to 2 cm in diameter that affected the mucosa of the lips and gingiva (Figure 1, panel A). Alignments of human and NHP alphaherpesvirus representatives show that the region amplified with the consensus herpesvirus primers is a highly conserved region of UL30 (Technical Appendix [PDF - 144 KB - 1 page] Figure).

However, serologic tests for HSV-1 and -2 exposure in the 5 clinically affected gorillas during this outbreak, including the gorilla from Goma, were negative, which suggests these animals were experiencing their first HSV infections, and antibodies were not yet detectable. The sequence alignments strongly suggested that the herpesvirus DNA in the oral lesion was HSV-1, although the gorilla-derived amplicon was an outlier in comparison with other HSV-1 isolates (data not shown). Although the HSV infection status of the poachers who captured and initially held the gorilla from Goma was unknown, as was the human HSV infection status of the caretakers (from whom samples were not collected) who had daily contact with this gorilla and her captive cohort, we can safely assume most of these persons were representative of the general human population and therefore infected because HSV-1 seropositivity has been documented at a prevalence of >90% in the region (13–15), and HSV infections are lifelong. The biopsy sample was fixed in 10% buffered formalin; the swab samples were stored frozen at –80°C, and these specimens were shipped to the United States for diagnostic testing. The relative divergence of the amplicon was due primarily to nucleotide changes encoding a 3-aa motif not found in any other annotated sequence (Technical Appendix [PDF - 144 KB - 1 page] Figure). DOIPubMedGao F, Bailes E, Robertson DL, Chen Y, Rodenburg CM, Michael SF, Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes.
Whether adaptation of the putative HSV-1 in the gorilla host represents a compensatory change to replication in the ectopic gorilla host is not known. B-virus (Cercopithecine herpesvirus 1) infection in humans and macaques: potential for zoonotic disease. DOIPubMedPalacios G, Lowenstine LJ, Cranfield MR, Gilardi KVK, Spelman L, Lukasik-Braum M, Human metapneumovirus infection in wild mountain gorillas in Rwanda.
DOIPubMedChen EC, Yagi S, Kelly KR, Mendoza SP, Maninger N, Rosenthal A, Cross-species transmission of a novel adenovirus associated with a fulminant pneumonia outbreak in a New World monkey colony. DOIPubMedOxford KL, Eberhardt MK, Yang KW, Strelow L, Kelly S, Zhou SS, Protein coding content of the ULb? region of wild-type rhesus cytomegalovirus. Detection of new DNA polymerase genes of known and potentially novel herpesviruses by PCR with degenerate and deoxyinosine-substituted primers. Spontaneous generalized Herpesvirus hominis infection of a lowland gorilla (Gorilla gorilla gorilla). Seroprevalence of infectious agents in free-living mountain gorillas (Gorilla beringei spp).
Proceedings of the Wildlife Disease Association International Conference 2005, Cairns, Australia. 291.Wagner HU, Van Dyck E, Roggen E, Nunn AJ, Kamali A, Schmid DS, Seroprevalence and incidence of sexually-transmitted diseases in a rural Ugandan population.
Prevalence of antibodies against herpes simplex virus types 1 and 2 in children and young people in an urban region in Tanzania. Risk of disease transmission between conservation personnel and the mountain gorillas: results from an employee health program in Rwanda.

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