Bayer-Garner I B
Marshfield Clinic, Marshfield, WI 54449, USA.
J Cutan Pathol. 2005 Jan;32(1):28-34. doi: 10.1111/j.0303-6987.2005.00254.x.
Human monkeypox, an emerging viral zoonosis first recognized in Africa, has recently emerged in the mid-western US. Initially, it presents with skin eruptions and fevers with diaphoresis and rigors. Clinically, the skin lesions progress from papules to vesiculopustules to resolving eschars.
Three cutaneous biopsy specimens from two patients with polymerase chain reaction (PCR)-proven monkeypox were available for review. The histologic, immunohistochemical and electron-microscopic features were identified.
The clinical progression of lesions is mirrored histologically with ballooning degeneration of basal keratinocytes and spongiosis of a mildly acanthotic epidermis progressing to full thickness necrosis of a markedly acanthotic epidermis containing few viable keratinocytes. A lichenoid-mixed inflammatory cell infiltrate is present, which exhibits progressive exocytosis with the keratinocyte necrosis. Inflammation of the superficial and deep vascular plexes, eccrine units and follicles is also present. Viral cytopathic effect is manifest by multinucleated syncytial keratinocytes. Immunohistochemically, viral antigen is detected within keratinocytes of the lesional epidermis, follicular and eccrine epithelium and few dermal mononuclear cells. Electron microscopy reveals virions at various stages of assembly within the keratinocyte cytoplasm.
The histologic differential diagnosis includes herpes simplex virus, varicella and other pox viruses, such as smallpox. The first one may be differentiated histologically, immunohistochemically and electron microscopically. The last two may be differentiated using PCR assay for the monkeypox extracellular-envelope virus protein gene.
人类猴痘是一种首次在非洲被确认的新兴病毒性人畜共患病，最近在美国中西部出现。最初，它表现为皮肤疹和伴有出汗及寒战的发热。临床上，皮肤病变从丘疹发展为水疱脓疱，再到结痂消退。
有来自两名经聚合酶链反应（PCR）证实感染猴痘患者的三份皮肤活检标本可供检查。确定了其组织学、免疫组织化学和电子显微镜特征。
病变的临床进展在组织学上得到反映，表现为基底角质形成细胞的气球样变性以及轻度棘层增厚的表皮海绵形成，进而发展为明显棘层增厚的表皮全层坏死，其中存活的角质形成细胞很少。存在苔藓样混合性炎性细胞浸润，随着角质形成细胞坏死出现渐进性胞吐作用。还存在浅表和深部血管丛、汗腺单位及毛囊的炎症。病毒细胞病变效应表现为多核巨细胞角质形成细胞。免疫组织化学检测显示，在病变表皮、毛囊和汗腺上皮的角质形成细胞以及少数真皮单核细胞内可检测到病毒抗原。电子显微镜显示在角质形成细胞胞质内有处于不同组装阶段的病毒颗粒。
组织学鉴别诊断包括单纯疱疹病毒、水痘和其他痘病毒，如天花。第一种可通过组织学、免疫组织化学和电子显微镜进行鉴别。后两种可使用针对猴痘细胞外包膜病毒蛋白基因的PCR检测进行鉴别。
