Two Distinct Clinical Courses of Human Cowpox, Germany, 2015
Abstract
:1. Introduction
2. Case Reports
2.1. Case 1
2.2. Case 2
3. Discussion
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Day | Figure | Clinic, Diagnostic Findings |
---|---|---|
Day 0 | Small pustule retroauricular on the right side | |
Day 6 | Pustule, lymphadenitis, local application of cortisone | |
Day 10 | Figure 1a | Round ulceration with sharp margin (ca. 10 × 10 mm) and surrounding erythema and edema, painful swelling, lymphadenitis, abscess suspected, hospitalization |
Day 11 | Skin swab: Growth of normal bacterial skin flora | |
Day 12 | Skin swab: Positive for Orthopoxvirus (OPV) DNA, anti-OPV-titer 80, virus isolation positive | |
Day 13 | Figure 1b | Round to ovoid ulceration with central necrosis and surrounding erythema and edema |
Day 20 | Figure 1c | Ulceration turns into an eschar with still inflamed surrounding skin (ca. 50 × 35 mm) |
Day 21 | Discharge from hospital | |
Day 30 | Figure 1d | Eschar at its maximum extend measuring ca. 60 × 40 mm with deep necrosis and prominent swelling of the margin of the wound |
Day 37 | Anti-OPV-titer 640 | |
Day 47 | Figure 1e | Eschar remodels into hyperkeratotic necrotic tissue and starts to flake off, surrounding erythema is progressive, anti-OPV-titer 320 |
Day 77 | Anti-OPV-titer 320 | |
Day 83 | Eschar falls off, biopsy of eschar: OPV-PCR-positive, virus isolation negative | |
Day 84 | Figure 1f | After flaking of the eschar a ca. 50 × 35 mm necrosis remains with incipient granulation of the wound and fibrin coating |
Day 89 | Figure 1g | Secondary wound healing with advanced granulation and fibrin coating, skin swab OPV-PCR-positive |
Day 106 | Anti-OPV-titer 320 | |
Day 110 | Ending of sick leave | |
Day 210 | Figure 1h | Scar formation, remaining hyperpigmentation of the formerly inflamed surrounding tissue, anti-OPV-titer 160 |
Day 326 | Figure 1i | A 60 mm long cicatrix remains |
Day | Figure | Clinic, Diagnostic Findings |
---|---|---|
Day 0 | Pustule on the forehead | |
Day 6 | Painful swelling, lymphadenitis | |
Day 10 | Figure 2a | Circular ulcerated wound with sharp margins and deep-seated eschar (ca. 10 × 10 mm) surrounded by erythema and edema Skin swab: Growth of normal bacterial skin flora Skin swab: Positive for OPV DNA, virus isolation positive Anti-OPV-titer 1280 |
Day 12 | Figure 2b | ca. 12 × 12 mm eschar on still inflamed surrounding skin |
Day 32 | Figure 2c | Regressive redness and swelling of the skin, flaking of the eschar, still incrusted wound base with granulation in the surrounding tissue, Anti-OPV-titer 2560 |
Day 41 | Figure 2d | Wound covered with epithelial tissue after secondary wound healing |
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Eder, I.; Vollmar, P.; Pfeffer, M.; Naether, P.; Rodloff, A.C.; Meyer, H. Two Distinct Clinical Courses of Human Cowpox, Germany, 2015. Viruses 2017, 9, 375. https://doi.org/10.3390/v9120375
Eder I, Vollmar P, Pfeffer M, Naether P, Rodloff AC, Meyer H. Two Distinct Clinical Courses of Human Cowpox, Germany, 2015. Viruses. 2017; 9(12):375. https://doi.org/10.3390/v9120375
Chicago/Turabian StyleEder, Ines, Patrick Vollmar, Martin Pfeffer, Philipp Naether, Arne Christian Rodloff, and Hermann Meyer. 2017. "Two Distinct Clinical Courses of Human Cowpox, Germany, 2015" Viruses 9, no. 12: 375. https://doi.org/10.3390/v9120375