Human Cowpox Infection Clinical Presentation

  • Author: Nikki A Levin, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 22, 2011
 

History

  • Generally, patients are young; 50% of patients are younger than 18 years.
  • Most cases occur in late summer to fall.
  • Cases present in endemic areas of Europe.
  • Contact with rodents, cats, or cows is reported in 50% of cases.[12, 13, 14, 15, 16] One case was reported in an animal keeper who was exposed to an infected circus elephant.[17]
  • Usually, only 1 or a small number of lesions occur on the hands (48%) and face (33%).
  • Patients may report having a flat red lesion that became raised and then blistered over a period of 2 weeks. The blister subsequently became crusted, with the surrounding skin becoming red and swollen. The lesions are characteristically described as quite painful.
  • Patients may have eye complaints.
  • Patients may report fever, malaise, lethargy, vomiting, and sore throat, which usually lasts 3-10 days but resolves during the eschar stage of cutaneous lesions.
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Physical

  • Physical findings generally are limited to the skin, eyes, and lymph nodes.
  • Cutaneous findings develop as follows:
    • Days 1-6 (after inoculation): An inflamed macule appears at the site of contact with the infected animal and at any secondary sites of accidental transfer.
    • Days 7-12: The inflamed lesion becomes papular, then vesicular.
    • Days 13-20: The vesicle becomes hemorrhagic, then pustular, and has a tendency to ulcerate, with surrounding edema and induration. Secondary lesions may form nearby.
    • Weeks 3-6: The vesicopustule progresses to a deep-seated, hard, black eschar, often surrounded by edema, induration, and erythema. Most patients present at this stage, which may appear similar to cutaneous anthrax.[18, 19]
    • Weeks 6-12: The eschar sloughs, and the lesion heals, usually with scarring.A 16-year-old boy with generalized cowpox. CourtesA 16-year-old boy with generalized cowpox. Courtesy of Dr. Reinhard Hoepfl, Innsbruck, Austria.
  • Rarely, the cutaneous lesions may become generalized before resolving.
  • Ocular findings include conjunctivitis, periorbital edema, and corneal involvement.
  • Enlarged painful local lymph nodes often are observed. Necrotizing lymphadenitis has been reported.[20]
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Causes

The natural reservoir of cowpox virus is believed to be small woodland mammals, such as bank voles and wood mice, with humans, cows, and cats being only accidental hosts.

  • Risk factors for infection with cowpox include exposure to potentially infected animals (eg, cats, cows, rodents) in an endemic area.
  • Risk factors for dissemination of infection include atopic dermatitis and use of systemic corticosteroids.
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Contributor Information and Disclosures
Author

Nikki A Levin, MD, PhD  Associate Professor of Medicine, Division of Dermatology, University of Massachusetts Medical School

Nikki A Levin, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Burton JL. Of mice and milkmaids, cats and cowpox. Lancet. Jan 8 1994;343(8889):67. [Medline].

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  4. Pelkonen PM, Tarvainen K, Hynninen A, et al. Cowpox with severe generalized eruption, Finland. Emerg Infect Dis. Nov 2003;9(11):1458-61. [Medline].

  5. Honlinger B, Huemer HP, Romani N, Czerny CP, Eisendle K, Hopfl R. Generalized cowpox infection probably transmitted from a rat. Br J Dermatol. Aug 2005;153(2):451-3. [Medline].

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  9. Amer M, El-Gharib I, Rashed A, Farag F, Emara M. Human cowpox infection in Sharkia Governorate, Egypt. Int J Dermatol. Jan 2001;40(1):14-7. [Medline].

  10. Haase O, Moser A, Rose C, Kurth A, Zillikens D, Schmidt E. Generalized cowpox infection in a patient with Darier disease. Br J Dermatol. May 2011;164(5):1116-8. [Medline].

  11. Blackford S, Roberts DL, Thomas PD. Cowpox infection causing a generalized eruption in a patient with atopic dermatitis. Br J Dermatol. Nov 1993;129(5):628-9. [Medline].

  12. Stolz W, Gotz A, Thomas P, et al. Characteristic but unfamiliar--the cowpox infection, transmitted by a domestic cat. Dermatology. 1996;193(2):140-3. [Medline].

  13. Postma BH, Diepersloot RJ, Niessen GJ, Droog RP. Cowpox-virus-like infection associated with rat bite. Lancet. Mar 23 1991;337(8743):733-4. [Medline].

  14. Vestey JP, Yirrell DL, Aldridge RD. Cowpox/catpox infection. Br J Dermatol. Jan 1991;124(1):74-8. [Medline].

  15. Vestey JP, Yirrell DL, Norval M. What is human catpox/cowpox infection?. Int J Dermatol. Oct 1991;30(10):696-8. [Medline].

  16. Wolfs TF, Wagenaar JA, Niesters HG, Osterhaus AD. Rat-to-human transmission of Cowpox infection. Emerg Infect Dis. Dec 2002;8(12):1495-6. [Medline].

  17. Kurth A, Wibbelt G, Gerber HP, Petschaelis A, Pauli G, Nitsche A. Rat-to-elephant-to-human transmission of cowpox virus. Emerg Infect Dis. Apr 2008;14(4):670-1. [Medline].

  18. Lewis-Jones MS, Baxby D, Cefai C, Hart CA. Cowpox can mimic anthrax. Br J Dermatol. Nov 1993;129(5):625-7. [Medline].

  19. Rajan N, Carmichael AJ, McCarron BM. Human cowpox: presentation and investigation in an era of bioterrorism. J Infect. Oct 2005;51(3):e167-9. [Medline].

  20. Pahlitzsch R, Hammarin AL, Widell A. A case of facial cellulitis and necrotizing lymphadenitis due to cowpox virus infection. Clin Infect Dis. Sep 15 2006;43(6):737-42. [Medline].

  21. Schupp P, Pfeffer M, Meyer H, Burck G, Kolmel K, Neumann C. Cowpox virus in a 12-year-old boy: rapid identification by an orthopoxvirus-specific polymerase chain reaction. Br J Dermatol. Jul 2001;145(1):146-50. [Medline].

  22. Smee DF, Bailey KW, Sidwell RW. Comparative effects of cidofovir and cyclic HPMPC on lethal cowpox and vaccinia virus respiratory infections in mice. Chemotherapy. Jun 2003;49(3):126-31. [Medline].

  23. Quenelle DC, Collins DJ, Kern ER. Cutaneous infections of mice with vaccinia or cowpox viruses and efficacy of cidofovir. Antiviral Res. Jul 2004;63(1):33-40. [Medline].

  24. Kesson AM, Ferguson JK, Rawlinson WD, Cunningham AL. Progressive vaccinia treated with ribavirin and vaccinia immune globulin. Clin Infect Dis. Oct 1997;25(4):911-4. [Medline].

  25. Thornburg NJ, Ray CA, Collier ML, Liao HX, Pickup DJ, Johnston RE. Vaccination with Venezuelan equine encephalitis replicons encoding cowpox virus structural proteins protects mice from intranasal cowpox virus challenge. Virology. Jun 5 2007;362(2):441-52. [Medline].

  26. Lee WC, Manjaly G, Skinner DW, O'Neill PM. Cowpox infection of the nose. J Laryngol Otol. Aug 1996;110(8):782-4. [Medline].

 
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A 16-year-old boy with generalized cowpox. Courtesy of Dr. Reinhard Hoepfl, Innsbruck, Austria.
 
 
 
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