title: The Munich outbreak of cutaneous cowpox infection: transmission by infected pet rats.
abstract: Cowpox virus infection of humans is an uncommon, potentially fatal, skin disease. It is largely confined to Europe, but is not found in Eire, or in the USA, Australasia, or the Middle or Far East. Patients having contact with infected cows, cats, or small rodents sporadically contract the disease from these animals. We report here clinical aspects of 8 patients from the Munich area who had purchased infected pet rats from a local supplier. Pet rats are a novel potential source of local outbreaks. The morphologically distinctive skin lesions are mostly restricted to the patients' necks, reflecting the infected animals' contact pattern. Individual lesions vaguely resemble orf or Milker's nodule, but show marked surrounding erythema, firm induration and local adenopathy. Older lesions develop eschar, leaving slow-healing, deep ulcerative defects after eschar separation. Severe flu-like illness may be present in the acute phase. Smallpox-vaccinated patients tend to develop less severe reactions and heal more quickly. The differential diagnosis may include other localized orthopoxvirus infections, herpes simplex, bacterial infection, anthrax, foreign body granuloma, and primary tuberculosis. Dermatologists should be aware of the diagnostic and therapeutic algorithms for handling this disease.
authors: Department of Dermatology and Allergology, Ludwig-Maximilan University, Munich, Germany.
authors: Sandra
authors: S
authors: Vogel
authors: Miklós
authors: M
authors: Sárdy
authors: Katharina
authors: K
authors: Glos
authors: Hans Christian
authors: HC
authors: Korting
authors: Thomas
authors: T
authors: Ruzicka
authors: Andreas
authors: A
authors: Wollenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D015605:Cowpox / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission* / Q000662:veterinary; D015608:Cowpox virus; D004196:Disease Outbreaks; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D057805:Pets / Q000821:virology*; D051381:Rats; D017193:Skin Diseases, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission* / Q000662:veterinary; D055815:Young Adult