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Novel poxvirus infection in 2 patients from the United States.

Osadebe LU, Manthiram K, McCollum AM, Li Y, Emerson GL, Gallardo-Romero NF, Doty JB, Wilkins K, Zhao H, Drew CP, Metcalfe MG, Goldsmith CS, Muehlenbachs A, Googe PB, Dunn J, Duenckel T, Henderson H, Carroll DS, Zaki SR, Denison MR, Reynolds MG, Damon IK
Clin Infect Dis. 2015 60 (2): 195-202

PMID: 25301210 · PMCID: PMC5854477 · DOI:10.1093/cid/ciu790

BACKGROUND - Some human poxvirus infections can be acquired through zoonotic transmission. We report a previously unknown poxvirus infection in 2 patients, 1 of whom was immunocompromised; both patients had known equine contact.

METHODS - The patients were interviewed and clinical information was abstracted from the patients' medical files. Biopsies of the skin lesions were collected from both patients for histopathology, immunohistochemistry, and transmission electron microscopy analysis. Oral and skin swabs were collected from animals with frequent contact with the patients, and environmental sampling including rodent trapping was performed on the farm where the immunosuppressed patient was employed. "Pan-pox and high Guanine-cytosine" polymerase chain reaction assays were performed on patient, animal, and environmental isolates. Amplicon sequences of the viral DNA were used for agent identification and phylogenetic analysis.

RESULTS - Specimens from both human cases revealed a novel poxvirus. The agent shares 88% similarity to viruses in the Parapoxvirus genus and 78% to those in the Molluscipoxvirus genus but is sufficiently divergent to resist classification as either. All animal and environmental specimens were negative for poxvirus and both patients had complete resolution of lesions.

CONCLUSIONS - This report serves as a reminder that poxviruses should be considered in cutaneous human infections, especially in individuals with known barnyard exposures. The clinical course of the patients was similar to that of parapoxvirus infections, and the source of this virus is currently unknown but is presumed to be zoonotic. This report also demonstrates the importance of a comprehensive approach to diagnosis of human infections caused by previously unknown pathogens.

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

MeSH Terms (10)

Biopsy DNA, Viral Humans Molecular Sequence Data Polymerase Chain Reaction Poxviridae Poxviridae Infections Sequence Analysis, DNA Skin United States

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