Novel Paramyxovirus Associated with Severe Acute Febrile Disease, South Sudan and Uganda, 2012

In 2012, a female wildlife biologist experienced fever, malaise, headache, generalized myalgia and arthralgia, neck stiffness, and a sore throat shortly after returning to the United States from a 6-week field expedition to South Sudan and Uganda.She was hospitalized, after which a maculopapular rash developed and became confluent.When the patient was discharged from the hospital on day 14, arthralgia and myalgia had improved, oropharynx ulcerations had healed, the rash had resolved without desquamation, and blood counts and hepatic enzyme levels were returning to reference levels.After several known suspect pathogens were ruled out as the cause of her illness, deep sequencing and metagenomics analysis revealed a novel paramyxovirus related to rubula-like viruses isolated from fruit bats.P aramyxoviruses comprise a large family of viruses, in- cluding pathogens that cause severe disease in humans (1).Worldwide, >100 paramyxoviruses have been identified in bats and rodents (2-4).Among these, few have been shown to be pathogenic to humans, possibly because of limited host range and/or infrequent exposure.We describe a novel rubula-like virus that was associated with a severe acute febrile illness in a woman.The patient was a wildlife biologist who had participated in a 6-week field expedition to South Sudan and Uganda.During this expedition, she had been exposed to bats and rodents of >20 species while wearing different levels of personal protective equipment. Clinical PresentationDuring the summer of 2012, a 25-year-old female wildlife biologist participated in a 6-week field expedition to South Sudan and Uganda, where she traveled to remote rural areas collecting bats and rodents for ecologic research.In the course of her duties, she manipulated animals in traps and mist nets, performed dissections, collected blood and tissues, and visited caves with large bat populations.She received no injuries from sharp objects and no bites or scratches from the animals with which she was working.She occasionally used respiratory protection when working with animals and specimens, and she wore a respirator while in caves.During her trip, she had no known contact with ill members of the field team, no contact with health care facilities, and no sexual contacts.She had been vaccinated against hepatitis A and B, yellow fever, measles, mumps, rubella, rabies, polio, tetanus/ diphtheria, and typhoid fever, and she fully complied with a malaria prophylaxis regimen of atovaquone/proguanil. Her medical history included migraines and treatment of presumptive malaria with artemether/lumefantrine during a similar expedition the previous year.Five days after returning to the United States, the woman was evaluated in the emergency department for a 2-day history of fever, malaise, headache, generalized myalgia and arthralgia, neck stiffness, a metallic taste, and sore throat.Results of rapid malaria test, performed on the day of fever onset, were negative.Other laboratory results and the patient's vital signs at the time of admission are summarized in the Table .The patient seemed to be fatigued but alert and oriented; she was anicteric, and she had no nuchal rigidity or focal neurologic deficits.Mild erythema of the soft palate without ulcerations or exudates was noted.The spleen tip was palpable despite absence of adenopathy.Examination of heart, abdomen, and lungs (including chest radiographs) revealed no abnormalities.