eMedicine Specialties > Infectious Diseases > Viral Infections

Vaccinia: Differential Diagnoses & Workup

Author: Tasneem A Poonawalla, MD, Staff Physician, Department of Internal Medicine, University of Texas Medical Branch at Galveston
Coauthor(s): Dayna Diven, MD, Clinical Professor, Department of Dermatology, University of Texas Medical Branch at Galveston; Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University; Ken Flanagan, BS, Department of Microbiology and Immunology, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Aug 24, 2006

Differential Diagnoses

Erythema Multiforme (Stevens-Johnson Syndrome)
Gas Gangrene
Impetigo

Other Problems to Be Considered

Pustular impetigo
Roseola
Conjunctivitis
Encephalitis of other causes

Workup

Laboratory Studies

  • The diagnosis of vaccinia virus complications usually is straightforward and depends on obtaining the history of recent vaccinia virus exposure by vaccination or contact with a vaccinated individual. A careful workup for immune deficiency should be considered in patients who do not improve promptly.
  • The diagnosis of CNS complications is more difficult because the signs and symptoms are nonspecific. Although rare, postvaccinial encephalitis should be considered in any patient with neurologic symptoms developing 1-2 weeks after exposure to live vaccinia virus. Vaccinia virus has not been isolated from cerebrospinal fluid (CSF) of patients with encephalitis, and CSF analysis usually produces normal results, except for increased pressure; however, CSF analysis may be indicated to exclude other causes of encephalitis.

Imaging Studies

  • Imaging studies are not useful in the diagnosis of vaccinia infection or a postvaccinial complication, although imaging modalities may be helpful to exclude other causes of disease (eg, MRI of the brain in cases of suspected encephalitis).

Other Tests

  • Patients who present with skin manifestations usually have live viral particles replicating in the dermal lesions. The presence of vaccinia virus can be confirmed by obtaining a biopsy of the skin lesion and examination through microscopy, plaque titer assay, Western blot, and polymerase chain reaction (PCR) analysis.

Histologic Findings

Light microscopy may reveal characteristic inclusions (ie, Guarnieri bodies) in the cytoplasm of infected cells. This is distinctive from viruses such as herpes simplex virus (HSV) which usually have intranuclear inclusion bodies.

More on Vaccinia

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

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Further Reading

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Keywords

vaccinia, vaccinia virus, smallpox, variola, cowpox, poxviruses, Poxviridae, vaccinia necrosum, eczema vaccinatum, vaccinia immune globulin, VIG, orthopoxvirus

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Contributor Information and Disclosures

Author

Tasneem A Poonawalla, MD, Staff Physician, Department of Internal Medicine, University of Texas Medical Branch at Galveston
Tasneem A Poonawalla, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dayna Diven, MD, Clinical Professor, Department of Dermatology, University of Texas Medical Branch at Galveston
Dayna Diven, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Idaho Medical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Howard L Kaufman, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, Association for Academic Surgery, Illinois State Medical Society, Massachusetts Medical Society, New York Academy of Sciences, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Ken Flanagan, BS, Department of Microbiology and Immunology, Albert Einstein College of Medicine
Ken Flanagan, BS is a member of the following medical societies: American Association for Cancer Research
Disclosure: Nothing to disclose.

Medical Editor

Brenda Jones, MD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, University of Southern California School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
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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