title: Novel Poxvirus Infection in an Immune Suppressed Patient.
abstract: BACKGROUND
  Human and animal poxvirus infections are being reported with increasing frequency. We describe a challenging case history and treatment of a previously unknown poxvirus rash illness in a renal transplant patient.
  
  
  METHODS
  A combination of classical microbiology techniques, including viral culture and electron microscopy, were used to provide initial clinical diagnosis. Subsequent standard polymerase chain reaction assays available in 2001 were noncontributory. Next generation sequencing was used to provide definitive diagnosis.
  
  
  RESULTS
  Retrospectively, next generation sequencing methods were used to ultimately provide the definitive diagnosis of a novel poxvirus infection initially identified by electron microscopy. The closest relative of this poxvirus, identified in North America, is a poxvirus collected from a mosquito pool from Central Africa in 1972.
  
  
  CONCLUSIONS
  This diagnostic quandary was ultimately solved using next generation DNA sequencing. This article describes the use of classical and next generation diagnostic strategies to identify etiologic agents of emerging infectious diseases and once again demonstrates the susceptibility of immunossupressed patients to novel pathogens. The virus identified is closely related to Yoka virus; these viruses appear to have independently diverged from a common ancestor of all known orthopoxviruses.
authors.affiliation: Department of Pathology, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Nelli S
authors.initials: NS
authors.lastname: Lakis
authors.affiliation: Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Pathology, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Jerrold L
authors.initials: JL
authors.lastname: Abraham
authors.affiliation: Department of Biochemistry and Microbiology, University of Victoria, British Columbia, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Upton
authors.affiliation: Department of Medicine, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Blair
authors.affiliation: Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Scott
authors.initials: S
authors.lastname: Smith
authors.affiliation: Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Inger K
authors.initials: IK
authors.lastname: Damon
mesh_terms: D005076:Exanthema / Q000209:etiology* / Q000473:pathology* / Q000821:virology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D010802:Phylogeny; D011212:Poxviridae / Q000145:classification* / Q000302:isolation & purification*; D011213:Poxviridae Infections / Q000175:diagnosis* / Q000473:pathology* / Q000821:virology; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D066027:Transplant Recipients; D014776:Virus Cultivation
keywords: immunosupression; pathology; poxvirus