A case of cowpox virus infection in the UK occurring in a domestic cat and transmitted to the adult male owner

Abstract

DEAR EDITOR, A 43-year-old man presented with a 25 9 20-mm fluctuant, nontender, solitary, haemorrhagic bulla with central necrosis on the left volar wrist, left-arm swelling (shown on days 2, 4 and 8), lymphangitis and pyrexia of 38 5 °C. His cat had recently become unwell and developed several dozen 3–4-mm erythematous annular and eroded lesions. These histologically demonstrated epidermal necrosis and pyogranulomatous dermatitis with large eosinophilic cytoplasmic inclusions within keratinocytes, which were consistent with poxvirus infection. Public Health England (Porton Down, UK) performed polymerase chain reaction of the haemorrhagic bulla fluid from the man, which identified Orthopoxvirus (suspected cowpox). Cats infected by bank voles can transmit the self-limiting disease to humans through minor skin fissures, remaining localized in immunocompetent individuals. The end of compulsory vaccinia vaccination 40 years ago and subsequent reduced cross-protection among orthopoxviruses may result in increased incidence of zoonotic Orthopoxvirus infections. C. Haddadeen, M. Van Ouwerkerk, T. Vicek and A. Fityan Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Pet Vet, Veterinary Dermatology, Thornhill, Southampton, UK; and Department of Veterinary Pathology, Finn Pathologists, Harleston, Norfolk, UK Correspondence: Adam Fityan. Email: adam.fityan@uhs.nhs.uk