Buffalo Pox in AIDS Patient

1. Buffalo Pox in AIDS
Patient
T.V.Rao and Chitra Valsan
Department of Microbiology
With
Dept of Medicine and Dermatology
Department of Microbiology
Vet nary Medical College
Dr.T.V.Rao MDDr.T.V.Rao MD 11

2. Case PresentationCase Presentation
Name xxxx Age 34 Sex M
Occupation Gold smith Ward MMW
Residence Palakad
Dr.T.V.Rao MDDr.T.V.Rao MD 22

3. Preset Clinical HistoryPreset Clinical History
• January 2007 Admitted with relapse of Pulmonary
tuberculosis
• On Anti tuberculosis treatment
April 2007
Presented with two pustular lesions on left palm
Manifestation of Oral Candidosis
Cervical Lymphadenopathy
Suscipicious of Fungal pneumonia
Retinitis provisonally diagnosed as CMV infection
Dr.T.V.Rao MDDr.T.V.Rao MD 33

4. Past HistoryPast History
• Presented with Pulmonary Tuberculosis in 2004
• A gold smith by profession living in Bombay in
the past
• Had several sex contacts with commercial sex
workers
• No History of contact with any animals.
Dr.T.V.Rao MDDr.T.V.Rao MD 44

5. Laboratory InvestigationsLaboratory Investigations
• Confirmed as HIV positive patient
• Established to be presented with AIDS
Dr.T.V.Rao MDDr.T.V.Rao MD 55

6. Pustular (Pox like ) lesionsPustular (Pox like ) lesions
• Two pustular (pox like) lesions on left
palm.
• Size is 5 mm with crusting
• Painful on touching with congestion
around the lesions.
Dr.T.V.Rao MDDr.T.V.Rao MD 66

7. Provisional DiagnosisProvisional Diagnosis
• Cow pox
• Orf
• Modified form of foot and mouth disease.
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8. Vesicular lesion on Palm of HandVesicular lesion on Palm of Hand
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9. Present workupPresent workup
MicrobiologyMicrobiology
• Fluid aspirated with Disposable syringe
• Fluid from one pock entirely leaked out
• From 2nd
pock we are able to aspirate
<0.5 ml of yellow colored fluid
• The fluid was clear yellowish and vesicle
entirely collapsed.
• Sterile dressing was done after aspiration
Dr.T.V.Rao MDDr.T.V.Rao MD 99

10. Dr.T.V.Rao MDDr.T.V.Rao MD 1010

11. Dr.T.V.Rao MDDr.T.V.Rao MD 1111

12. Comparative PicturesComparative Pictures
Dr.T.V.Rao MDDr.T.V.Rao MD 1212

13. Cow PoxCow Pox
Cow Pox Produce by ( Orthopox virus ) cow pox viruses or cat pox
Viruses
Rodents harbor - cattle and Humans accidental Hosts
Domestic cats get infected.
• A contact with cat start the infection
• Infection with cowpox virus is more commonly seen among the domestic
cats.
• Present as Milkers nodes on hands
• Immunological relations in humans like variola infections.
• Produce deep red hemorrhagic lesions on the
Chorioallontoic membrane.
• In humans usually appear on hands and appear like vaccinia
Dr.T.V.Rao MDDr.T.V.Rao MD 1313

14. How rare the DiseaseHow rare the Disease
• Fewer than 150 cases are recorded
worldwide.
• Germany, U K , and Belgium
• India not reported in 2006 – 2007 ( CDC )
• A self limited condition
Dr.T.V.Rao MDDr.T.V.Rao MD 1414

15. Classical ManifestationsClassical Manifestations
• A self limited condition
• 48 % of the cases represent with1 or 2
pocks on hands
• 33% of cases represent on face.
• Quite painful
Dr.T.V.Rao MDDr.T.V.Rao MD 1515

16. DiagnosisDiagnosis
• Electron Microscopy
• Inoculation into Chorioallontoic membrane
• PCR.
Dr.T.V.Rao MDDr.T.V.Rao MD 1616

17. Buffalo PoxBuffalo Pox
• Derivative of Vaccinia virus
• Water Buffalo harbors the virus Prevalent
since the discontinuation of small pox
vaccination
• Difficult to differentiate from cow pox
• Human to human transmission
possible
Dr.T.V.Rao MDDr.T.V.Rao MD 1717

18. ORFORF
• Contagious pustular disease
• History of contact with sheep essential
• Present with Papulovasicular lesions
with central ulceration
Dr.T.V.Rao MDDr.T.V.Rao MD 1818

19. Molluscum ContagiosumMolluscum Contagiosum
• Molluscipox virus
• Present as small wart like lesions
• Infection on palms and sole are rare
• Several cases reported among the AIDS
patients.
• Sexually transmitted.
Dr.T.V.Rao MDDr.T.V.Rao MD 1919

20. Culturing for Viral IsolationCulturing for Viral Isolation
With assistance of Vet naryWith assistance of Vet nary
Medical College Trichur.Medical College Trichur.
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21. Viral IsolationViral Isolation
• The specimen is submitted for characterization
of Aetiological Agent with assistance of virology
department of Vet nary Medical College
• The virus adopted to egg inoculation observed
to be growing without any hemorrhagic pocks
(Only congestion )
• Two egg passages processed
• Definitive indication of viral growth
Dr.T.V.Rao MDDr.T.V.Rao MD 2121

22. How to establish the FinalHow to establish the Final
DiagnosisDiagnosis
• Electron Microscopy
• Polymerase chain reaction
• Molecular studies
• Estimation of antibodies to Buffalo pox
Dr.T.V.Rao MDDr.T.V.Rao MD 2222

23. CDC ( Atlanta )CDC ( Atlanta )
GuidanceGuidance
• In touch with CDC with clinical details and
pictorial presentation, with findings on
embryonated egg.
• Informed us to be provisional diagnosis of
Buffalo pox
Dr.T.V.Rao MDDr.T.V.Rao MD 2323

24. WHO recorded evidenceWHO recorded evidence
• Buffalo pox in India 1996 In Beed District of
Maharastra manifested in pediatric age group
patients , total of 5 cases are documents by
WHO in official records.
• An outbreak in Gujarat among cattle in 2006
• A recent outbreak in Burns unit Pakistan
presented with 3 cases presented as hospital
infection
( Nosocomial Buffalo pox virus infection ,Karachi ,Pakistan ‘ Zafar et al
Emerging infectious diseases, June 2007)
Dr.T.V.Rao MDDr.T.V.Rao MD 2424

25. Importance of Buffalo pox in ourImportance of Buffalo pox in our
HospitalsHospitals
• Single room isolation of Patients
• Effective infection control measures and
education of staff
• Environment needs frequent cleaning with
Hypochlorite solution.
Dr.T.V.Rao MDDr.T.V.Rao MD 2525

26. Significance of Buffalo pox inSignificance of Buffalo pox in
Human infections.Human infections.
• The review of literature not yet recorded
the occurrence of Buffalo pox in AIDS.
• The scope to study on academic basis of
relation of Vaccinia virus in HIV patients.
• Buffalo pox can spread to close contacts,
while serving the infected patients.
• Can spread to cattle in vicinity bring in
more human infections.
Dr.T.V.Rao MDDr.T.V.Rao MD 2626

27. • Buffalo pox included in list of communicable
diseases, with Nosocomial potential and a
Reemerging Infection
CDC
Thank Q
Dr.T.V.Rao MDDr.T.V.Rao MD 2727