| Concerns about the possibility of bioterrorism or unconventional weaponry using the variola virus have emerged following the events of September 11, 2001. immunization of emergency personnel in israel against smallpox started in September 2002. This case report describes the skin reaction following immunization with vaccinia virus. physicians should be aware of the variations at the site of the inoculation. ( info) |
2/14. Disseminated vaccinia false alarm. We report the case of a 6-year-old girl who presented in December 2002 with fever and a vesicular rash. Initially she was diagnosed with stevens-johnson syndrome. The differential diagnosis was expanded, however, when an exposure to a person who was believed to be vaccinated recently against smallpox was revealed. We describe the sequence of events that ensued and the workup for a possible case of disseminated virus. ( info) |
3/14. Conjugal transfer vaccinia. Two cases of conjugal contact transfer vaccinia are described. Each patient had intimate contact after their respective partners, active-duty military personnel, received the smallpox vaccination. ( info) |
4/14. Clinical and pathologic differential diagnosis of selected potential bioterrorism agents of interest to pediatric health care providers. The early recognition of potential bioterrorism agents has been of increasing concern in recent years. The Centers for disease Control and Prevention has categorized and listed biological terrorism agents. Although any or all of the highest risk biological agents (including inhalation anthrax, pneumonic plague, smallpox, tularemia, botulism, and viral hemorrhagic fevers) can be seen in the pediatric patient, several agents might closely resemble--at least in their initial stages-some of the more common childhood illnesses. The awareness of these similarities and, more importantly,their differences, are critical for all health care professionals. Selected examples of some typical childhood illnesses are presented and then compared with three of the most virulent biological agents (smallpox, anthrax and plague) that might be used in a bioterrorism attack. ( info) |
5/14. Human poxvirus disease after smallpox eradication. A 5-year-old boy living in a small camp in the rural Ivory Coast had a disease resembling smallpox. This occurred 4 years after smallpox had been eradicated from the Ivory Coast and 1.5 years after the last case of smallpox was detected in West and Central africa. Clinical, serological, and epidemiological evidence indicated this disease was probably monkeypox, a poxvirus of the variola/vaccina subgroup. A serologic survey of poxvirus antibodies in the wild animal population detected neutralizing antibodies in rodents, larger mammals, primates, and birds. The laboratory and ecological characteristics of poxviruses require further elucidation, especially those which have been found in animals near human monkeypox cases. ( info) |
6/14. Surgical repair of atresia of nasal passages. Surgical correction of nasal atresia following healing of smallpox lesions in a 15-year-old girl is presented. The surgical technique used was complete excision of the scars and resurfacing of the resulting wound with grafts of full-thickness retroauricular skin. Particular attention was paid to prevention of postoperative contracture. ( info) |
7/14. Variola minor in Braganca Paulista county, 1956. Observations on the clinical course of variola minor and on pregnancy in women with the disease. Occasional observations on the clinical course of 485 cases of variola minor composing an epidemic are reported. 17% of the cases showed a complication. otitis was observed in one case. An erythematous rash limited to the upper chest, neck and head appeared, instead of the pock eruption, after the pre-eruptive phase, in a previously vaccinated case. Convulsions, drowsiness, stupor, delusions, dizziness or deafness were observed in 23 patients whose individual characteristics are also presented. One of these cases showed a definite neurologicl syndrome: encephalitis. Neurologic complications were mostly seen in patients with medium to severe variola minor. Neither abortion nor death were seen among 4 pregnant women who developed variola minor, even though one of them delivered, on term, a dead foetus, 4 months after developing variola minor. ( info) |
8/14. Osseous deformity from osteomyelitis variolosa. A case report. Smallpox osteomyelitis (osteomyelitis variolosa) with gross clinical and radiologic deformities of the elbows, hands and feet occurred in a 53-year-old Vietnamese refugee. This disease, once common in asia and africa, may cause permanent damage to joints and growth centers in the course of the acute infection in childhood. The roentgenographic features are sufficiently diagnostic to exclude congenital dysplasia of the skeletal system, leprosy, or sequelae of thermal injury, and other joint disorders. ( info) |
9/14. gastritis varioliformis. Chronic erosive gastritis with protein-losing gastropathy. A patient with chronic erosive gastritis and protein-losing gastropathy is reported. Presentation was with weight loss and abdominal discomfort. There were endoscopic and radiological features of erosive gastritis. Radioactive chromium studies confirmed that the low serum albumin was associated with fecal protein loss. No improvement occurred with bed rest or Caved S but coincided with DeNol therapy. ( info) |
10/14. Human monkeypox. Human monkeypox, occurring in the tropical rainforest of west and central africa, is regarded as the most important orthopoxvirus infection for epidemiological surveillance during the post-smallpox era. This disease, first recognized in Zaire in 1970 resembles smallpox clinically but differs epidemiologically. Clinical features, their evolution and sequelae of monkeypox could be compared with discrete ordinary or modified type of smallpox. A case-fatality rate of 14% has been observed but some cases can be exceedingly mild or atypical and may easily remain undetected and unreported. Pronounced lymphadenopathy has been the only clinical feature found commonly in monkeypox but not in smallpox. Fifty-seven cases of human monkeypox have occurred since 1970, in the tropical rainforests in six west and central African countries, the majority of them (45) being reported from Zaire. The disease appears to be more frequent in dry season. Children below ten years of age comprise 84% of the cases. Smallpox vaccination protects against monkeypox. Clusters of cases have been observed in certain areas within countries and within affected households. Human-to-human spread has possibly occurred seven times. No cases of possible tertiary spread were observed. The secondary attack rate among susceptible close household contacts was 10%, among all susceptible contacts 5%. This is much lower than that occurring with smallpox, which is between 25-40%. The limited avidity of monkeypox virus for human beings indicates that monkeypox is probably a zoonosis, although the animal reservoir(s) have not yet been identified. The low transmissibility, resulting in low frequency of disease in man indicates that monkeypox is not a public health problem. Human monkeypox has been a relatively newly recognized disease. Studies are in progress to identify the natural cycle of monkeypox virus and to define better its clinical and epidemiological characteristics. Special surveillance is maintained in endemic areas with the aim to provide assurance that in spite of waning immunity of the human population following cessation of the smallpox vaccination, the disease does not constitute a potential danger to man. ( info) |