Cowpox B08.01

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Cow pox

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Smallpox disease of cattle, cats or other animals. As a zoonosis in an attenuated form rarely occurring in humans. (see also milking knot)

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Poxvirus bovis (Orthopoxvirus). Pathogen reservoir: rodents (e.g. rats). Infects humans, cats, cattle, elephants, rhinoceroses. S.u. poxviruses.

In Central Europe, sporadic infections transmitted from animals to humans are repeatedly reported. The sources of infection are cows, cats, rats, etc. A few days after contact, the typical symptoms appear, such as a general feeling of being seriously ill with exhaustion and tiredness, an itching, possibly painful, high fever exanthema, generalized lymphadenitis, and at the primary entry points up to 2 cm large, greasy ulcers.

The disease is usually not recognized or misdiagnosed due to its rare occurrence. Affected rodents (rats, mice) usually show no symptoms after infection.

Cats (the most common carriers to humans) can develop large ulcers on the skin; large amounts of virus are excreted via these tissue defects. They are therefore highly contagious. For cats the disease can be fatal.

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Transmission of the cowpox virus from wild domestic cats, rodents or cattle to humans Inoculation usually via skin lesions.

Notice! At present, cats are increasingly classified as carriers.

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Hands or fingers (about 50% of cases) and face or neck (about 30% of cases).

Clinical features
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Integument: Predominantly only one primary lesion (72% of cases). Usually begins as a reddened spot. Within 7-14 days formation of hemorrhagic papules and nodules surrounded by pustules. Marked regional, painful lymphadenitis, with a tendency to extensive ulceration of the skin lesions. Mostly strong collateral edema. After 6-8 weeks scarred healing.

Exanthematic form: In immunocompromised patients and patients with extensive skin diseases (atopic eczema, Darier's disease, erythroderma), however, severe, generalised courses are also described (see case report).

Extracutaneous manifestations: lymphangitis, generalized febrile symptoms. See also vaccine nodules.

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Clinic; electron microscopy (negative contrast); viral antigen detection from a smear (material from the pox virus consultation laboratory: Robert Koch Institute/Berlin; antibody detection in serum; PCR.

Differential diagnosis
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Eye involvement (keratitis, conjunctivitis); generalization in immunocompromised patients.

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Approved systemic therapy against orthopox virus infections does not exist. Cidovir shows an experimental antiviral effect against vaccinia and was therefore considered for the treatment of vaccination complications. Cave! partly lethal side effects! Otherwise symptomatic therapy. In case of secondary bacterial infection: systemic antibiotic therapy.

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The virus is not identical to the vaccinia virus, as has been mistakenly assumed many times.

Case report(s)
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Case 1:

A 54-year-old woman noticed a papule on her chin which developed into a lump with central necrosis within a few days. She complained of general symptoms such as fever and nausea.

Diag: Detection of cowpox by PCR

Etio: Obviously the infection was transmitted by the own domestic cat.

Therapy: Under symptomatic therapy local findings and general condition improved. Within weeks the nodule showed a healing tendency with crust formation and subsequent cosmetic revision of the scar.


A 50-year-old patient with a severe, generalized atopic eczema suddenly fell ill with severe symptoms of fever, nausea, severe headache and a polymorphic exanthema with red papules, blisters and pustules on forehead, neck, shoulders and in the genital area. The medical history revealed multiple episodes of an equally severe eccema herpeticatums. Thus the "prima vista diagnosis" was also eczema herpeticatum.

Laboratory: direct detection of herpes simplex and varicella zoster virus: negative. CRP: 120mg/l (significantly elevated), BSG: 30/70 mm nW; serological: no evidence of a fresh herpes infection. Detection of IgG and IgM antibodies to cowpox virus.

Histology: intraepithelial blistering with acantholysis and eosinophilic corpuscles in multinucleated keratinocytes.

Electron microscopy and real-time PCR: detection of orthopox in lesional smears.

Course: No improvement of symptoms and skin lesions was observed when i.v. acyclovir was administered. After revision of the original diagnosis only a symptomatic therapy with internal antiphlogistics and locally with drying and disinfecting lotions was performed. After 10 days, the general symptoms improved significantly. The exanthema had subsided after 4 weeks.

Note: The now healthy cat of the patient was identified as the source of infection; detection of virus-specific IgG and IgM antibodies.

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  1. Haase O et al (2011) Generalized cowpox infection in Darier disease. Abstract CD 46th DDG meeting: P15/04
  2. Nitsch A, Pauli G (2007) Infections with cowpox virus in Germany - an overview: Cats are currently important as carriers. RKI Bulletin. 9.3.2007, No.10
  3. Schupp P et al (2001) Cowpox virus in a 12-year-old boy: rapid identification by an orthopoxvirus-specific polymerase chain reaction. Br J Dermatol 145: 146-150
  4. Steinborn A et al (2003) Human cowpox/catpox infection. A potentially unrecognized disease. Dtsch Med Weekly 128: 607-610
  5. Wolfs TF et al (2002) Rat-to-human transmission of Cowpox infection. Emerg Infect Dis 8: 1495-1496


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020