eMedicine Specialties > Infectious Diseases > Viral Infections

Poxviruses: Treatment & Medication

Author: John D Shanley, MD, MPH, Professor Emeritus, University of Connecticut; Professor of Preventive Medicine, Stony Brook Medical Center
Contributor Information and Disclosures

Updated: Aug 26, 2008

Treatment

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.3 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.4,5 Cidofovir has also been successful in treating orf in an immunocompromised patient.6
  • 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.

Consultations

  • 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.

Activity

  • 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.

Medication

Numerous nucleoside and nucleotide agents have demonstrated potent antiviral activity against poxvirus infection in vitro and in animal models. Cidofovir has been used successfully to treat extensive molluscum contagiosum and orf in patients with AIDS.4,6,5

More on Poxviruses

Overview: Poxviruses
Differential Diagnoses & Workup: Poxviruses
Treatment & Medication: Poxviruses
Follow-up: Poxviruses
Multimedia: Poxviruses
References
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References

  1. Preston R. The Demon in the Freezer. In: The New Yorker. July 12, 1999:44-61. [Full Text].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. Baxby D, Bennett M. Poxvirus zoonoses. J Med Microbiol. Jan 1997;46(1):17-20, 28-33. [Medline].

  8. Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis. Lancet Infect Dis. Jan 2004;4(1):15-25. [Medline].

  9. Fenner F. Adventures with poxviruses of vertebrates. FEMS Microbiol Rev. Apr 2000;24(2):123-33. [Medline].

  10. Fenner F. Poxviruses. In: Richman D, Whitley RJ, Hayden FG, eds. Clinical Virology. ed. New York, NY: Churchill Livingstone; 1996:357-74.

  11. Fenner F, Henderson DH, Arita I, et al. Smallpox and its eradication. Geneva, Switzerland: World Health Organization.; 1988.

  12. 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].

  13. Henderson DH, Moss B. Smallpox and vaccinia. In: Plotkin S, Orenstein WA, eds. Vaccines. 3rd. Philadelphia, Pa: WB Saunders; 1999:74-97.

  14. Lewis-Jones S. Zoonotic poxvirus infections in humans. Curr Opin Infect Dis. Apr 2004;17(2):81-9. [Medline].

  15. Perna AG, Tyring SK. A review of the dermatologic manifestations of poxvirus infections. Dermatol Clin. Apr 2002;20(2):343-6. [Medline].

  16. Slifka MK, Hanifin JM. Smallpox: the basics. Dermatol Clin. Jul 2004;22(3):263-74, vi. [Medline].

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Further Reading

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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

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Contributor Information and Disclosures

Author

John D Shanley, MD, MPH, Professor Emeritus, University of Connecticut; 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, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

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 and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

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.

 
 
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