Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
Fatal Borealpox in an Immunosuppressed Patient Treated With Antivirals and Vaccinia Immunoglobulin-Alaska, 2023.
СтатьяКлинический случайПоддержка правительства СШАПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Rogers Julia H, Westley Benjamin, Mego Thomas, Newell Katherine G, Laurance John, Smith Lisa, Parker Jayme, Park Sarah Y, Venkatasubrahmanyam Shivkumar, Noll Nicholas, Bercovici Sivan, Rao Agam K, McCollum Andrea M, Davidson Whitni, Carson William C, Townsend Michael B, Doty Jeffrey B, Hutson Christina, Li Yu, Wilkins Kimberly, Deng Jiusheng, Gigante Crystal M, Satheshkumar Panayampalli S, Tuttle Alexandra, Villalba Julian A, Bhatnagar Julu, Reagan-Steiner Sarah, Castrodale Louisa J, McLaughlin Joseph B
Аннотация
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 6 patients with infection previously observed, BRPV involved mild and 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 after symptom 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 1 week posttherapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days after symptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected.
CONCLUSIONS: 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.
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 after symptom 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 1 week posttherapy. He later exhibited delayed wound healing, malnutrition, acute renal failure, and respiratory failure. He died 138 days after symptom onset. Serologic testing revealed no evidence the patient generated a humoral immune response. No secondary cases were detected.
CONCLUSIONS: 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.