La viruela símica como enfermedad zoonótica viral y reemergente en el actual contexto sanitario mundial / Mpox as a Viral Zoonotic Disease Reemerging in the Current Global Health Context

Introducción: La viruela símica es una enfermedad zoonótica que también se trasmite de persona a persona por contacto estrecho. En el brote actual hasta el 31 de agosto de 2022 se reportaban 50 496 casos diagnosticados en 101 países, por lo que se consideró una situación preocupante por la Organización Mundial de la Salud. Objetivo: Exponer información actualizada sobre la viruela símica en el contexto sanitario actual. Métodos: Se realizó una búsqueda de literatura científica en las bases de datos ScienceDirect, PubMed/Medline, SciELO y Google Académico, mediante los descriptores o palabras relacionadas con la enfermedad, para encontrar revisiones, comunicados, informes, distintos artículos de revistas, entre otros documentos especializados de producción científica. Se seleccionó un total de 30 citas, actualizadas en su totalidad. Desarrollo: Desde su identificación en humanos se han reportado brotes de viruela símica en varios países; el más preocupante, ha sido el de reciente declaración en 2022, debido a la presencia de casos en países no endémicos, con un alcance geográfico extenso. Las manifestaciones clínicas pueden cursar con síntomas leves, como erupciones en la cara y el resto del cuerpo, fiebre, cefalea, mialgias y fatiga, por lo que no constituye una enfermedad potencialmente mortal; sin embargo, de presentarse comorbilidades la evolución podría ser tórpida. Conclusiones: La presencia de casos de viruela símica en humanos se ha mantenido desde su aparición, sin encontrar un tratamiento específico y vacunas autorizadas para su administración, lo que podría generar un aumento de contagios y fallecidos(AU)

Introduction: Mpox is a zoonotic disease also transmitted from person to person by close contact. The current outbreak, up to August 31, 2022, reported 50 496 diagnosed cases from 101 countries; therefore; it was considered a situation of concern by the World Health Organization. Objective: To present updated information on Mpox in the current health context. Methods: A scientific literature search was carried out in the databases ScienceDirect, PubMed/Medline, SciELO and Google Scholar, using descriptors or words related to the disease, in order to find reviews, communications, reports, different journal articles, among other specialized documents of scientific production. A total of 30 entirely updated citations were selected. Development: Since Mpox was identified in humans, outbreaks of the disease have been reported in several countries; the most worrisome has been reported recently in 2022, due to the presence of cases in nonendemic countries, with an extensive geographical scope. The clinical manifestations may occur with mild symptoms, such as rash on the face or the rest of the body, fever, headache, myalgia and fatigue; therefore, it is not a potentially mortal disease. However, in case of comorbidity, the evolution could be torpid. Conclusions: Mpox cases in humans has been present since its appearance, without any specific treatment or vaccines authorized to be administered, which could generate an increase in contagions and deaths(AU)

Un caso de viruela símica en cuidados intensivos en Argentina / A case of monkeypox in intensive care in Argentina

Resumen La viruela símica es una enfermedad zoonótica poco frecuente. Fue descripta en humanos por primera vez en África en 1970. El 23 de julio del 2022, ante la cantidad ascendente de casos notificados en diversos países y territorios, la Organización Mundial de la Sa lud (OMS) concluyó que el brote mundial constituye una emergencia de salud pública de importancia internacional. En nuestro país el primer caso se noti ficó el 22 de mayo de 2022 hasta el 22 de noviembre se confirmaron 895 casos. Describimos el primer caso registrado en Argentina, según el boletín epidemiológico de la semana epidemiológica 46, del Ministerio de Salud de la Nación con requerimiento de cuidados intensivos. Se trata de un hombre de 44 años con síndrome de in munodeficiencia adquirida y viruela símica grave, que presentó insuficiencia ventilatoria obstructiva, por com promiso de vías aéreas y lesiones generalizadas extensas de tegumento, genitales y fauces. En conclusión, el caso presentado alerta sobre las potenciales complicaciones que pueden requerir cuidados críticos y poner en riesgo la vida del paciente.

Abstract Monkey pox is a rare zoonotic disease. It was first described in humans in Africa in 1970. On July 23, 2022, in view of the increasing number of cases reported in several countries and territories, the World Health Or ganization (WHO) concluded that the global outbreak constitutes a public health emergency of international concern. In our country, the first case was reported on May 22, 2022 and up to November 22 of this year, 895 patients were reported. We describe here the first case registered in Argentina requiring intensive care, accor ding to the Epidemiological Bulletin, 46th epidemio logical week, National Ministry of Health. The patient was a 44-year-old man with acquired immunodeficiency syndrome and severe Monkeypox, who presented obs tructive ventilatory failure due to airway compromise and extensive generalized lesions of the integument, genitalia and fauces. In conclusion, the case presented alerts about potential complications that may require critical care and risk the patient's life.

Ocular manifestations of monkeypox: a case report / Manifestações oculares da monkeypox: um relato de caso

ABSTRACT Monkeypox disease is a viral zoonosis with symptoms similar to those seen in the past in smallpox (variola), although clinically less severe. Following the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus from a public health standpoint. Monkeypox virus occurs primarily in central and western Africa, often in tropical forests, and has increasingly manifested in urban areas. Animal hosts include various rodents and nonhuman primates. We report the case of a patient with monkeypox disease who developed ocular complaints (eye discomfort and conjunctivitis) and had detectable conjunctival lesions on biomicroscopy and fluorescein testing. Its ophthalmological manifestations are still poorly known.

RESUMO Varíola do Macaco é uma zoonose viral com sintomas semelhantes aos observados no passado em pacientes com Varíola, embora seja clinicamente menos grave. Com a erradicação da varíola em 1980 e a subsequente cessação da vacinação contra a varíola, a varíola dos macacos emergiu como o ortopoxvírus mais importante em saúde pública. O vírus monkeypox ocorre principalmente na África central e ocidental, muitas vezes nas proximidades de florestas tropicais, e tem se manifestado cada vez mais em áreas urbanas. Os hospedeiros animais incluem uma variedade de roedores e primatas não humanos. O presente estudo relata o caso de um paciente com Monkeypox que evoluiu com queixa oftalmológica de desconforto ocular e conjuntivite e, à biomicroscopia e teste da fluoresceína, detecção de lesões conjuntivais. Alterações oftalmológicas da doença são, ainda, pouco conhecidas.

Metanalysis of Vaccine Efficacy for Monkeypox According to Clinical Criteria of History Taking, Clinical Features and Laboratory Investigation

Monkeypox virus is DNA virus of Orthopoxvirus. The Monkeypox is zoonosis disease first diagnosed in the Democratic Republic of the Congo in 1970 and originally transmitted from Vertebrate Reservoir. In 1796, Edward Jenner was the first physician achieved vaccine and prove its efficacy through exposing James Phipps to smallpox after immunization. The current study revises the vaccine efficacy and mortality rate of monkeypox. It is mainly transmitted from Squirrels to human and cause mortality rate ranging from 2.7 to 10.1%. Globally, it estimated 4.4% the mortality rate of Monkeypox cases. Based on current review study, the effectiveness of smallpox vaccine in preventing the monkeypox is quite variable due to several selective clinical cases criteria such as history taking and clinical features and laboratory investigation, which modify the statistical result of the vaccine efficacy. The current study clarifies the faults of calculation by eliminating several reasons and estimating the effectiveness of vaccine in the household and find it to be 16.3% whereas total Vaccine efficacy is 0.6%. Using preventive measures are the first line to avoid infection therefore healthcare workers must adhere to infection control precautions. A current study warns scientists to create monkeypox vaccine rather than depending on smallpox vaccine effectiveness due to lacking of current vaccine effectiveness evidence and treatment.

Viruela símica: descripción de dos casos en seguimiento en Buenos Aires / Monkeypox: description of two cases under follow-up in Buenos Aires

Resumen La viruela símica es una enfermedad endémica en varios países de África. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en segui miento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.

Abstract Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was repor ted in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appea rance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.

Viruela símica: zoonosis emergente con impacto global / Monkeypox: emerging zoonosis with unprecedentedglobal impact

El virus de la viruela símica es un orthopoxvirus de características zoonóticas endémico en las regiones de África Central y África Occidental, donde causa brotes desde 1970. En las últimas décadas se registró un aumento exponencial de casos, probablemente asociado a la disminución en la inmunidad conferida por la vacuna antivariólica, discontinuada luego de la erradicación de la viruela. En los últimos años se registraron casos esporádicos fuera del continente africano, siempre relacionados epidemiológicamente a la permanencia en áreas endémicas o contacto con animales infectados. Desde el 13 de mayo de 2022 se encuentra en curso el mayor brote de viruela símica registrado fuera de las áreas endémicas de África, con casos en los cinco continentes. La extensión, el impacto y la duración del brote permanecen aún inciertos.

Monkeypox virus is an orthopoxvirus with zoonotic characteristics endemic in Central and West Africa regions, where it has caused outbreaks since 1970. An exponential increase in cases has been registered in the last decades, probably associated with a decrease in the immunity conferred by the smallpox vaccine, discontinued after smallpox eradication. In recent years, sporadic cases have been reported outside the African continent, always epidemiologically related to permanence in endemic areas or contact with infected animals. Since May 13, 2022, the largest monkeypox outbreak ever reported outside Africa endemic areas, with cases on the five continents, is unfolding. The extent, impact and duration of this outbreak still remain uncertain

Viruela símica: una infección emergente desatendida / Monkeypox: an unattendedemerging infection

El virus de la viruela símica estrechamente relacionado al virus de la viruela humana, es una zoonosis endémica de África occidental y central. En los seres humanos, la infección puede provocar una enfermedad similar a la viruela humana, aunque de menor severidad, pese a ello se asocia a una letalidad reportada variable desde menos del 1% al 11%. La transmisión se produce principalmente a través de gotitas respiratorias o contacto directo con el exudado de lesiones. La transmisión persona a persona está bien descrita, tanto comunitaria como nosocomial. El cuadro clínico se caracteriza por un pródromo de fiebre, al cual se agrega exantema y linfadenopatía. Dentro de las complicaciones se pueden incluir neumonía, encefalitis y queratitis. No existe un tratamiento aprobado establecido, aunque se incluyen estrategias en base a antivirales y vacunas. (AU)

Monkeypox virus, closely related to human smallpox virus, is a zoonosis endemic to West and Central Africa. In humans, the infection can cause a disease similar to smallpox, although less severe, despite this it is associated with a variable reported lethality from less than 1% to 11%. Transmission occurs primarily through respiratory droplets or direct contact with exudate from lesions. Person-to-person transmission is well described, both in the community and nosocomial. The clinical picture is characterized by a prodrome of fever, to which is added rash and lymphadenopathy. Complications may include pneumonia, encephalitis, and keratitis. There is no established approved treatment, although strategies based on antivirals and vaccines are included. (AU)

New progress in medicinal chemistry of anti-poxvirus drugs research / 药学学报

Poxvirus is the largest and most complex virus of the known virions, and the main pathogenicity to humans is Orthopoxvirus. In recent years, with the deep understanding of the biological structure and replication cycle of Orthopoxvirus, new small molecular compounds with high efficiency and low toxicity have been discovered as new drugs, and some have entered the clinical trial stage. This article summarizes the research progress of poxvirus inhibitors with different targets.

Bovine Vaccinia in dairy cattle and suspicion of vesicular disease on milkers in Brazil / Vaccinia bovina em gado leiteiro e suspeita de doença vesicular em ordenhadores no Brasil

ABSTRACT: Bovine vaccinia (BV) is a vesicular disease induced by the Vaccinia virus (VACV) that affects milk production and is an occupational zoonosis. This research had the following objectives: (i) detection of VACV by qPCR in cattle with clinical suspicion of vesicular disease; (ii) symptoms characterization in animals and milkers with clinical suspicion of the disease and virus detection in humans; and (iii) identification of risk factors for infections of VACV in herds from several Brazilian states. A total of 471 bovine epithelial samples from dairy farms, in 15 Brazilian states, were evaluated between 2007 and 2012. The samples were tested by quantitative PCR (qPCR) using SYBR Green® reagents, validated with a lower limit of detection of 100 TCID50/50µL (1.7x100 viral particles), and 45.1% of VACV positive samples were detected. Using official forms for epidemiological investigation (FORM-IN), the risk factors for VACV infections in cattle were determined to be farms with a lack of technological facilities (P=0.029) and the presence of rodents (P=0.001). There was an effect of seasonality in cattle with a higher occurrence of BV during the dry season. A total of 420 epidemiological questionnaires were applied at public health care centers, where 100% of the milkers had vesicular lesions on their hands (98.1%) and on their arms (6.9%). The most frequent clinical symptoms in humans were: local swelling (74.2%), headache (20.7%), fever (10.4%) and inguinal lymphadenopathy (74.2%). Only 19.98% of milkers aged between 39 and 58 years were seroreactive to VACV and were immunized with the human anti-smallpox vaccine. There was an increase in the frequency of BV in older individuals due to their natural decrease in specific immunity. It has been shown that the implementation of zootechnical management techniques and health planning are important for the prevention of BV in animals and humans.

RESUMO: Vaccinia bovina (VB) é uma doença vesicular induzida pelo Vaccinia virus (VACV) que afeta a produção de leite e é uma zoonose ocupacional. Este trabalho teve os seguintes objetivos: (i) detecção de VACV por qPCR em bovinos com suspeita clínica de doença vesicular; (ii) caracterização dos sintomas apresentados por animais e ordenhadores com suspeita clínica da doença e detecção do vírus em humanos; e (iii) identificação de fatores de risco para infecção por VACV em rebanhos de vários estados brasileiros. Um total de 471 amostras de epitélio bovino de fazendas leiteiras, em 15 estados brasileiros, foram avaliados entre 2007 e 2012. As amostras foram testadas por PCR quantitativa (qPCR) usando reagentes SYBR Green®, validados com um limite inferior de detecção de 100TCID50/50μL (1,7x100 partículas virais) e 45,1% das amostras positivas de VACV foram detectadas. Usando formulários oficiais de investigação epidemiológica (FORM-IN), os fatores de risco para infecções por VACV em bovinos foram determinados como fazendas com falta de instalações tecnológicas (P=0,029) e presença de roedores (P=0,001). Houve um efeito da sazonalidade no gado com maior ocorrência de VB durante a estação seca. Um total de 420 questionários epidemiológicos foram aplicados nos centros públicos de saúde, onde 100% dos ordenhadores apresentaram lesões vesiculares nas mãos (98,1%) e nos braços (6,9%). Os sintomas clínicos mais frequentes em humanos foram: inchaço local (74,2%), cefaleia (20,7%), febre (10,4%) e linfadenopatia inguinal (74,2%). Apenas 19,98% dos produtores de leite com idade entre 39 e 58 anos foram sororreagentes ao VACV e foram imunizados com a vacina contra a varíola humana. Houve um aumento na frequência de BV em indivíduos mais velhos devido à sua diminuição natural na imunidade específica. Demonstrou-se que a implementação de técnicas de gestão zootécnica e planejamento sanitário são importantes para a prevenção da VB em animais e seres humanos.

Outbreaks of vesicular disease caused by Vaccinia virus in dairy cattle from Goiás State, Brazil (2010-2012) / Surtos de doença vesicular causados pelo Vaccinia virus em bovinos de leite no Estado de Goiás, Brasil (2010-2012)

Cases of vesicular and exanthematic disease by Vaccinia virus (VACV) have been reported in dairy herds of several Brazilian regions, occasionally also affecting humans. The present article describes eight outbreaks of vesicular disease caused by VACV in dairy herds of six counties of Goiás state, Midwestern Brazil (2010-2012), involving a total of 122 cows, 12 calves and 11 people. Dairy cows (3 to 9 years old) were affected in all cases and calves (2 to 9 months old) were affected in five outbreaks, presenting oral lesions. The morbidity ranged between 8 and 100% in cows, and 1.5 to 31% in calves. In the cows, the clinical signs started with vesicles (2-7mm), painful and coalescent papules (3-8 mm), which resulted in ulcers (5-25mm) and scabs in teats, and, occasionally, in the muzzle. The clinical course lasted from 16 to 26 days. The histopathology of bovine skin samples revealed superficial perivascular inflammatory infiltrate of lymphocytes, plasma cells, neutrophils, macrophages and multifocal areas of acanthosis, spongiosis, hipergranulosis and parakeratotic or orthokeratotic hyperkeratosis with adjacent focally extensive ulcers. Eosinophilic inclusion bodies were noted in the cytoplasm of the keratinocytes. PCR to vgf gene of Orthopoxvirus was positive in samples collected from all outbreaks, and in some cases, genomic VACV sequences were identified by nucleotide sequencing of the PCR amplicons. Infectious virus was isolated in cell culture from scabs from one outbreak. Antibodies to Orthopoxvirus were detected in at least 3 or 4 animals in most outbreaks, by ELISA (outbreaks 1, 2, 3, 4, 5 and 7) or virus-neutralization (outbreak 6). Neutralizing titers ranging from 8 to 64 in outbreak 6. In all outbreaks, VACV infection was suspected based on the clinical and pathological findings and it was confirmed by laboratory tests. Upon the etiological confirmation, other agents associated with vesicular disease were discarded. In all outbreaks, at least one milker who handled the affected cows developed malaise, headache, fever, painful vesico-pustular lesions mainly in the hands, but also in the neck and nose. These results confirm the circulation of VACV in the region and call attention for a correct diagnosis and the adoption of prophylactic and control measures.

Casos de doença vesicular e exantemática associados ao Vaccinia virus (VACV) têm sido descritos em rebanhos leiteiros em diversas regiões do Brasil, ocasionalmente afetando também os ordenhadores. Este artigo descreve oito surtos de doença vesicular associados ao VACV ocorridos em rebanhos leiteiros de seis municípios do estado de Goiás (2010-2012), com o envolvimento de 122 vacas em lactação, de 12 bezerros e de 11 pessoas. Vacas em lactação (3-9 anos de idade) foram afetadas em todos os casos. Em cinco rebanhos, bezerros de 2-9 meses apresentaram lesões orais. A morbidade nos rebanhos variou entre oito e 100% (vacas) e entre 1,5 e 31% (bezerros). As lesões iniciavam como vesículas (2-7mm) ou pápulas doloridas e coalescentes (3-8mm), que progrediam para úlceras (5-25mm) e crostas, localizadas principalmente nas tetas e, eventualmente, no focinho das vacas. O curso clínico variou entre 16 e 26 dias. Histopatologia de amostras de pele coletadas de bovinos revelou dermatite perivascular superficial com infiltrado de linfócitos, neutrófilos, plasmócitos e macrófagos, além de áreas multifocais de acantose, espongiose, hipergranulose e hiperceratose ortoceratótica ou paraceratótica com úlceras focalmente extensas. No citoplasma dos ceratinócitos adjacentes às úlceras, observaram-se numerosos corpúsculos de inclusão eosinofílicos. Em todos os surtos, amostras de lesões cutâneas dos bovinos foram positivas para o gene vgf dos Orthopoxvirus por PCR, e em alguns casos, a identificação do VACV foi confirmada por sequenciamento de nucleotídeos dos amplicons. O vírus foi detectado por isolamento em cultivo celular em um dos surtos e, pelo menos 2 a 3 vacas por rebanho, apresentaram sorologia positiva para Orthopoxvirus pelos testes de ELISA (surtos 1, 2, 3, 4, 5 e 7) e soroneutralização (surto 6). No surto 6, os títulos de anticorpos neutralizantes variaram de 8 a 64. O diagnóstico da infecção pelo VACV, inicialmente suspeito com base nos achados clínicos e patológicos, foi confirmado em todos os surtos por exames laboratoriais. Em todos os surtos, pelo menos um ordenhador que teve contato com os bovinos afetados apresentou mal-estar geral, febre alta, dor de cabeça e lesões vesiculo-pustulosas doloridas, principalmente nas mãos, mas também no pescoço e nariz. Esses resultados confirmam a circulação do VACV no rebanho bovino da região centro-oeste, alertando para necessidade de diagnóstico correto e adoção de medidas profiláticas e de controle.

Infecção em humanos por varíola bovina na região de Ibertioga, estado de Minas Gerais / Human infection with bovine smallpox in the Ibertioga region, State of Minas Gerais, Brazil

Introdução e objetivo: a varíola bovina é uma zoonose causada pela proliferação do vírus do gênero ortopoxvírus, sendo os bovinos a fonte primária de infecção humana. É importante apresentar relatos de casos dessa doença para que os profissionais de saúde, em especial os médicos, fiquem atentos para seu diagnóstico e tratamento corretos. Resultados: quatro casos de varíola bovina em humanos foram identificados e comprovados por exames sorológicos na região de Ibertioga, Minas Gerais. Todos os pacientes apresentavam sintomas em comum, como febre alta, falta de apetite, mialgia e lesões de pele. Conclusão: deve ser dada mais atenção aos casos dessa zoonose, no sentido de seu correto diagnóstico, adequada terapia de suporte e boa orientação para os pacientes, para que possa se evitar a transmissão intrafamiliar, bem como para animais com os quais venham a ter contato, considerando que a quase totalidade dos casos ocorre em áreas rurais.

Introduction and objective: Bovine smallpox is a zoonosis caused by Ortopxvirus proliferation, bovines being the primary source for human infection. Case reports of this disease are important to raise health professionals? consciousness of correct diagnosis and treatment.Results: Four cases of human infection with bovine smallpox were identified and confirmed by serologic exams in the Ibertioga region, State of Minas Gerais, Brazil Patients shared common symptoms such as high fever, decreased appetite, myalgia, and skin injury. Conclusion:The cases of this zoonosis should be paid more attention in order to enhance diagnosis, support therapy and guidance for patients witha view to avoiding intra-familiar and further animal transmission (as virtually all cases are reported in rural areas).

Infecções humanas causadas por poxvirus relacionados ao vírus vaccinia no Brasil / Human infections caused by vaccinia-like poxviruses in Brazil

A partir de 1999, infecções humanas por Orthopoxvirus vem sendo observadas em pelo menos oito estados no país, com a formação de vesículas as quais evoluem para pústulas e crostas, principalmente nos membros superiores e face, após contacto com bovinos apresentando lesões semelhantes no úbere. Alem das lesões na pele, foram descritas nos pacientes reações ganglionares axilares por vezes dolorosas, febre, cefaléia, fadiga, desidratação, anorexia, sudorese, artralgia e mialgia, evoluindo o quadro por três a quatro semanas. Lesão vulvar bem como transmissão intrafamiliar foram igualmente descritas. Estudos moleculares demonstraram que os poxvirus identificados são geneticamente relacionados a amostras do vírus vaccinia utilizadas no passado, nas campanhas de vacinação. Especimens clínicos de 80 infecções humanas foram estudados no laboratório e a infecção por orthopoxvirus confirmada em 68 casos. São apresentadas lesões observadas em pacientes bem como discutidas as implicações desta zoonose no Brasil.

Since 1999, human infection caused by Orthopoxvirus has been observed in at least eight Brazilian states, with the presence of vesicles that evolve to pustules and crusts, especially on the hands, arms and face, after contact with cows showing comparable lesions on the udder. In addition to the skin lesions, there have been descriptions of patients with axillary ganglionic reactions that are sometimes painful, along with fever, headache, fatigue, dehydration, anorexia, sudoresis, arthralgia and muscle pain. The condition evolves over a three to four-week period. Vulvar lesions and transmission within families have also been described. Molecular studies have shown that the poxviruses identified are genetically related to vaccinia virus samples that were used in vaccination campaigns in the past. Clinical specimens from 80 human infections were studied in the laboratory, and orthopoxvirus infections were confirmed in 68 cases. The lesions observed in these patients are presented and the implications of this zoonosis in Brazil are discussed.

Animal infections by vaccinia-like viruses in the state of Rio de Janeiro: an expanding disease / Infecções animais por vírus semelhantes ao vaccínia no estado do Rio de Janeiro: uma doença em expansão

In the present study we investigated the presence of infections by vaccinia-like viruses in dairy cattle from 12 counties in the state of Rio de Janeiro in the last 9 years. Clinical specimens were collected from adult animals with vesicular/pustular lesions mainly in the udder and teats, and from calves with lesions around the nose and mouth. A plaque reduction neutralization test (PRNT) was applied to search for antibodies to Orthopoxvirus; the vesicular/pustular fluids and scabs were examined by PCR, electron microscopy (EM) and by inoculation in VERO cells for virus isolation. Antibodies to Orthopoxvirus were detected in most cases. The PCR test indicated a high nucleotide homology among the isolates and the vaccinia viruses (VACV) used as controls. By EM, typical orthopoxvirus particles were observed in some specimens. The agents isolated in tissue culture were confirmed as vaccinia-like viruses by EM and PCR. The HA gene of the vaccinia-like Cantagalo/IOC virus isolated in our laboratory was sequenced and compared with other vaccinia-like isolates, showing high homology with the original Cantagalo strain, both strains isolated in 1999 from dairy cattle. Antibodies to Orthopoxvirus were detected in one wild rodent (genus Akodon sp.) collected in the northwestern region of the state, indicating the circulation of poxvirus in this area. Nonetheless, PCR applied to tissue samples collected from the wild rodents were negative. Vesicular/pustular lesions in people in close contact with animals have been also recorded. Thus, the vaccinia-like virus infections in cattle and humans in the state seem to be an expanding condition, resulting in economic losses to dairy herds and leading to transient incapacitating human disease. Therefore, a possible immunization of the dairy cattle in the state should be carefully evaluated.

Neste estudo avaliou-se a presença de infecções por vírus semelhantes ao vírus vaccínia (VACV) em gado leiteiro em 12 municípios no estado do Rio de Janeiro, ao longo dos últimos nove anos. Amostras clínicas foram coletadas de animais com vesículas, pústulas e crostas no úbere e tetas, e da região do nariz e da cavidade oral de bezerros. Um teste de neutralização viral por redução de placas foi desenvolvido para investigar a presença de anticorpos contra Orthopoxvirus. Os fluidos de vesículas / pústulas e as crostas foram testadas por PCR, microscopia eletrônica (ME) e por inoculação em células VERO para isolamento viral. Anticorpos contra Orthopoxvirus foram detectados na grande maioria dos animais. O teste de PCR demonstrou homologia entre os vírus isolados e amostras de vírus vaccínia usados como controles. Na ME, partículas típicas de Orthopoxvirus foram observadas em vários espécimes analisados. Os vírus isolados em cultivo celular foram confirmados como Orthopoxvirus por PCR e ME. O gene HA da amostra Cantagalo/IOC isolada em nosso laboratório foi seqüenciado e comparado com outras amostras semelhantes ao vaccínia, mostrando uma alta homologia com a amostra original Cantagalo, tendo sido as duas amostras isoladas em 1999 de gado leiteiro. Anticorpos para Orthopoxvirus foram detectados em um roedor silvestre do gênero Akodon sp. coletado na região noroeste do estado, sugerindo uma circulação de poxvírus na natureza. No entanto, os testes de PCR aplicados a tecidos de roedores silvestres foram negativos. Infecções vesiculares / pustulares em humanos que mantinham contato com os animais afetados também foram relatadas. Assim, infecções por amostras semelhantes ao vírus VACV em bovinos e em humanos parecem em expansão no estado, gerando perdas econômicas em animais e quadros de doença incapacitante temporária em pacientes humanos. Dessa forma, a possibilidade da imunização do gado leiteiro no estado deve ser devidamente avaliada.

Infecção em humanos por varíola bovina na microrregião de Itajubá, Estado de Minas Gerais: relato de caso / Human infection by the cowpox virus in the microregion of Itajubá, state of Minas Gerais: case report

Os autores relatam três casos de varíola bovina em humanos, ordenhadores manuais em vacas infectadas, na microrregião de Itajubá, MG. As técnicas diagnósticas foram: isolamento de amostra semelhante ao vírus vaccinia de secreções das lesões cutâneas, reação em cadeia de polimerase, microscopia eletrônica e anticorpos para Orthopoxvirus no sangue dos pacientes.

The authors report three human cases of cowpox infection, among farm workers who were manually milking infected cows, in the microregion of Itajubá, Minas Gerais. The diagnostic techniques used were: isolation of samples similar to the vaccinia virus, from skin lesion secretions; polymerase chain reaction; electronic microscopy; and antibodies for Orthopoxvirus in the patients' blood.