Images in Clinical Medicine
Cowpox Infection
N Engl J Med 2003; 348:415January 30, 2003
- Article
A nine-year-old girl living in a rural area who had no known exposure to cows presented with a two-week history of several painful lesions on her left forearm where she had been scratched by a free-roaming cat. Two days after the scratch, small vesicles had appeared. Within two weeks the lesions turned to pustules and then enlarged to painful, ulcerated nodules up to 2 cm in diameter and ulcers with black eschars (Panel A). The patient had fever, malaise, and night sweats. Swabs from the lesions grew commensal bacteria. Transmission electron microscopy of biopsy specimens of the lesions did not reveal viral particles. A highly cytopathic virus was isolated from cell culture of biopsy specimens; examination of glutaraldehyde-fixed thin sections revealed mature and immature poxvirus particles (Panel B; ×26,000). Panel C shows the results of a polymerase-chain-reaction assay used to amplify a 587-bp fragment of the hemagglutinin gene of orthopoxviruses. Lane 2 shows the original biopsy specimen, and lane 3 shows cell-culture material. Restriction-enzyme digestion of cell-culture material with Taq1 (lane 4) showed a fragment pattern similar but not identical to that of vaccinia virus strain MVA (lane 5, after digestion with Taq1, and lane 6, before digestion), used as a positive control. Lanes 7 and 8 show DNA from herpes simplex type 1 and varicella–zoster viruses. Lanes 1 and 9 show size markers. A serum sample from the child was positive for orthopoxvirus antibodies on neutralization assay and competitive enzyme-linked immunosorbent assay. She was treated with broad-spectrum antibacterial agents. The necrotic material was removed, and the lesions healed after six weeks.
Bernadette Feuerstein-Kadgien, M.D.
Klaus Korn, M.D.
University of Erlangen, D-91052 Erlangen, Germany- Citing Articles (1)
Citing Articles
1
Elena V. Gavrilova, Dmitrii N. Shcherbakov, Rinat A. Maksyutov, Sergei N. Shchelkunov. (2010) Development of real-time PCR assay for specific detection of cowpox virus. Journal of Clinical Virology 49:1, 37-40
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