Poxviruses Treatment & Management

Updated: Nov 08, 2019
  • Author: John D Shanley, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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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. [7] 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. [8, 9] Cidofovir has also been successful in treating orf in an immunocompromised patient. [10]

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. [11] 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.

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Surgical Care

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

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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.

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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.

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Prevention

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

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