{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:43:37Z","timestamp":1761709417059,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2017,12,7]],"date-time":"2017-12-07T00:00:00Z","timestamp":1512604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Here we present two cases of human infection with cowpox virus with distinct clinical courses. A series of clinical photographs documents lesion progression over time. In the first case\u2014an unvaccinated young veterinary assistant\u2014a pustule was treated locally with cortisone. The lesion turned into a large ulcer accompanied by severe lymphadenitis. Based on her close contact to a sick stray cat, infection with cowpox virus was assumed and confirmed by virus isolation, PCR, and serology. The clinical course took up to eleven months until healing of the wound was complete. Transmission of cowpox virus from the cat was likely because a skin swab was PCR-positive and the cat had a high titer of anti-orthopoxvirus antibodies. In contrast, a rather mild clinical course of cowpox was confirmed in a 49-year-old male farmer vaccinated against smallpox. Only a small eschar developed, and wound closure was complete after 6 weeks.<\/jats:p>","DOI":"10.3390\/v9120375","type":"journal-article","created":{"date-parts":[[2017,12,7]],"date-time":"2017-12-07T11:49:10Z","timestamp":1512647350000},"page":"375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Two Distinct Clinical Courses of Human Cowpox, Germany, 2015"],"prefix":"10.3390","volume":"9","author":[{"given":"Ines","family":"Eder","sequence":"first","affiliation":[{"name":"Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Vollmar","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory Division, Bundeswehr Institute of Microbiology, 80937 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Naether","sequence":"additional","affiliation":[{"name":"Ear, Nose and Throat Clinic, University Hospital, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arne","family":"Rodloff","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Viruses and Intracellular Agents, Bundeswehr Institute of Microbiology, 80937 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.vetmic.2009.08.026","article-title":"Zoonotic poxviruses","volume":"140","author":"Essbauer","year":"2010","journal-title":"Vet. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3201\/eid2203.151158","article-title":"Generalized Cowpox Virus Infection in a Patient with HIV, Germany, 2012","volume":"22","author":"Fassbender","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","first-page":"E070419","article-title":"Sporadic human cases of cowpox in Germany","volume":"12","author":"Nitsche","year":"2007","journal-title":"Eurosurveillance"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/S0140-6736(05)17836-2","article-title":"Cowpox and a cat","volume":"365","author":"Coras","year":"2005","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"777","DOI":"10.3201\/eid1505.090159","article-title":"Cowpox virus transmission from pet rats to humans, Germany","volume":"15","author":"Campe","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/0140-6736(90)92387-W","article-title":"Fatal cowpox-like virus infection transmitted by cat","volume":"336","author":"Gerritzen","year":"1990","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"299","DOI":"10.2340\/00015555-2499","article-title":"Multilocular facial necrosis in a young boy: A quiz","volume":"97","author":"Miernik","year":"2017","journal-title":"Acta Derm. Venereol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1128\/JCM.42.5.1940-1946.2004","article-title":"Real-time PCR system for detection of orthopoxviruses and simultaneous identification of smallpox virus","volume":"42","author":"Olson","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Franke, A., Pfaff, F., Jenckel, M., Hoffmann, B., H\u00f6per, D., Antwerpen, M., Meyer, H., Beer, M., and Hoffmann, D. (2017). Classification of Cowpox Viruses into Several Distinct Clades and Identification of a Novel Lineage. Viruses, 9.","DOI":"10.3390\/v9060142"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"871","DOI":"10.3201\/eid1505.090235","article-title":"Cowpox virus transmission from pet rats to humans","volume":"15","author":"Ninove","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1111\/j.1365-2133.2011.10226.x","article-title":"Generalized cowpox infection in a patient with Darier disease","volume":"164","author":"Haase","year":"2011","journal-title":"Br. J. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/j.1365-2133.1993.tb00500.x","article-title":"Cowpox infection causing a generalized eruption in a patient with atopic dermatitis","volume":"129","author":"Blackford","year":"1993","journal-title":"Br. J. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.3201\/eid0911.020814","article-title":"Cowpox with severe generalized eruption, Finland","volume":"9","author":"Pelkonen","year":"2003","journal-title":"Emerg. Infect. 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