Suspected monkeypox-like infections in persons having contact with prairie dogs
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Suspected monkeypox-like infections in persons having contact with prairie dogs

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      Saturday, June 07, 2003, 23:32 EDT (11:32 PM EDT)

      CDCHAN -00145-03-06-07-ADV–N

      An extensive multidisciplinary investigation in Wisconsin, Illinois, and Indiana has identified cases of febrile rash illness in persons who had direct or close contact with recently purchased ill prairie dogs. Scientists at the Marshfield Clinic in Marshfield, Wisconsin, recovered viral isolates from a patient and a prairie dog and demonstrated a virus morphologically consistent with a poxvirus by electron microscopy (see for electron microscopy images).

      Preliminary results of serologic testing and polymerase chain reaction testing of patients' specimens performed at the Centers for Disease Control and Prevention (CDC) on June 6-7 suggest that the causative agent is most closely related to monkeypox virus, a member of the orthopoxvirus family of viruses. Results of additional evaluation at CDC by electron microscopy and immunohistochemical studies are consistent with the finding of an orthopoxvirus. These findings represent the first evidence of community-acquired monkeypox-like infection in the United States. Further characterization of the virus is in progress.

      Human monkeypox is a rare zoonotic viral disease that occurs primarily in the rain forest countries of central and west Africa. In humans, the illness produces a vesicular and pustular rash similar to that of smallpox. Limited person-to-person spread of infection has been reported in disease-endemic areas in Africa; the incubation period is about 12 days. Case-fatality ratios in Africa have ranged from 1% to 10% (for additional information about monkeypox, see

      In the current U.S. outbreak, cases have been reported among residents of Wisconsin (17), northern Illinois (1), and northwestern Indiana (1). Onset of illness among patients began in early May. Patients typically experienced a prodrome consisting of fever, headaches, myalgias, chills, and drenching sweats. Roughly one-third of patients had nonproductive cough. This prodromal phase was followed 1 -10 days later by the development of a popular rash that typically progressed through stages of vesiculation, pustulation, umbilication, and crusting. In some patients, early lesions have become ulcerated. Rash distribution and lesions have occurred on head, trunk, and extremities; many of the patients had initial and satellite lesions on palms and soles and extremities. Rashes were generalized in some patients. After onset of the rash, patients have generally manifested rash lesions in different stages.

      All patients reported direct or close contact with prairie dogs, most of which were sick. Illness in prairie dogs was frequently reported as beginning with a blepharo-conjunctivitis, progressing to presence of nodular lesions in some cases. Some prairie dogs have died from the illness, while others reportedly recovered.

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