Lewis-Jones Sue
Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland DD1 9SY.
Curr Opin Infect Dis. 2004 Apr;17(2):81-9. doi: 10.1097/00001432-200404000-00003.
The 2003 USA monkeypox epidemic caused by imported African rodents, newly emergent poxvirus zoonoses in Brazil and the possible use of variola virus for biological warfare has led to renewed interest in poxviruses and anti-poxviral therapies. Increasing foreign travel and importation of exotic animal species increases the likelihood of poxvirus infections occurring outside their usual geographical range and diagnostic delay has important implications. The present review provides an overview of these rare zoonoses.
Three genera of Poxviridae are known to cause human zoonoses: orthopoxviruses, parapoxviruses and yatapoxvirus. Most cases are occupational, sporadic and have few cutaneous lesions with low morbidity. The exception is monkeypox, similar to smallpox, with significant morbidity and childhood mortality. Molecular characterization using polymerase chain reaction (PCR) amplification and other methods provides accurate phylogenetic identification and suggests that a cowpox-like virus is the probable ancestor of variola and other zoonotic poxviruses. DNA genomic sequencing of the Brazilian Cantagalo and Araçatuba viruses shows a close relationship to vaccinia virus. Poxviruses have potential in cancer immunotherapy and their ability to evade host-cell immune responses may provide a basis for new antipoxvirus therapies. Other agents, particularly nucleoside phosphonates such as cidofovir, show therapeutic action against poxviruses.
Human zoonotic poxvirus infections are rare but increasingly encountered outside their usual geographical range. The 2003 USA monkeypox outbreak emphasizes the importance of early accurate diagnosis, particularly because increasing numbers of immunosuppressed individuals increases the potential for severe or fatal infections. PCR methodology enables accurate phylogenetic typing and has identified new diseases, but rapid, reliable methods must be made available for clinicians. More research into therapeutic agents for the prevention and treatment of poxvirus infections is required.
2003年美国因进口非洲啮齿动物引发的猴痘疫情、巴西新出现的痘病毒人畜共患病以及天花病毒可能被用于生物战，这些事件引发了人们对痘病毒和抗痘病毒疗法的新关注。出国旅行增加以及外来动物物种的进口，使得痘病毒感染在其通常地理范围之外发生的可能性增加，而诊断延迟具有重要影响。本综述概述了这些罕见的人畜共患病。
已知痘病毒科的三个属会导致人类人畜共患病：正痘病毒属、副痘病毒属和雅塔痘病毒属。大多数病例为职业性、散发性，皮肤病变较少，发病率较低。例外的是猴痘，与天花相似，发病率高且有儿童死亡病例。使用聚合酶链反应（PCR）扩增和其他方法进行分子特征分析可提供准确的系统发育鉴定，并表明一种类似牛痘的病毒可能是天花和其他人畜共患痘病毒的祖先。对巴西坎塔加洛病毒和阿拉萨图巴病毒的DNA基因组测序显示它们与痘苗病毒关系密切。痘病毒在癌症免疫治疗方面具有潜力，其逃避宿主细胞免疫反应的能力可能为新的抗痘病毒疗法提供基础。其他药物，特别是核苷膦酸盐如西多福韦，对痘病毒有治疗作用。
人类人畜共患痘病毒感染很少见，但在其通常地理范围之外越来越多地被发现。2003年美国猴痘疫情强调了早期准确诊断的重要性，特别是因为免疫抑制个体数量的增加增加了严重或致命感染的可能性。PCR方法能够进行准确的系统发育分型并已识别出新疾病，但必须为临床医生提供快速、可靠的方法。需要对预防和治疗痘病毒感染的治疗药物进行更多研究。
