Edith Lederman

Are You Confident of the Diagnosis? Characteristic findings on physical examination During the early stage of the infection, there appears to be an acute, nonspecific worsening in the patient’s baseline eczema (erythema, increased pruritus and weeping: Figure 1). Obtaining additional historical information (contact with a known smallpox vaccinee or any military member) is key to…

Are You Confident of the Diagnosis? What you should be alert for in the history Patients who develop cowpox lesions live in (or visit) Western Europe and have direct contact with rodents or with companion animals that hunt rodents (usually cats). Characteristic findings on physical examination The cowpox lesion is typical for poxviruses: annular with…

Are You Confident of the Diagnosis? What you should be alert for in the history Patients with progressive vaccinia (PV) have been given the smallpox vaccination (or have been exposed to a vaccinee) and have significant underlying immunocompromise (eg, HIV, underlying malignancy, transplant recipient) preventing them from controlling and eradicating the vaccinia infection. PV lesions…

Are You Confident of the Diagnosis? What you should be alert for in the history Parapoxviruses (such as orf virus [goats and sheep], pseudocowpox virus [dairy cattle], sealpox virus [grey seals], and deer-associated parapoxviruses) all produce clinically indistinguishable vesiculopustular lesions in humans. Infections occur at the site of contact with the infected animal (or fomite…