Skin lesions caused by Orthopoxvirus in children

Abstract

Introduction: The global eradication of smallpox and abandonment of mandatory smallpox vaccination has led to an increased proportion of the population who are immunologically naïve to infections caused by Orthopoxviruses (OPV). Aim: To present the different courses of OPV infection in children and to highlight the diagnostic difficulties in their differentiation from the other inflammatory processes. Material and methods: We retrospectively evaluated the medical documentation of 5 children with OPV infection. Clinical diagnosis of OPV infection was based on evaluation of animal contact and skin symptoms, characterised by either a single ulcer or disseminated lesions. In all five cases, blood samples and skin swabs were collected from the lesion(s) to identify specific OPV DNA fragments (Vgf, b9R and D11L genes) using PCR. Results: Two children presented with high fever, a single ulcer on the skin and local lymphadenopathy. The three other patients were in good general health and their skin lesions presented as a disseminated vesicular rash. Using the Vgf gene as the target for PCR, OPV infection was confirmed in material collected from skin lesions of all children and in blood samples of 4 children. The B9R and d11L genes tested positive in the skin material of 2 children and blood samples of 2 children. All analysed patients presented a history of ineffective antibiotic therapy. Conclusions: In the case of unclear necrotising skin lesions in children, the primary diagnosis always includes bacterial dermatitis. However, if the patient has come into contact with animals, diagnosis of OPV infection should also be considered.

Skin lesions caused by Orthopoxvirus, cowpox - case report from Poland

“…CMX001 treatment has been tested in animal models: MPXV, rabbit pox virus, for its effectiveness in the pox epidemic [12]. Other medicines were also tested, including oral tecovirimat, thiosemicarbazones, nucleoside and nucleotide analogs, interferon, and interferon inducers, but none have been proven as an effective treatment [13]. In the past, vaccination against smallpox may have provided cross-resistance to CPXV and other OPV zoonoses [14].…”