A Case of Facial Cellulitis and Necrotizing Lymphadenitis due to Cowpox Virus Infection.

A Case of Facial Cellulitis and Necrotizing Lymphadenitis due to Cowpox Virus Infection.

Clin Infect Dis. 2006 Sep 15;43(6):737-42. Epub 2006 Aug 10

Pahlitzsch R,
Hammarin AL,
Widell A.

Department of Otolaryngology, Blekinge County Hospital, Karlskrona, Sweden. roland.pahlitzsch@ltblekinge.se.

We describe a patient with facial cellulitis/erysipelas due to cowpox virus inoculation in the respiratory epithelium of the nose. A cytopathic agent was isolated in cell culture, and the diagnosis of cowpox was confirmed by electron microscopy and polymerase chain reaction.

The most likely source of infection was exposure to the family cats. In addition to the severe edematous cellulitis of the face, the clinical course was dominated by several areas of subcutaneous, necrotizing lymphadenitis, from one of which a huge abscess formed that had to be incised. Hyperbaric oxygen treatment was provided to prevent development of dermal necrosis.

The healing process in the numerous areas of lymphadenitis was markedly protracted, and 1 persisting node (which yielded positive results on polymerase chain reaction) had to be excised 2 years after onset of disease.

This is the first reported case of inoculation of cowpox virus in the respiratory mucosa of the nose. It resulted in a clinical course totally different than that for inoculation in the skin. We also present a short review of findings on orthopoxvirus infection that focuses on the chain of transmission.

PMID: 16912948 [PubMed - in process]

[Human cowpox/catpox infection. A potentially unrecognized disease]

Steinborn A,
Essbauer S,
Marsch WCh.
Universitatsklinik und Poliklinik fur Dermatologie und Venerologie, Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale).

HISTORY AND ADMISSION FINDINGS:

A 36-year-old woman initially noticed a red spot, about pea-sized, with a central pimple over the right eyebrow and a swollen submandibular lymph node. A pressure-sensitive, 4 cm large, node developed out of this small spot, with a central, black, tightly-adhering crust bearing several varioliform vesicles around its edge. In addition to swelling of the right half of the face, the patient had a fever up to 39.5 degrees C, general malaise, nausea and vomiting. Various antibiotics were ineffective. The woman was hospitalized with a diagnosis of facial erysipelas. She owned a cat which had developed a purulent nodule on a forepaw a few days before onset of the patient's disease.

LABORATORY TEST:

ESR and CRP were moderately elevated, no leukocytosis and blood cultures were sterile. Wound smears showed colonization with Klebsiella pneumoniae and Enterobacter cloacae.

DIAGNOSIS, TREATMENT AND COURSE:

The patient's general condition improved under initially calculated antibiotic dosages, which was later adapted to the measured resistance. The black-crusted nodes became larger, however, and incision was performed on the 8 th day after hospitalization, under the suspicion of fluctuation. However, no pus was removed, but there was massive inflammatory infiltration of the soft tissue. Examination of samples of skin and part of the crust revealed orthopox virus (cowpox virus). Spontaneous healing followed within 3 weeks, leaving only a small scar.

CONCLUSIONS:

This was a cowpox virus in the sense of a zoonosis transmitted by the cat. In Germany, now that smallpox has been eradicated, the clinical presentation of infections with the orthopox virus, which are closely related to variola virus, are too little recognized. Atopic and immunocompromised patients are at risk of a cutaneous dissemination with a more severe course of the infectious illness; even a lethal outcome has been reported in Germany.

PMID: 12649797 [PubMed - indexed for MEDLINE]

[Cowpox virus infection in a child]

April 2004

[Article in French]
Heilbronner C,
Harzic M,
Ferchal F,
Pothier A,
Charara O,
Beal G,
Bellaiche M,
Lesca C,
Foucaud P.
Service de pediatrie, hopital Andre-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le-Chesnay, France. cheilb@yahoo.com

Although human cowpox virus infection is rare nowadays, an animal reservoir of this virus still exists. The general course of cowpox virus infections is usually benign but the diagnosis is difficult and often late.

CASE REPORT: An 11-year-old boy, owner of two cats, presented with an infected sacral wound lesion associated with fever and lymph nodes. The wound became necrotic and other cutaneous and mucous membrane lesions developed secondarily. Blood tests did not show hyperleukocytosis or a systemic inflammatory response. Concurrently one of the cats was examined by a veterinary because of multifocal cutaneous lesions. Evocative skin biopsy specimens from the animal and, secondarily from the patient, allowed the identification of orthopoxvirus. Evolution was slowly favourable under symptomatic treatment.

CONCLUSION: Poxviruses are responsible for many animal and human diseases, the most famous of them being smallpox which today is considered eradicated. Vaccination against smallpox is no longer performed since 1977. Whether the arrest of vaccinations against smallpox may induce the apparition of other poxviruses infections or alter their clinical expression is an open question.]

PMID: 15051092 [PubMed - indexed for MEDLINE]