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Info


A. Introduction

  1. Orthopoxvirus related to varicella zoster and herpes simplex viruses
  2. Uncommon cause of febrile illness with skin eruption

B. Epidemiology

  1. Outbreak in April-June, 2003, in midwestern USA
  2. 87 cases reported as of June 18, 2003
  3. 20% of cases hospitalized
  4. Associated with direct or close contact with wild or exotic animals from Africa
    1. Prairie dogs
    2. Gambian giant rats
    3. Likely that prairie dogs had picked up the virus from the rats
    4. Prarie dogs most likely the major source of transmission to humans
  5. Human to human contact transmission may be possible

C. Clinical Criteria

  1. Rash
    1. Macular, papular, vesicular, or pustular
    2. Generalized or localized
    3. Discrete or confluent
  2. Fever: >99.2°F or >37.3°C
  3. Other signs and symptoms
    1. Chills and/or sweats
    2. Headache
    3. Backache
    4. Lymphadenopathy
    5. Sore throat
    6. Cough
    7. Shortness of breath
  4. Most cases are mild
  5. Hospitalize patients with sevrere disease for supportive care

D. Diagnosis

  1. Polymerase chain reaction (PCR) is definitive test
  2. Orthopox antigen testing with immunohistochemistry
  3. Isolation of monkeypox virus in culture
  4. Demonstration of virus morphologically consistent with orthopoxvirus

E. Tanapox [3]

  1. Poxvirus endemic to equatorial Africa
  2. Related to monkeypox, smallpox and various herpesviruses
  3. Febrile prodrome with headaches and myalgias
  4. Tender papules with erythematous base
  5. May be transmitted from monkeys and related primates

References

  1. Langkop CW, Austin C, Dworkin M, et al. 2003. MMWR. 52:561
  2. Reed KD, Melski JW, Graham MB, et al. 2004. NEJM. 350(4):342 abstract
  3. Dhar AD, Werchniak AE, Li Y, et al. 2004. NEJM. 350(4):361 (Case Report) abstract