Observations on Vaccinial Eruptions and Differential Diagnosis of Generalized Vaccinia

Abstract

Dumbell, 1947;Kempe, 1956) from both specimens. Complement fixation (McCarthy and Downie, I953) titers of I 2: I80 were found in each of two serum specimens collected five days and eight days, respectively, after the onset of the illness. In the same specimens, the hiemagglutination inhibition test (McCarthy and Downie, 1953) yielded titers of I: 320 and I :5120, respectively. Comment. The superimposition of a pock-rash on the atopic dermatitis composed a clinical picture usually known as Kaposi's varicelliform eruption, but it might as well be called eczema vaccinatum. The pock-rash presented such a close similarity with variolous eruptions that a clinician with ample experience in variola and generalized vaccinia identified it, without hesitation, as a smallpox exanthem. Incidentally, the outbreaks of generalized vaccinia had disappeared when this case was examined. The pock-distribution was so widespread that the asymmetry and accumulation of lesions characterizing many of the other cases occurring during the outbreaks were not present. In addition, the morphology of individual pocks closely mimicked that of classical variolous lesions. The patient showed a definite prodromal period whose symptomatology and duration made the diagnosis of smallpox more likely since cases of generalized vaccinia not infrequently show few if any manifestations before the onset of the exanthem. In an overall appraisal, the distribution of pocks was rather uniform because neither centrifugal copyright.