Necrotic ulcerated lesion in a young boy caused by cowpox virus infection

Abstract

The case presented here points towards the fact that skin lesion observed with a cowpox virus is a rare event but should be considered more as the number of cases has increased in the last years. Cowpox virus (CPXV) belongs to the Poxviridae family. The transmission of CPXV to humans is caused by wild rodents or mostly by domestic animals and pet rats. In humans, CPXV is responsible for localized skin lesions regularly accompanied by lymphadenopathy. The lesions remain localized but self-inoculation from the primary lesions could occur. Then physicians have to be vigilant concerning bandages. In this case report, a necrotic and ulcerated lesion of a CPXV infection in a young boy is reported. The CPXV was possibly transmitted by wild rodents. The importance of performing the diagnosis is also pointed out. Virus information was obtained from phylogenetic analyses showing that the CPXV isolate was distinct from outbreaks of human cowpox which occurred in 2009 in France and Germany but was close to the CPXV Brighton Red strain. For several years, cases of viral zoonosis caused by CPXV have increased and physicians should be made aware that people could be infected without history of direct contact with animals.

Keywords: Cowpox virus; Diagnosis; Hemagglutinin gene; Necrotic; Orthopoxvirus; Rodent; Ulcerated lesion; Zoonosis.

Fig. 1

Cowpox illustrations. a Lesion with necrotic ulcer on the outside of right arm with regional solid axillary lymphadenopathy. b Negative-staining electron microscopy of virus particle. C = Core; L = lateral bodies.

Fig. 2

Phylogenetic trees of selected orthopoxvirus genes. Sequence alignments were performed using the BioEdit program using BLOSUM62 similarity matrix. Phylogenetic analyses were performed from the BioEdit alignment with a global gap removal to exclude gaps from alignments. Neighbor-joining trees were constructed using the program MEGA3 with a Tamura-Nei substitution model. The robustness of trees was evaluated by bootstrap analysis with 1,000 rounds of replication. a Nucleotide sequences of the hemagglutinin gene from 2010-French human case (CPXV-F2010; HQ634150), 2009-French human case (CPXV-F2009; FJ79031) and additional poxvirus available in GenBank: VARV-BGD (variola major virus, strain Bangladesh; DQ441420), VARV-GAR (variola minor virus, strain Garcia; Y16780), MPXV-COP (monkeypox virus, strain Copenhagen; AY753185), CMLV-M96 (camelpox virus, strain M-96, AF438165), VACV-LIST (vaccinia virus, strain Lister-clone 107; DQ121394), ECTV-MOS (ectromelia virus, strain Moscow; AF012825), CPXV-BR (cowpox virus, strain Brighton Red; AF482758), CPXV-GRI (cowpox virus, strain GRI-90; X94355), CPXV-GER (cowpox virus, strain Germany 91-3; DQ437593), CPXV-FIN2003 (cowpox virus isolated from human in Finland in 2003, AY366478), CPXV-AUS2007 (cowpox virus isolated from human in Austria in 2007, EU582018), CPXV-cat1999 (cowpox virus isolated from cat in Germany in 1999, AF377885), CPXV-elephant2000 (cowpox virus isolated from elephant in Germany in 2000, AY902307). 2009 French rat-to-human outbreak (CPXV-FR-rat2009, bankit1198424), 2009 German rat-to-human outbreak (CPXV-GER-rat2009, FJ654467). The branch length is proportional to evolutionary distance (scale bar). b Phylogenetic tree of nucleotide sequences of the 7 concatenated genes. The 7 selected genes were concatenated to form a single sequence in the following order: A56R, J2K, D4R, A48R, B5R, C22L and E3L. Nucleotide sequences from CPXV isolate from 2010 French human case (CPXV-F2010; HQ634150), 2009 French human case (CPXV-F2009; FJ79031) and additional poxvirus available in GenBank: VARV-BGD (variola major virus, strain Bangladesh; DQ441420), VARV-GAR (variola minor virus, strain Garcia; Y16780), MPXV-COP (monkeypox virus, strain Copenhagen; AY753185), VACV-LIST (vaccinia virus, strain Lister-clone 107; DQ121394), ECTV-MOS (ectromelia virus, strain Moscow; AF012825), CPXV-BR (cowpox virus, strain Brighton Red; AF482758), CPXV-GRI (cowpox virus, strain GRI-90; X94355), CPXV-GER (cowpox virus, strain Germany 91-3; DQ437593). The branch length is proportional to evolutionary distance (scale bar).