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Previous Volume 350:342-350 January 22, 2004 Number 4 Next

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ABSTRACT

Background During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie dogs obtained through a common distributor. Zoonotic transmission of a bacterial or viral pathogen was suspected.

Methods We reviewed medical records, conducted interviews and examinations, and collected blood and tissue samples for analysis from 11 patients and one prairie dog. Histopathological and electron-microscopical examinations, microbiologic cultures, and molecular assays were performed to identify the etiologic agent.

Results The initial Wisconsin cases evaluated in this outbreak occurred in five males and six females ranging in age from 3 to 43 years. All patients reported having direct contact with ill prairie dogs before experiencing a febrile illness with skin eruptions. We found immunohistochemical or ultrastructural evidence of poxvirus infection in skin-lesion tissue from four patients. Monkeypox virus was recovered in cell cultures of seven samples from patients and from the prairie dog. The virus was identified by detection of monkeypox-specific DNA sequences in tissues or isolates from six patients and the prairie dog. Epidemiologic investigation suggested that the prairie dogs had been exposed to at least one species of rodent recently imported into the United States from West Africa.

Conclusions Our investigation documents the isolation and identification of monkeypox virus from humans in the Western Hemisphere. Infection of humans was associated with direct contact with ill prairie dogs that were being kept or sold as pets.

Source Information

From the Departments of Pathology (K.D.R.) and Dermatology (J.W.M., E.J.S.), Marshfield Clinic; and the Clinical Research Center, Marshfield Clinic Research Foundation (K.D.R.) — both in Marshfield, Wisc.; the Division of Infectious Diseases (M.B.G.) and the Departments of Dermatology (J.A.F.), Family and Community Medicine (G.R.S., S.L.F.), and Pathology (S.C.K.), Medical College of Wisconsin; and the City of Milwaukee Health Department (G.R.S., S.L.F.) — both in Milwaukee; the Poxvirus Section, Office of the Director, Division of Viral and Rickettsial Diseases (R.L.R., V.A.O., E.K.S., M.A.F., R.K., I.K.D.), and the Epidemic Intelligence Service (M.J.S.), Centers for Disease Control and Prevention, Atlanta; and the Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison (M.J.S., M.V.W., J.J.K., J.P.D.).

Address reprint requests to Dr. Reed at the Clinical Research Center, Marshfield Clinic Research Foundation, 1000 N. Oak, Marshfield, WI 54449, or at reed.kurt{at}mcrf.mfldclin.edu.

Full Text of this Article

Related Letters:

Monkeypox in the Western Hemisphere
Huhn G. D., Chase R. A., Dworkin M. S., DiGiulio D. B., Eckburg P. B., Reed K. D., Davis J. P., Damon I. K.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:1790-1791, Apr 22, 2004. Correspondence

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