New Archetypal Poxvirus Infection in an Immunosuppressed Man
Nelli Lakis, Donald Blair, Jerrold L Abraham, Yu Li, Inger Damon. SUNY Upstate Medical University, Syracuse, NY; CDC, Atlanta, GA
Background: Orthopoxvirus genus includes many species isolated from mammals, such as Variola, Vaccinia, Cowpox, Monkeypox. We report a patient with severe necrotizing skin lesions caused by a recently sequenced novel archetypal poxvirus.
Design: A 45-year old Caucasian man with a stable renal allograft presented with a 3-week history of a rash, which worsened, eventually involving the entire right flank. Multiple debridements revealed the histopathological finding of a dense inflammatory infiltrate of lymphocytes and histiocytes extending into the subcutaneous adipose tissue. Eosinophilic cytoplasmic inclusions were noted.
There was no evidence of Herpes Simplex, Varicella, acid fast bacilli and/or fungi. Further analyses included viral cultures, electron microscopy (EM), and viral genomic sequencing.
Results: Classic cytoplasmic poxvirus A-type inclusions were identified by EM in cultured Hep-2 cells.
Samples sent to the CDC could not be identified by any of the standard PCR primer sets targeting hemaglutinin (HA) or A-type inclusion body protein genes used to speciate orthopoxviruses. Massive parallel sequencing, and de novo assembly, allowed further characterization. The assembled virus genome was 200,058 nucleotides in length, 70.5% Adenosine and Thymidine (A-T), and encoded 201 putative genes. This novel poxvirus has a similar structure to orthopoxviruses both in the number and ordering of the genes in the central region. No HA gene coding region was identified. This virus is not efficiently neutralized by anti-orthopoxvirus serum. The new poxvirus encoded open reading frame DNA sequences (ORFs) not previously annotated in any poxvirus genome. The genome has been sequenced entirely and the poxvirus has since been named Pox_NY014.
Conclusions: This appears to be the first human case of infection with a novel poxvirus that represents an ancestral virus to the orthopoxvirus genus.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 250, Wednesday Morning