Parapoxviruses Workup

  • Author: Luke Bloomquist, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 6, 2011
 

Laboratory Studies

Real-time polymerase chain reaction (PCR) of frozen tissue, vesicle material, or scab debris has a higher sensitivity than standard PCR and enables identification of not only the genus Parapoxvirus but also the specific species.[20] This is not true of the other diagnostic tests available. This is of mostly academic importance in cases in which the affected individual may have had exposure to cattle as well as goats or sheep.

Negative-stain electron microscopy (EM) of skin tissue allows direct visualization of the parapoxvirus; identification is based on the characteristic ovoid cross-hatched appearance of the virions.[21]

Serologic testing using serum antibody (IgM and IgG) levels can confirm parapoxvirus infection, but this test unable to distinguish the specific species.

Light microscopy and traditional histopathologic techniques may afford accurate identification of the characteristic cutaneous changes observed in a parapoxvirus infection, although histopathologic features are frequently nonspecific, particularly in later lesions.

Gram stain and bacterial culture are useful in cases in which Bacillus anthracis infection or bacterial superinfection is a concern.

If performed, complete blood cell count and C-reactive protein level are usually normal in uncomplicated parapoxvirus infection.[16]

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Histologic Findings

Histologically, parapoxvirus infections are indistinguishable from one another.

Epidermal hyperplasia, mild acanthosis, parakeratosis, spongiform keratinocytic degeneration, and viral cytopathic changes occur, including cytoplasmic inclusion bodies and nuclear and cytoplasmic vacuolization. In the dermis, a dense mixed inflammatory infiltrate develops, consisting of mast cells, lymphocytes, polymorphonuclear leukocytes, eosinophils, and prominent upper-dermal edema. Prominent capillary dilatation and proliferation give the impression of an angiomatous dermal lesion.[11]

Later, histology shows a nonspecific ulcerative process.[22]

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Contributor Information and Disclosures
Author

Luke Bloomquist, MD  Combat Aviation Brigade Surgeon, 1st Armored Division, Fort Bliss, Texas

Luke Bloomquist, MD is a member of the following medical societies: American Academy of Family Physicians and Society of US Army Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Gary P Holmes, MD, FSHEA, FIDSA  Joint Associate Professor, Department of Epidemiology and Biostatistics, Texas A&M University School of Rural Public Health

Gary P Holmes, MD, FSHEA, FIDSA is a member of the following medical societies: American Society for Microbiology, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Pranatharthi Haran Chandrasekar, MBBS, MD  Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Larry I Lutwick, MD, and Adam M Rotunda, MD, to the development and writing of this article.

References

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