Vaccinia necrosum

Vaccinia Vaccinia immune globulin Consult the CDC.3 Treatment of severe reactions to vaccinia vaccination, including eczema vaccinatum, vaccinia necrosum, and ocular vaccinia. Available from the CDC.3... 

Progressive vaccinia, also known as vaccinia necrosum, occurs when the vaccinial lesion fails to heal and instead progresses to involve adjacent skin with tissue necrosis (Fig. 2.11 see color plate 2.11). The lesion can spread metastatically to other parts of the skin, to bones and to viscera (26). Although progressive vaccinia occurs... 

Undoubtedly, both cellular and humoral immune responses are important to recovery from smallpox. The inability of poxviruses to persist stably within the host cell accounts for their infections being relatively short-lived, without establishment of a latent infection. The importance of cellular immunity in recovery from infection has been demonstrated with other poxviruses,39 and the same is generally assumed with variola. Vaccination experiences demonstrated the rare but terrible consequence of vaccinia necrosum in persons with defects of cellular immunity. Early presentation on the host cell membrane of virus-encoded proteins provides means for immune recognition.40 It has been demonstrated that both antibody-dependent cellular cytotoxicity41 and heterogeneous cluster of differentiation (CD) 4+ cytotoxic T-lymphocyte clones42 are induced in response to vaccinia infection, and some immunodominant B-cell epitopes have been defined in both mice and vaccinated humans.43 The relatively large size of poxvirus polypeptides facilitates their rec-... 

Progressive vaccinia (vaccinia necrosum) is a progressive necrosis in the area of vaccination, often with metastatic lesions (Figure 27-8). This complication occurred almost exclusively in persons with cellular immunodeficiency,93 with a case fatality rate of higher than 75%.94... 

Fig. 27-8. Progressive vaccinia or vaccinia necrosum. As seen in this child, progressive viral replication at the inoculation site in an immunocompromised individual leads to inexorable local tissue destruction. Reprinted with permission from Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID. Smallpox and Its Eradication. Geneva, Switzerland World Health Organization 1988 298. Photograph by C. H. Kempe.

Freed ER, Richard JD, Escobar MR. Vaccinia necrosum and its relationship to impaired immunologic responsiveness. Am J Med. 1972 52 411-420. 

Progressive vaccinia (or vaccinia necrosum). Ongoing infection of skin with tissue destruction frequently leading to death. 

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