Feline orthopoxvirus infection transmitted from cat to human

doi:10.1067/S0190-9622(03)00762-X

Journal of the American Academy of Dermatology

Volume 49, Issue 3, September 2003, Pages 513-518

https://doi.org/10.1067/S0190-9622(03)00762-X Get rights and content

Abstract

We report the case of a 56-year-old female patient who presented with an inflamed, ulcerated lesion on the left side of her neck after contact (scratch) with a cat living in the patient's house. Satellite lesions developed despite local treatment and parenteral clindamycin. Histopatholgic examination and the Tzanck test showed evidence of a viral infection. Subsequent transmission electron microscopy of scrap tissue and material from a fresh pustule exhibited multiple typical poxvirus particles, predominantly in remnants of scaled-off layers of degenerated keratinocytes, and virus particles in intermingled phagocytes, leading to the diagnosis of feline Orthopoxvirus (cowpox virus) infection. These results were verified by polymerase chain reaction and sequencing. Concern has been raised as to whether discontinuation of smallpox vaccine would cause an increase in Orthopoxvirus infection, but this has not yet shown to be the case.

Section snippets

History

Three weeks before admission, a 56-year-old female patient noticed a small erythematous papule on the left side of her neck. Exploration revealed an initial scratch from a cat living in the patient's house. The animal had temporarily refused to eat but had shown no further symptoms. The patient was otherwise free of symptoms. Within 14 days the lesion enlarged, forming a central necrosis with inflammatory induration. Suspecting superinfected herpes simplex, valacyclovir was prescribed by her

Results

Laboratory tests revealed that the blood count was initially normal, but gradually leukocyte counts were increasing up to 22,500/μL (normal range: 4000-8000) with lymphocytosis of 4992/μL (1120-2410), monocytosis of 1664/μL (270-860), and an increase of natural killer cells up to 50% of total lymphocytes (6-29). Thrombocytosis was 471,000/μL (140,000-400,000), erythrocyte sedimentation rate was elevated with 32/64 mm Hg (up to 12/24); electrolytes, renal, and liver function tests were normal;

Discussion

The subfamily of Chordopoxvirinae of the family of Poxviridae is divided into 8 genera, of which the genus Orthopoxvirus includes vaccinia virus, variola virus, cowpox virus, and at least 6 other species such as monkeypox virus, ectromelia virus, camelpox virus, taterapox virus, and racoonpox virus.2 Besides viruses within the genus Orthopoxvirus, only members of 3 other poxvirus genera may cause human disease: parapoxviruses (pseudocowpox virus causing milker's nodule or paravaccinia);

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Sequence comparison as shown in Fig. 1, revealed that the A36R gene sequence of the isolate is most closely related to sequences EP1 and EP6 derived from infected elephants from Germany (Baxby and Ghaboosi, 1977), whereas CPXV isolates from the UK or Norway seem to form a distinct cluster. The HA gene was found closely related to Austrian CPXV isolates cpv-531, -667, and -610 from 1992, 1994 and 1997, which all have been isolated from diseased cats (Nowotny et al., unpublished), and a local human isolate from Styria from 2009, whereas the HA gene of the human isolate cpv-1218 from the Austrian federal state of Salzburg from the year 2000 (Hawranek et al., 2003) seems more distant. Interestingly other German or Italian isolates are rather unrelated supporting the facts of high variation among CPXV strains, and the finding of highly divergent regional clusters (Essbauer et al., 2009; Kaysser et al., 2010).
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Cowpox virus (CPXV) is known to circulate in European rodents [18] and occasionally leads to human infection. In most cases cat-transmitted such zoonotic infections are rather mild and restricted to single skin lesions [19], but severe and even lethal cases have also been observed [20]. There are no valid data on the incidence in humans, as there is no mandatory reporting and due to the self-limiting character many cases will remain undiagnosed.
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^☆

Funding sources: None.

Conflicts of interest: None identified.

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Case reportFeline orthopoxvirus infection transmitted from cat to human☆

Abstract

Section snippets

History

Results

Discussion

Lancet

Lancet

Lancet

Lancet

Lancet

Lancet

Biophys J

J Am Acad Dermatol

Antiviral Res

PCR strategy for identification and differentiation of smallpox and other orthopoxviruses

J Clin Microbiol

Introduction to poxviridae

An overview of poxviruses

J Am Acad Dermatol

Cowpox viruses in Germanyan analysis of 5 cases in 1998

Berl Munch Tierarztl Wochenschr

Cowpox in the domestic cat

Vet Rec

Outbreak of pox disease among Carnivora (Felidae) and Edentata

J Infect Dis

Is cowpox misnamed? A review of 10 human cases

Br Med J

Poxvirus hosts and reservoirs

Arch Virol

Serological evidence for the reservoir hosts of cowpox virus in British wildlife

Epidemiol Infect

New outlook on the biology of cowpox virus

Acta Virol

Identification and study of a poxvirus isolated from wild rodents in Turkmenia

Arch Virol

Cowpoxreservoir hosts and geographic range

Epidemiol Infect

Case report
Feline orthopoxvirus infection transmitted from cat to human☆