Novel poxvirus infection in 2 patients from the United States

Lynda U. Osadebe, Kalpana Manthiram, Andrea M. McCollum, Yu Li, Ginny L. Emerson, Nadia F. Gallardo-Romero, Jeffrey B. Doty, Kimberly Wilkins, Hui Zhao, Clifton P. Drew, Maureen G. Metcalfe, Cynthia S. Goldsmith, Atis Muehlenbachs, Paul Googe, John Dunn, Todd Duenckel, Heather Henderson, Darin S. Carroll, Sherif R. Zaki, Mark R. Denison & 2 others Mary G. Reynolds, Inger K. Damon

Research output: Contribution to journalArticle

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Abstract

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 patientsâ €™ 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. â €œ Pan-pox and high Guanine-cytosineâ € 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.

Original languageEnglish (US)
Pages (from-to)195-202
Number of pages8
JournalClinical Infectious Diseases
Volume60
Issue number2
DOIs
StatePublished - Jan 15 2015
Externally publishedYes

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Poxviridae Infections
Poxviridae
Parapoxvirus
Zoonoses
Molluscipoxvirus
Skin
Cytosine
Viral DNA
Guanine
Virus Diseases
Infection
Transmission Electron Microscopy
Horses
Rodentia

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Osadebe, L. U., Manthiram, K., McCollum, A. M., Li, Y., Emerson, G. L., Gallardo-Romero, N. F., ... Damon, I. K. (2015). Novel poxvirus infection in 2 patients from the United States. Clinical Infectious Diseases, 60(2), 195-202. https://doi.org/10.1093/cid/ciu790

Novel poxvirus infection in 2 patients from the United States. / Osadebe, Lynda U.; Manthiram, Kalpana; McCollum, Andrea M.; Li, Yu; Emerson, Ginny L.; Gallardo-Romero, Nadia F.; Doty, Jeffrey B.; Wilkins, Kimberly; Zhao, Hui; Drew, Clifton P.; Metcalfe, Maureen G.; Goldsmith, Cynthia S.; Muehlenbachs, Atis; Googe, Paul; Dunn, John; Duenckel, Todd; Henderson, Heather; Carroll, Darin S.; Zaki, Sherif R.; Denison, Mark R.; Reynolds, Mary G.; Damon, Inger K.

In: Clinical Infectious Diseases, Vol. 60, No. 2, 15.01.2015, p. 195-202.

Research output: Contribution to journalArticle

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, P, Dunn, J, Duenckel, T, Henderson, H, Carroll, DS, Zaki, SR, Denison, MR, Reynolds, MG & Damon, IK 2015, 'Novel poxvirus infection in 2 patients from the United States', Clinical Infectious Diseases, vol. 60, no. 2, pp. 195-202. https://doi.org/10.1093/cid/ciu790
Osadebe LU, Manthiram K, McCollum AM, Li Y, Emerson GL, Gallardo-Romero NF et al. Novel poxvirus infection in 2 patients from the United States. Clinical Infectious Diseases. 2015 Jan 15;60(2):195-202. https://doi.org/10.1093/cid/ciu790
Osadebe, Lynda U. ; Manthiram, Kalpana ; McCollum, Andrea M. ; Li, Yu ; Emerson, Ginny L. ; Gallardo-Romero, Nadia F. ; Doty, Jeffrey B. ; Wilkins, Kimberly ; Zhao, Hui ; Drew, Clifton P. ; Metcalfe, Maureen G. ; Goldsmith, Cynthia S. ; Muehlenbachs, Atis ; Googe, Paul ; Dunn, John ; Duenckel, Todd ; Henderson, Heather ; Carroll, Darin S. ; Zaki, Sherif R. ; Denison, Mark R. ; Reynolds, Mary G. ; Damon, Inger K. / Novel poxvirus infection in 2 patients from the United States. In: Clinical Infectious Diseases. 2015 ; Vol. 60, No. 2. pp. 195-202.
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abstract = "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{\^a} €™ 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. {\^a} €œ Pan-pox and high Guanine-cytosine{\^a} € 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.",
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AU - Gallardo-Romero, Nadia F.

AU - Doty, Jeffrey B.

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AU - Dunn, John

AU - Duenckel, Todd

AU - Henderson, Heather

AU - Carroll, Darin S.

AU - Zaki, Sherif R.

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N2 - 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 patientsâ €™ 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. â €œ Pan-pox and high Guanine-cytosineâ € 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.

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