Fatal borealpox in an immunosuppressed patient treated with antivirals and vaccinia immunoglobulin - Alaska, 2023.

IF 8.2 1区 医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2024-11-05 DOI:10.1093/cid/ciae536
Julia H Rogers, Benjamin Westley, Thomas Mego, Katherine G Newell, John Laurance, Lisa Smith, Jayme Parker, Sarah Y Park, Shivkumar Venkatasubrahmanyam, Nicholas Noll, Sivan Bercovici, Agam K Rao, Andrea M McCollum, Whitni Davidson, William C Carson, Michael B Townsend, Jeffrey B Doty, Christina Hutson, Yu Li, Kimberly Wilkins, Jiusheng Deng, Crystal M Gigante, Panayampalli S Satheshkumar, Alexandra Tuttle, Julian A Villalba, Julu Bhatnagar, Sarah Reagan-Steiner, Louisa J Castrodale, Joseph B McLaughlin
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Abstract

Background: Borealpox virus (BRPV, formerly known as Alaskapox virus) is a zoonotic member of the Orthopoxvirus genus first identified in a person in 2015. In the six patients with infection previously observed BRPV involved mild, self-limiting illness. We report the first fatal BRPV infection in an immunosuppressed patient.

Methods: A man aged 69 years from Alaska's Kenai Peninsula was receiving anti-CD20 therapy for chronic lymphocytic leukemia. He presented to care for a tender, red papule in his right axilla with increasing induration and pain. The patient failed to respond to multiple prescribed antibiotic regimens and was hospitalized 65 days postsymptom onset for progression of presumed infectious cellulitis. BRPV was eventually detected through orthopoxvirus real-time polymerase chain reaction testing of mucosal swabs. He received combination antiviral therapy, including 21 days of intravenous tecovirimat, intravenous vaccinia immunoglobulin, and oral brincidofovir. Serial serology was conducted on specimens obtained posttreatment initiation.

Findings: The patient's condition initially improved with plaque recession, reduced erythema, and epithelization around the axillary lesion beginning one-week post-therapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days postsymptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected.

Conclusion: This report demonstrates that BRPV can cause overwhelming disseminated infection in certain immunocompromised patients. Based on the patient's initial response, early BRPV identification and antiviral therapies might have been beneficial. These therapies, in combination with optimized immune function, should be considered for patients at risk for manifestations of BRPV.

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2023 年,阿拉斯加,一名接受抗病毒药物和疫苗免疫球蛋白治疗的免疫抑制患者患上致命的伯劳痘。
背景:博拉痘病毒(BRPV,原名阿拉斯加痘病毒)是人畜共患的正痘病毒属成员,2015年首次在一人身上发现。在之前观察到的六名感染患者中,BRPV涉及轻微的自限性疾病。我们报告了首次在免疫抑制患者中发生的致命BRPV感染:一名来自阿拉斯加基奈半岛的 69 岁男子正在接受慢性淋巴细胞白血病的抗 CD20 治疗。他因右侧腋窝出现触痛的红色丘疹并伴有越来越多的压痛而就诊。患者对多种处方抗生素治疗无效,在症状出现 65 天后因推测为感染性蜂窝组织炎恶化而住院治疗。通过对粘膜拭子进行实时聚合酶链反应检测,最终检测出 BRPV。他接受了联合抗病毒治疗,包括 21 天的静脉注射替考韦酯、静脉注射疫苗免疫球蛋白和口服布林昔多福韦。对治疗开始后获得的标本进行了连续血清学检查:治疗一周后,患者的病情开始好转,斑块消退,红斑减轻,腋窝皮损周围上皮脱落。后来,他出现了伤口愈合延迟、营养不良、急性肾功能衰竭和呼吸衰竭等症状。他在发病后 138 天死亡。血清学检测显示,没有证据表明患者产生了体液免疫反应。未发现继发病例:本报告表明,BRPV 可在某些免疫力低下的患者中引起压倒性播散感染。根据该患者的初步反应,早期识别 BRPV 和抗病毒疗法可能是有益的。对于有 BRPV 表现风险的患者,应考虑将这些疗法与优化免疫功能相结合。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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