Buffalo Pox in AIDS Patient

Buffalo Pox in AIDS Patient

T.V.Rao and Chitra ValsanDepartment of Microbiology

With Dept of Medicine and Dermatology

Department of MicrobiologyVet nary Medical College

Dr.T.V.Rao MDDr.T.V.Rao MD 11

Case PresentationCase Presentation

Name xxxx Age 34 Sex M

Occupation Gold smith Ward MMW

Residence Palakad


Preset Clinical HistoryPreset Clinical History

• January 2007 Admitted with relapse of Pulmonary tuberculosis

• On Anti tuberculosis treatment

April 2007 Presented with two pustular lesions on left palm Manifestation of Oral Candidosis Cervical Lymphadenopathy Suscipicious of Fungal pneumonia Retinitis provisonally diagnosed as CMV infection


Past HistoryPast History

• Presented with Pulmonary Tuberculosis in 2004

• A gold smith by profession living in Bombay in the past

• Had several sex contacts with commercial sex workers

• No History of contact with any animals.


Laboratory InvestigationsLaboratory Investigations

• Confirmed as HIV positive patient

• Established to be presented with AIDS


Pustular (Pox like ) lesionsPustular (Pox like ) lesions

• Two pustular (pox like) lesions on left palm.

• Size is 5 mm with crusting

• Painful on touching with congestion around the lesions.


Provisional DiagnosisProvisional Diagnosis

• Cow pox

• Orf

• Modified form of foot and mouth disease.


Vesicular lesion on Palm of HandVesicular lesion on Palm of Hand


Present workupPresent workupMicrobiologyMicrobiology

• Fluid aspirated with Disposable syringe

• Fluid from one pock entirely leaked out

• From 2nd pock we are able to aspirate <0.5 ml of yellow colored fluid

• The fluid was clear yellowish and vesicle entirely collapsed.

• Sterile dressing was done after aspiration




Comparative PicturesComparative Pictures


Cow Pox Cow Pox

Cow Pox Produce by ( Orthopox virus ) cow pox viruses or cat pox Viruses Rodents harbor - cattle and Humans accidental Hosts Domestic cats get infected.• A contact with cat start the infection• Infection with cowpox virus is more commonly seen among the domestic

cats.• Present as Milkers nodes on hands• Immunological relations in humans like variola infections.

• Produce deep red hemorrhagic lesions on the Chorioallontoic membrane.

• In humans usually appear on hands and appear like vaccinia


How rare the DiseaseHow rare the Disease

• Fewer than 150 cases are recorded worldwide.

• Germany, U K , and Belgium

• India not reported in 2006 – 2007 ( CDC )

• A self limited condition


Classical ManifestationsClassical Manifestations

• A self limited condition

• 48 % of the cases represent with1 or 2 pocks on hands

• 33% of cases represent on face.

• Quite painful


DiagnosisDiagnosis

• Electron Microscopy

• Inoculation into Chorioallontoic membrane

• PCR.


Buffalo PoxBuffalo Pox

• Derivative of Vaccinia virus

• Water Buffalo harbors the virus Prevalent since the discontinuation of small pox vaccination

• Difficult to differentiate from cow pox

• Human to human transmission possible


ORFORF

• Contagious pustular disease

• History of contact with sheep essential

• Present with Papulovasicular lesions with central ulceration


Molluscum ContagiosumMolluscum Contagiosum

• Molluscipox virus

• Present as small wart like lesions

• Infection on palms and sole are rare

• Several cases reported among the AIDS patients.

• Sexually transmitted.


Culturing for Viral IsolationCulturing for Viral Isolation

With assistance of Vet nary With assistance of Vet nary Medical College Trichur.Medical College Trichur.


Viral IsolationViral Isolation

• The specimen is submitted for characterization of Aetiological Agent with assistance of virology department of Vet nary Medical College

• The virus adopted to egg inoculation observed to be growing without any hemorrhagic pocks (Only congestion )

• Two egg passages processed• Definitive indication of viral growth


How to establish the Final How to establish the Final DiagnosisDiagnosis

• Electron Microscopy

• Polymerase chain reaction

• Molecular studies

• Estimation of antibodies to Buffalo pox


CDC ( Atlanta )CDC ( Atlanta )GuidanceGuidance

• In touch with CDC with clinical details and pictorial presentation, with findings on embryonated egg.

• Informed us to be provisional diagnosis of Buffalo pox


WHO recorded evidenceWHO recorded evidence

• Buffalo pox in India 1996 In Beed District of Maharastra manifested in pediatric age group patients , total of 5 cases are documents by WHO in official records.

• An outbreak in Gujarat among cattle in 2006• A recent outbreak in Burns unit Pakistan

presented with 3 cases presented as hospital infection

( Nosocomial Buffalo pox virus infection ,Karachi ,Pakistan ‘ Zafar et al Emerging infectious diseases, June 2007)


Importance of Buffalo pox in our Importance of Buffalo pox in our HospitalsHospitals

• Single room isolation of Patients

• Effective infection control measures and education of staff

• Environment needs frequent cleaning with Hypochlorite solution.


Significance of Buffalo pox in Significance of Buffalo pox in Human infections.Human infections.

• The review of literature not yet recorded the occurrence of Buffalo pox in AIDS.

• The scope to study on academic basis of relation of Vaccinia virus in HIV patients.

• Buffalo pox can spread to close contacts, while serving the infected patients.

• Can spread to cattle in vicinity bring in more human infections.


• Buffalo pox included in list of communicable diseases, with Nosocomial potential and a

Reemerging Infection

CDC

Thank Q


Healthcare

Buffalo Pox in AIDS Patient