Plano estadual de contingência para o enfrentamento da doença - Monkeypox 2022 / State contingency plan to fight - Monkeypox disease 2022

Em 14 de maio de 2022, 02 (dois) casos de do Reino Unido (UKHSA). Nos dias seguintes, vários outros Estados notificaram casos da doença. Em 21 de maio de 2022, a OMS declarou a existência de um surto global emerge infecção pelo vírus Monkeypox (MPXV), com transmissão comunitária documentada entre pessoas que tiveram contato com casos sintomáticos, em países não endêmicos. O Monkeypox é uma doença zoonótica causada por vírus, sendo este classificado pelo on Taxonomy of Viruses (ICTV) como pertencente à família Poxviridae, gênero Monkeypoxvírus (2). O Estado de Goiás instituiu o Centro de Operações Estratégicas de Saúde Pública (COE) em 03 de agosto de 2022. E, seguindo as orientações nacionais, propõe o presente Plano Estadual de Contingência para a fim de organizar e fortalecer as políticas públicas de saúde, visto que, o alcance de alta eficácia e eficiência das medidas, depende de uma atuação conjunta e ordenada de todos os os entes federados, bem como dos setores públicos e privados

As of May 14, 2022, 02 (two) cases of from the United Kingdom (UKHSA). In the following days, several other states reported cases of the disease. On May 21, 2022, the WHO declared the existence of a global outbreak emerging Monkeypox virus (MPXV) infection, with documented community transmission among people who had contact with symptomatic cases in non-endemic countries. Monkeypox is a zoonotic disease caused by a virus, which is classified by the on Taxonomy of Viruses (ICTV) as belonging to the Poxviridae family, Monkeypoxvirus genus (2). The State of Goiás established the Center for Strategic Public Health Operations (COE) on August 3, 2022. And, following national guidelines, it proposes this State Contingency Plan in order to organize and strengthen public health policies, since, the reach of high effectiveness and efficiency of the measures, depends on a joint and orderly action of all the federated entities, as well as of the public sectors and private

Coinfection of a lingual lesion with bovine papular stomatitis virus and bovine papillomavirus.

To date, there have been no reports of coinfection with bovine papular stomatitis virus (BPSV) and bovine papillomavirus (BPV) in the same lesion. In the present study, one lingual papilloma-like sample was collected at an abattoir from the tongue of a 31-month-old Japanese black cow. Coinfection with BPSV and BPV was confirmed by histopathology, immunohistochemistry, PCR and RT-PCR. The evidence for coinfection with BPSV and BPV in the same lesion and an association of BPV with lingual papillomatosis will contribute to future epidemiological studies of these two viruses.

Molusco contagioso por trasmisión vertical / Molluscum contagiosum due to vertical transmission

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Lymphocytic choriomeningitis, Ljungan and orthopoxvirus seroconversions in patients hospitalized due to acute Puumala hantavirus infection.

BACKGROUND: The emergence and re-emergence of zoonotic and vector-borne diseases are increasing in Europe. Prominent rodent-borne zoonotic viruses include Puumala hantavirus (PUUV; the causative agent of nephropathia epidemica, NE), lymphocytic choriomeningitis virus (LCMV), and orthopoxviruses (OPV). In addition, Ljungan virus (LV) is considered a potentially zoonotic virus. OBJECTIVE: The aim of this study was to compare clinical picture between acute PUUV patients with and without additional rodent-borne viral infections, to investigate if concurrent infections influence disease severity. STUDY DESIGN: We evaluated seroprevalence of and seroconversions to LCMV, LV and OPV in 116 patients hospitalized for NE. Clinical and laboratory variables were closely monitored during hospital care. RESULTS: A total of five LCMV, 15 LV, and one OPV seroconversions occurred. NE patients with LCMV seroconversions were younger, and had lower plasma creatinine concentrations and platelet counts than patients without LCMV seroconversions. No differences occurred in clinical or laboratory findings between patients with and without seroconversions to LV and OPV. We report, for the first time, LCMV seroprevalence in Finland, with 8.5% of NE patients seropositive for this virus. Seroprevalences for LV and OPV were 47.8% and 32.4%, respectively. CONCLUSION: Cases with LCMV seroconversions were statistically younger, had milder acute kidney injury and more severe thrombocytopenia than patients without LCMV. However, the low number of seroconversion cases precludes firm conclusions. Concurrent LV or OPV infections do not appear to influence clinical picture for NE patients.

Poxvirus-induced angiogenesis after a thermal burn.

Orf (contagious ecthyma) is a zoonotic infection caused by a dermatotropic parapoxvirus that commonly infects sheep, goats, and oxen. Parapoxviruses are transmitted to humans through contact with an infected animal or fomites. Orf virus infections can induce ulceration, and papulonodular, pustular, or ecthymic lesions of the skin after contact with an infected animal or contaminated fomite. Rarely, orf virus provokes extensive vasculo-endothelial proliferation as a skin manifestation. Here, we present the case of an 8-year old female with poxvirus-induced vascular angiogenesis that developed 10 days after a thermal burn. An 8-year-old female presented at our outpatient clinic with red swellings and a yellow-brown crust on them. After a thermal burn with hot water, she went to a clinic and the burn was dressed with nitrofurazone and covered for 2 days. When the dressing was removed after 2 days, nodules were seen in the burnt areas. When the clinical findings were considered with the histopathological features, a reactive vascular proliferation due to a viral agent was suspected. Following PCR, parapoxvirus ovis was detected. Viral infections such as pox virus can trigger pyogenic granulomas or pyogenic granuloma-like vascular angiogenesis. Infectious agents must be considered when dealing with pyogenic granuloma-like lesions.

Fatal combined infection with canine distemper virus and orthopoxvirus in a group of Asian marmots (Marmota caudata).

A fatal combined infection with canine distemper virus (CDV) and orthopoxvirus (OPXV) in Asian marmots (Marmota caudata) is reported in this article. A total of 7 Asian marmots from a small zoological garden in Switzerland were found dead in hibernation during a routine check in the winter of 2011. The marmots died in February 2011. No clinical signs of disease were observed at any time. The viruses were detected in all individuals for which the tissues were available (n = 3). Detection of the viruses was performed by reverse transcription polymerase chain reaction. The most consistent gross lesion was a neck and thorax edema. A necrotizing pharyngitis and a multifocal necrotizing pneumonia were observed histologically. Numerous large intracytoplasmic eosinophilic inclusions were seen in the epithelial cells of the pharynx, of the airways, and in the skin keratinocytes. Brain lesions were limited to mild multifocal gliosis. Phylogenetic analysis revealed that the marmot CDV strain was closely related to the clusters of CDVs detected in Switzerland in wild carnivores during a local outbreak in 2002 and the 2009-2010 nationwide epidemic, suggesting a spillover of this virus from wildlife. The OPXV was most closely related to a strain of cowpoxvirus, a poxvirus species considered endemic in Europe. This is the first reported instance of CDV infection in a rodent species and of a combined CDV and OPXV infection.

Concurrent avian malaria and avipox virus infection in translocated South Island saddlebacks (Philesturnus carunculatus carunculatus).

CASE HISTORY: Outbreaks of mortality in South Island saddlebacks (Philesturnus carunculatus carunculatus) that had been translocated to two offshore islands in the Marlborough Sounds of New Zealand were investigated during the summers of 2002 and 2007. Both outbreaks were associated with a severe decrease in numbers of saddlebacks of up to 60% of approximately 200 birds. CLINICAL AND PATHOLOGICAL FINDINGS: Many of the surviving birds were in poor condition, and had skin lesions on the legs and head. Necropsy showed pale liver and lungs, and a swollen spleen. Histopathology revealed schizonts resembling Plasmodium spp. within the cytoplasm of many hepatocytes and splenic histiocytes. The skin lesions consisted of epithelial proliferations containing numerous Bollinger bodies typical of avipox virus (APV) infection. Two different APV were isolated, using PCR, from two different birds exhibiting skin lesions. Each isolate had 100% sequence homology with APV members from either Clade A or Clade B. In addition, PCR analysis revealed that the Plasmodium elongatum present in infected birds belonged to a strain that was endemic in the population of North Island saddlebacks (Philesturnus carunculatus rufusater). DIAGNOSIS: Concurrent infections with Plasmodium spp. haemoparasites and APV were identified as the likely cause of death in the birds examined. CONCLUSIONS AND CLINICAL RELEVANCE: Although the Plasmodium spp. identified is thought to be endemic to saddlebacks in New Zealand, the affected birds were likely to be immunocompromised by concurrent APV infection or through lack of genetic diversity. Both the introduced mosquito Culex quinquefasicatus and the native mosquito Culex pervigilans are likely vectors for both these diseases, and the provision of water supplies less favourable to mosquito-breeding is recommended.

Avian pox infection with secondary Candida albicans encephalitis in a juvenile golden eagle (Aquila chrysaetos).

Abstract: A juvenile golden eagle (Aquila chrysaetos) was presented with proliferative epithelial lesions, consistent with avian poxvirus infection, around the eyes, on commissures of the beak, and on both feet. Despite treatment, the eagle declined clinically, and, 15 days after presentation, the eagle began seizuring and was euthanatized because of a poor prognosis. On postmortem examination, avian poxvirus infection was confirmed in the nodular skin lesions, and Candida albicans was cultured from the skin, lungs, and brain. Breaks in the skin barrier from poxvirus infection likely led to secondary infection with C albicans. Systemic vascular dissemination of C albicans to the brain resulted in thrombosis, hemorrhage, local hypoxia, and the clinically observed seizures. The combination of the breach in the primary immune system, immunosuppression, and a prolonged course of antibiotics were contributory factors to the opportunistic fungal infection in this eagle. Candida albicans should be considered as a differential diagnosis for encephalitis in an immunocompromised avian patient.

Unusual pathology of canary poxvirus infection associated with high mortality in young and adult breeder canaries (Serinus canaria).

Mortality in excess of 65% occurred in a flock of 450 canaries (Serinus canaria). Clinical signs in the canaries included severe respiratory distress, loss of feathers and/or scaly skin on the head, neck and back, anorexia, loss of weight and fluffed-up appearance of several days duration before death. Gross pathology in most of the canaries included thickened eye lids and small scab-like nodules on the skin of the head and neck, enlarged thymus, mild to severe consolidation of lungs and exudate in the sinuses and trachea. A few birds also had thickened air sacs and enlarged and pale spleens. Microscopically unusual lesions included severe epithelial proliferation and hypertrophy and mononuclear inflammatory cells containing eosinophilic intracytoplasmic inclusion bodies of poxvirus in the thymus, bursa of Fabricius, spleen, bone marrow, air sac, peritoneum, external and middle ears, and lachrymal gland. Similar inclusion bodies associated with inflammation were also seen in the epidermis, dermis, feather follicles, conjunctivae, sinuses, turbinates, choana, oral mucosa including tongue, oesophagus, larynx, trachea, syrinx and bronchi and parabronchi of lungs. Some of the birds also had concurrent bacterial, mycotic and polyomavirus infections. Poxvirus was isolated from lungs and skin in chicken embryo liver cells and confirmed as avian poxvirus by polymerase chain reaction.

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.

Molluscum Contagiosum / Molluscum Contagiosum

El Molluscum contagiosum es una infección viral benigna, causada por un poxvirus, que afecta habitualmente a niños entre 2 y 5 años con tasas de incidencia de entre el 5 y el 8%. Afecta también a individuos adultos sexualmente activos y los pacientes con infección por VIH presentan especial predisposición a esta infección. Generalmente las lesiones son autolimitadas y, aunque se han empleado numerosos tratamientos, no se ha demostrado que ninguna intervención sea más eficaz, por lo que se plantea el debate sobre si las lesiones del molusco contagioso deben ser tratadas o dejar que se resuelvan espontáneamente. Presentamos el caso de un adulto de 21 años con lesiones características y describimos brevemente el diagnóstico y tratamiento de esta infección (AU)

The Molluscum contagiosum is a benign viral infection. It is caused by a poxvirus and usually affects children from 2 to 5 years. The incidence rate is 5-8%. Also affects sexually active adults. Patients with HIV infection presents special predisposition to this infection. Skin lesions are usually self-limited. Although many treatments have been used, no treatment has been proved be more effective than the other. It is unknown whether the skin lesions should be treated or not. We present the case of an adult of 21 years old with characteristic lesions and we brief y describe the diagnosis and treatment of this infection (AU)

Variation in host susceptibility and infectiousness generated by co-infection: the myxoma-Trichostrongylus retortaeformis case in wild rabbits.

One of the conditions that can affect host susceptibility and parasite transmission is the occurrence of concomitant infections. Parasites interact directly or indirectly within an individual host and often these interactions are modulated by the host immune response. We used a free-living rabbit population co-infected with the nematode Trichostrongylus retortaeformis, which appears to stimulate an acquired immune response, and the immunosuppressive poxvirus myxoma. Modelling was used to examine how myxoma infection alters the immune-mediated establishment and death/expulsion of T. retortaeformis, and consequently affects parasite intensity and duration of the infection. Simulations were based on the general TH1-TH2 immunological paradigm that proposes the polarization of the host immune response towards one of the two subsets of T helper cells. Our findings suggest that myxoma infections contribute to alter host susceptibility to the nematode, as co-infected rabbits showed higher worm intensity compared with virus negative hosts. Results also suggest that myxoma disrupts the ability of the host to clear T. retortaeformis as worm intensities were consistently high and remained high in old rabbits. However, the co-infection model has to include some immune-mediated nematode regulation to be consistent with field data, indicating that the TH1-TH2 dichotomy is not complete. We conclude that seasonal myxoma outbreaks enhance host susceptibility to the nematode and generate highly infected hosts that remain infectious for a longer time. Finally, the virus-nematode co-infection increases heterogeneities among individuals and potentially has a large effect on parasite transmission.

Visceral leishmaniosis and parapoxvirus infection in a Mediterranean monk seal (Monachus monachus).

A Mediterranean monk seal was shown by immunohistochemical and polymerase chain reaction techniques to be dually infected with a Leishmania sp. and parapoxvirus. The pathological findings included a deep ulcer on the side of the head, ulcers on the gingival and inner aspect of the lower lip, enlarged lymph nodes and tonsils, and respiratory lesions (pulmonary consolidation, oedema, haemorrhages and emphysema; tracheal and bronchial congestion, exudates and haemorrhage). Amastigotes were demonstrated in macrophages in the lymph nodes and spleen, and intracytoplasmic inclusion bodies were observed in the tracheal and oral mucosa.

Shope fibroma virus keratitis and spontaneous cataracts in a domestic rabbit.

A 7-year-old domestic rabbit presented for an enlarging ventral perilimbal mass OS. Keratectomy was performed to remove the mass. A diagnosis of Shope fibroma virus keratitis was confirmed based on signalment, clinical signs, histologic evaluation and virus isolation. Progression of bilateral cataracts leading to visual deficits was addressed with phacoemulsification. The rabbit remained visual and comfortable 5 months postoperatively and free of recurrence of the limbal mass 9 months after initial presentation.

Immunopathogenesis of poxvirus infections: forecasting the impending storm.

Variola virus, the causative agent of smallpox, is a member of the poxvirus family and one of the most virulent human pathogens known. Although smallpox was eradicated almost 30 years ago, it is not understood why the mortality rates associated with the disease were high, why some patients recovered, and what constitutes an effective host response against infection. As variola virus infects only humans, our current understanding of poxvirus infections comes largely from historical clinical data from smallpox patients and from animal studies using closely related viruses such as ectromelia, myxoma and monkeypox. The outcome of an infection is determined by a complex interaction between the type of immune response mounted by the host and by evasion mechanisms that the virus has evolved to subvert it. Disease pathogenesis is also a function of both host and viral factors. Poxviruses are not only cytopathic, causing host tissue damage, but also encode an array of immunomodulatory molecules that affect the severity of disease. The ability of the host to control virus replication is therefore critical in limiting tissue damage. However, in addition to targeting virus, the immune response can inadvertently damage the host to such a degree that it causes illness and even death. There is growing evidence that many of the symptoms associated with serious poxvirus infections are a result of a 'cytokine storm' or sepsis and that this may be the underlying cause of pathology.

Milkers' nodules complicated by erythema multiforme and graft-versus-host disease after allogeneic hematopoietic stem cell transplantation for multiple myeloma.

We describe a case of cow-transmitted parapoxvirus infection--also known as milkers' nodules--after a hematopoietic stem cell transplantation for multiple myeloma. The infection was complicated by erythema multiforme and acute exacerbation of graft-versus-host disease. Parapoxvirus was confirmed by electron microscopy. The natural history of milker's nodules in immunocompetent hosts is described and compared to that in our immunocompromised patient.

[Treatment of cutaneous human papilloma virus, poxvirus and herpes simplex virus infections with topical cidofovir in HIV positive patients]. / Traitement par cidofovir topique d'infections cutanées à papillomavirus humain, poxvirus et herpes simplex virus chez des malades séropositifs pour le VIH.

INTRODUCTION: Cidofovir (Vistide) is an antiviral marketed for the treatment of cytomegalovirus retinitis. Clinical efficacy has been reported with its broad antiviral spectrum that includes poxvirus, human papilloma virus and Herpes simplex. In immunodepressed patients, these infectious dermatoses are often recurrent and resistant. In an open study, we assessed the efficacy and clinical tolerance of cidofovir gel at 1 p. 100. PATIENTS AND METHODS: Twelve HIV-infected adults were included. Cidofovir gel at 1 p. 100 was applied directly on the lesions, once a day, for two weeks on the molluscum and condylomas, four weeks on the warts and one week on the chronic herpes. RESULTS: Four patients presented with warts and 3 of them with verruca plana. In 2 of the verruca plana patients, regression was complete although relapse was observed. Two failures were noted. Local application of the gel was not tolerated by one patient suffering from condylomas of the penis. Four patients presented with molluscum contagiosum. Two complete regressions with strong local reaction and two partial regressions were observed. The latter two patients exhibited severe immunodepression, one of them subsequently received infusions of cidofovir. Two women suffering from vulvar and perianal herpes resistant to acyclovir were treated for one week with cidofovir gel at 1 p. 100: no response was obtained. One of the patients stopped treatment because of local intolerance. A third, less immunodepressed, woman responded partially. COMMENTS: In HIV-positive patients, cidofovir in topical form appears to be indicated in extensive and confluent molluscum contagiosum. However, the effect occurs at the cost of local inflammation. The results are disappointing in papillomavirus lesions and in chronic acyclovir-resistant herpes ulcerations, efficacy is debatable.

A virulence factor of myxoma virus colocalizes with NF-kappaB in the nucleus and interferes with inflammation.

NF-kappaB is one of the most important elements that coordinate stress-induced, immune, and inflammatory responses. Myxoma virus, a member of the Poxviridae family responsible for rabbit myxomatosis, codes for several factors that help its survival in the host. In this study, we focused on the product of the M150R gene. We show that the protein has nine ankyrin repeats (ANKs), with the eighth having a close similarity with the nuclear localization signal-containing ANK of I-kappaBalpha, which regulates NF-kappaB activity by sequestering it in the cytosol. Because the viral protein is targeted to the nucleus, it was named MNF, for myxoma nuclear factor. This localization was lost when the eighth ANK was removed. In tumor necrosis factor alpha-treated cells, MNF and NF-kappaB colocalized as dotted spots in the nucleus. In vivo experiments with a knockout virus showed that MNF is a critical virulence factor, with its deletion generating an almost apathogenic virus. Detailed histological examinations revealed an increase in the inflammatory process in the absence of MNF, consistent with the interference of MNF with the NF-kappaB-induced proinflammatory pathway. Because MNF has homologs in other poxviruses, such as vaccinia, cowpox, and variola viruses, this protein is probably part of a key mechanism that contributes to the immunogenic and pathogenic properties of these viruses.