eMedicine Specialties > Infectious Diseases > Viral Infections
Poxviruses: Differential Diagnoses & Workup
Updated: Aug 26, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Anthrax | Meningococcemia |
| Bacillary Angiomatosis | Molluscum Contagiosum |
| Coxsackieviruses | Vaccinia |
| Hand-Foot-and-Mouth Disease | Varicella-Zoster Virus |
| Herpes Simplex | |
| Herpes Zoster | |
| Impetigo |
Other Problems to Be Considered
Chickenpox
North American blastomycosis
Varicella
Workup
Laboratory Studies
- Most poxvirus infections can be recognized clinically. The virions can be recognized with negative staining and electron microscopy.
- Variola and vaccinia can be cultured in vitro on chorioallantoic membranes of eggs and in tissue culture. In suspected cases of smallpox, the public health authorities should be notified immediately and clinical samples processed in containment facilities.
- Infections with poxviruses induce humoral responses that include hemagglutination inhibition (HI), complement fixing (CF), and neutralizing antibodies. In vaccinia cases, the HI, CF, and antibody titers decline over time.
Other Tests
- Histological analysis of the nodular skin lesions can be performed.
Histologic Findings
The cutaneous lesions of smallpox begin with vascular congestion of the dermis associated with mononuclear (lymphocytes and monocytes) infiltration. Epidermal cells develop ballooning degeneration, and intraepithelial multiloculated vesicles develop by rupture of cellular membranes in the stratum spinosum. Cells develop cytoplasmic acidophilic inclusions known as Guarnieri bodies. The lesions of vaccinia and monkeypox follow a similar evolution.
The lesion of molluscum contagiosum consists of a localized area of hypertrophic and hyperplastic epidermis that extends down to the dermis and produces a nodule that rises above the skin. Individual epidermal cells are enlarged and contain a characteristic cytoplasmic inclusion of hyaline acidophilic material called a molluscum body. The center of the lesion consists of degenerating epidermal cells and keratin. Very little inflammation is present.
More on Poxviruses |
| Overview: Poxviruses |
Differential Diagnoses & Workup: Poxviruses |
| Treatment & Medication: Poxviruses |
| Follow-up: Poxviruses |
| Multimedia: Poxviruses |
| References |
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References
Preston R. The Demon in the Freezer. In: The New Yorker. July 12, 1999:44-61. [Full Text].
Kile JC, Fleischauer AT, Beard B, et al. Transmission of monkeypox among persons exposed to infected prairie dogs in Indiana in 2003. Arch Pediatr Adolesc Med. Nov 2005;159(11):1022-5. [Medline].
De Clercq E, Neyts J. Therapeutic potential of nucleoside/nucleotide analogues against poxvirus infections. Rev Med Virol. Sep-Oct 2004;14(5):289-300. [Medline].
Meadows KP, Tyring SK, Pavia AT, et al. Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir. Arch Dermatol. Aug 1997;133(8):987-90. [Medline].
Ibarra V, Blanco JR, Oteo JA, et al. Efficacy of cidofovir in the treatment of recalcitrant molluscum contagiosum in an AIDS patient. Acta Derm Venereol. Jul-Aug 2000;80(4):315-6. [Medline].
Geerinck K, Lukito G, Snoeck R, et al. A case of human orf in an immunocompromised patient treated successfully with cidofovir cream. J Med Virol. Aug 2001;64(4):543-9. [Medline].
Baxby D, Bennett M. Poxvirus zoonoses. J Med Microbiol. Jan 1997;46(1):17-20, 28-33. [Medline].
Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis. Lancet Infect Dis. Jan 2004;4(1):15-25. [Medline].
Fenner F. Adventures with poxviruses of vertebrates. FEMS Microbiol Rev. Apr 2000;24(2):123-33. [Medline].
Fenner F. Poxviruses. In: Richman D, Whitley RJ, Hayden FG, eds. Clinical Virology. ed. New York, NY: Churchill Livingstone; 1996:357-74.
Fenner F, Henderson DH, Arita I, et al. Smallpox and its eradication. Geneva, Switzerland: World Health Organization.; 1988.
Henderson DA, Inglesby TV, Bartlett JG, et al. Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. Jun 9 1999;281(22):2127-37. [Medline].
Henderson DH, Moss B. Smallpox and vaccinia. In: Plotkin S, Orenstein WA, eds. Vaccines. 3rd. Philadelphia, Pa: WB Saunders; 1999:74-97.
Lewis-Jones S. Zoonotic poxvirus infections in humans. Curr Opin Infect Dis. Apr 2004;17(2):81-9. [Medline].
Perna AG, Tyring SK. A review of the dermatologic manifestations of poxvirus infections. Dermatol Clin. Apr 2002;20(2):343-6. [Medline].
Slifka MK, Hanifin JM. Smallpox: the basics. Dermatol Clin. Jul 2004;22(3):263-74, vi. [Medline].
Further Reading
Keywords
poxviruses, pox virus, orthopoxviruses, parapoxviruses, smallpox, variola major, variola minor, flat smallpox, hemorrhagic variola, vaccinia, monkeypox, orf, contagious pustular dermatitis, contagious ecthyma, pseudocowpox, milker's nodule, molluscum contagiosum, Poxviridae, bovine papular stomatitis virus, pseudocowpox virus, sealpox virus, yatapoxviruses, yatapoxvirus, tanapox virus, yabapoxviruses, yabapoxvirus, buffalopox, cantagalo, aracatuba, deerpox virus
Differential Diagnoses & Workup: Poxviruses