Medical Care

Because cowpox is generally a self-limited disease, treatment is largely supportive. Patients often do not feel well and require bed rest or, occasionally, hospitalization.

Antiviral medications are not routinely used in cases of human cowpox, nor are antibiotics given unless the patient has developed a secondary bacterial infection. However, studies in mice suggest a role for the viral DNA polymerase inhibitor cidofovir, given parenterally, topically, or in an aerosolized form, for disseminated cases of cowpox.^{[27, 28]}

Patients should be made aware that their lesions are potentially infectious, but no person-to-person transmission has been reported. Occlusive bandages may be applied to avoid this risk.

In severe cases, antivaccinia gammaglobulin may be given.

Surgical Care

Standard wound dressings may be applied to lesions. Draining of pus or removal of eschars may actually prolong infection or spread it to other body sites and is therefore not recommended.

Consultations

Consult infectious disease and/or dermatology specialists for help in making a diagnosis and in differentiating it from parapoxvirus infections and other entities.

Prevention

One may prevent infection with cowpox virus by avoiding exposure to sick cats or other sick animals. Recombinant vaccines against cowpox are being studied in mice and may eventually be available for human use.^[29]

Medication

Esposito, JJ, Fenner F. Poxviruses. Knipe D, Howley PM, Griffin DE, Lamb RA, Martin MA, Roizman B, Straus SE, eds. Fields Virology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001. Chapter 85.
Burton JL. Of mice and milkmaids, cats and cowpox. Lancet. 1994 Jan 8. 343(8889):67. [QxMD MEDLINE Link].
Reperant LA, Brown IH, Haenen OL, de Jong MD, Osterhaus AD, Papa A, et al. Companion Animals as a Source of Viruses for Human Beings and Food Production Animals. J Comp Pathol. 2016 Jul. 155 (1 Suppl 1):S41-53. [QxMD MEDLINE Link].
Baxby D, Bennett M, Getty B. Human cowpox 1969-93: a review based on 54 cases. Br J Dermatol. 1994 Nov. 131(5):598-607. [QxMD MEDLINE Link].
Pelkonen PM, Tarvainen K, Hynninen A, et al. Cowpox with severe generalized eruption, Finland. Emerg Infect Dis. 2003 Nov. 9(11):1458-61. [QxMD MEDLINE Link].
Honlinger B, Huemer HP, Romani N, Czerny CP, Eisendle K, Hopfl R. Generalized cowpox infection probably transmitted from a rat. Br J Dermatol. 2005 Aug. 153(2):451-3. [QxMD MEDLINE Link].
Moss B, Shisler JL. Immunology 101 at poxvirus U: immune evasion genes. Semin Immunol. 2001 Feb. 13(1):59-66. [QxMD MEDLINE Link].
Dasgupta A, Hammarlund E, Slifka MK, Fruh K. Cowpox virus evades CTL recognition and inhibits the intracellular transport of MHC class I molecules. J Immunol. 2007 Feb 1. 178(3):1654-61. [QxMD MEDLINE Link].
Byun M, Wang X, Pak M, Hansen TH, Yokoyama WM. Cowpox virus exploits the endoplasmic reticulum retention pathway to inhibit MHC class I transport to the cell surface. Cell Host Microbe. 2007 Nov 15. 2(5):306-15. [QxMD MEDLINE Link].
Amer M, El-Gharib I, Rashed A, Farag F, Emara M. Human cowpox infection in Sharkia Governorate, Egypt. Int J Dermatol. 2001 Jan. 40(1):14-7. [QxMD MEDLINE Link].
Haase O, Moser A, Rose C, Kurth A, Zillikens D, Schmidt E. Generalized cowpox infection in a patient with Darier disease. Br J Dermatol. 2011 May. 164(5):1116-8. [QxMD MEDLINE Link].
Blackford S, Roberts DL, Thomas PD. Cowpox infection causing a generalized eruption in a patient with atopic dermatitis. Br J Dermatol. 1993 Nov. 129(5):628-9. [QxMD MEDLINE Link].
Gazzani P, Gach JE, Colmenero I, Martin J, Morton H, Brown K, et al. Fatal disseminated cowpox virus infection in an adolescent renal transplant recipient. Pediatr Nephrol. 2017 Mar. 32 (3):533-536. [QxMD MEDLINE Link].
Stolz W, Gotz A, Thomas P, et al. Characteristic but unfamiliar--the cowpox infection, transmitted by a domestic cat. Dermatology. 1996. 193(2):140-3. [QxMD MEDLINE Link].
Postma BH, Diepersloot RJ, Niessen GJ, Droog RP. Cowpox-virus-like infection associated with rat bite. Lancet. 1991 Mar 23. 337(8743):733-4. [QxMD MEDLINE Link].
Vestey JP, Yirrell DL, Aldridge RD. Cowpox/catpox infection. Br J Dermatol. 1991 Jan. 124(1):74-8. [QxMD MEDLINE Link].
Vestey JP, Yirrell DL, Norval M. What is human catpox/cowpox infection?. Int J Dermatol. 1991 Oct. 30(10):696-8. [QxMD MEDLINE Link].
Wolfs TF, Wagenaar JA, Niesters HG, Osterhaus AD. Rat-to-human transmission of Cowpox infection. Emerg Infect Dis. 2002 Dec. 8(12):1495-6. [QxMD MEDLINE Link].
Kurth A, Wibbelt G, Gerber HP, Petschaelis A, Pauli G, Nitsche A. Rat-to-elephant-to-human transmission of cowpox virus. Emerg Infect Dis. 2008 Apr. 14(4):670-1. [QxMD MEDLINE Link].
Lewis-Jones MS, Baxby D, Cefai C, Hart CA. Cowpox can mimic anthrax. Br J Dermatol. 1993 Nov. 129(5):625-7. [QxMD MEDLINE Link].
Rajan N, Carmichael AJ, McCarron BM. Human cowpox: presentation and investigation in an era of bioterrorism. J Infect. 2005 Oct. 51(3):e167-9. [QxMD MEDLINE Link].
Pahlitzsch R, Hammarin AL, Widell A. A case of facial cellulitis and necrotizing lymphadenitis due to cowpox virus infection. Clin Infect Dis. 2006 Sep 15. 43(6):737-42. [QxMD MEDLINE Link].
Lee WC, Manjaly G, Skinner DW, O'Neill PM. Cowpox infection of the nose. J Laryngol Otol. 1996 Aug. 110(8):782-4. [QxMD MEDLINE Link].
Schupp P, Pfeffer M, Meyer H, Burck G, Kolmel K, Neumann C. Cowpox virus in a 12-year-old boy: rapid identification by an orthopoxvirus-specific polymerase chain reaction. Br J Dermatol. 2001 Jul. 145(1):146-50. [QxMD MEDLINE Link].
Gilchuk I, Gilchuk P, Sapparapu G, et al. Cross-Neutralizing and Protective Human Antibody Specificities to Poxvirus Infections. Cell. 2016 Oct 20. 167 (3):684-694.e9. [QxMD MEDLINE Link].
Tamošiūnaitė A, Hoffmann D, Franke A, Schluckebier J, Tauscher K, Tischer BK, et al. Histopathological and Immunohistochemical Studies of Cowpox Virus Replication in a Three-Dimensional Skin Model. J Comp Pathol. 2016 Jul. 155 (1):55-61. [QxMD MEDLINE Link].
Smee DF, Bailey KW, Sidwell RW. Comparative effects of cidofovir and cyclic HPMPC on lethal cowpox and vaccinia virus respiratory infections in mice. Chemotherapy. 2003 Jun. 49(3):126-31. [QxMD MEDLINE Link].
Quenelle DC, Collins DJ, Kern ER. Cutaneous infections of mice with vaccinia or cowpox viruses and efficacy of cidofovir. Antiviral Res. 2004 Jul. 63(1):33-40. [QxMD MEDLINE Link].
Thornburg NJ, Ray CA, Collier ML, Liao HX, Pickup DJ, Johnston RE. Vaccination with Venezuelan equine encephalitis replicons encoding cowpox virus structural proteins protects mice from intranasal cowpox virus challenge. Virology. 2007 Jun 5. 362(2):441-52. [QxMD MEDLINE Link].
Kesson AM, Ferguson JK, Rawlinson WD, Cunningham AL. Progressive vaccinia treated with ribavirin and vaccinia immune globulin. Clin Infect Dis. 1997 Oct. 25(4):911-4. [QxMD MEDLINE Link].