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Poxviruses Treatment & Management

  • Author: John D Shanley, MD, MPH; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
Updated: Oct 07, 2015

Medical Care

Variola infections have been eradicated worldwide. However, concern exists about the reintroduction of smallpox through bioterrorism. The reappearance of smallpox would precipitate an international health care emergency. Suspected cases of smallpox should be reported to state and federal public health officials.

No known treatments are presently available for smallpox or vaccinia.

Several nucleoside and nucleotide analogues have demonstrated potent in vitro and in vivo antiviral activity against numerous poxviruses, including variola, vaccinia, monkeypox, cowpox, molluscum contagiosum and orf.[5] Cidofovir and a number of its derivatives have proven to be most efficacious so far.

Alkoxyalkyl esters of cidofovir have good bioavailability, cause reduced renal toxicity, and are currently being studied for treatment of poxvirus infections.

Cidofovir has been used successfully to treat recalcitrant molluscum contagiosum in patients with AIDS.[6, 7] Cidofovir has also been successful in treating orf in an immunocompromised patient.[8]

Vaccinia vaccination confers at least short-term (up to 10 y) protection from smallpox. Vaccination has also been shown to blunt clinical smallpox if administered early after exposure. The current vaccine, Dryvax, was prepared in the late 1970s as lyophilized virus derived from calf lymph. Fresh stocks of vaccinia vaccine prepared using tissue culture methods are now available.

Curettage can be used to treat molluscum contagiosum but is usually ineffective in immunocompromised patients.

Early recognition of poxvirus infection is essential to prevent inadvertent secondary spread.


Surgical Care

The nodules of molluscum contagiosum infection can be removed by curettage.



Consultation with a dermatologist and infectious disease specialist may be appropriate.

If smallpox is suspected, the CDC and local public health departments should be notified immediately.



Patients suspected of having smallpox or monkeypox should be isolated according to CDC protocol, and the CDC and local health officials should be notified.

Patients with other poxvirus infections generally do not require activity modification.

Contributor Information and Disclosures

John D Shanley, MD, MPH Professor Emeritus, University of Connecticut School of Medicine; Professor of Preventive Medicine, Stony Brook Medical Center

John D Shanley, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Poxviruses. Following vaccination for smallpox, this patient with chronic lymphocytic leukemia developed vaccinia gangrenosum.
Poxviruses. Following vaccination for smallpox, a patient with chronic lymphocytic leukemia developed vaccinia gangrenosum. The lesion was on the left shoulder. As the lesion progressed, the patient also developed evidence of dissemination. This image shows a vaccinia pustule on the foot.
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