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An epidemiologic link between the two cases in different regions of Wisconsin was established, and public health case-finding and animal “trace-back” and “trace-forward” activities were initiated ( Figure 1). By June 3 it was determined that he had sold two prairie dogs to the index patient's family at the swap meet. On May 31 he was hospitalized, and tularemia and plague were considered in the differential diagnosis. He was examined and released from a local emergency department, but his illness worsened.
BUILDING ENVELOPE MILWAUKEE SKIN
He had been bitten and scratched by a prairie dog on May 18, a nodular skin lesion developed at the scratch site on May 23, and fever, chills, sweats, and lymphadenopathy began on May 26. On June 2, the DPH was notified by the Milwaukee Health Department of an illness in a meat inspector (Distributor 2, who was also Patient 4) who resided in southeastern Wisconsin and also worked as a distributor of exotic animals. Rounded rectangles denote distributors, rectangles households, octagons pet stores, and circles veterinary clinics. Laboratory-confirmed cases of monkeypox were confirmed by means of viral culture (C), polymerase-chain-reaction assay (PCR), electron microscopy (EM), and immunohistochemical analysis (IHC). Laboratory-Confirmed Cases (Yellow Symbols) and Probable and Suspected Cases (Blue Symbols) of Monkeypox Reported among Wisconsin Residents as of June 7, 2003.Ĭase status was determined by means of clinical and laboratory data obtained on or after June 7, 2003. No similar illnesses were reported, and the case appeared to be an isolated event. It was ultimately identified as an acinetobacter species and considered to be a contaminant. On May 24, a gram-negative bacillus was isolated, raising the suspicion of tularemia or plague. The animal died on May 20, and an enlarged submandibular lymph node was submitted to Marshfield Laboratories for bacterial culture. It became ill on May 13 and was noted to have ocular discharge, lymphadenopathy, and papular skin lesions. The prairie dog had been purchased on May 11 at a swap meet where animals are bought or traded. On May 24, 2003, the Wisconsin Division of Public Health (DPH) was notified of a three-year-old girl (Patient 1) hospitalized in central Wisconsin with cellulitis and fever after a bite from Prairie Dog 1 on May 13. Infection of humans was associated with direct contact with ill prairie dogs that were being kept or sold as pets. Our investigation documents the isolation and identification of monkeypox virus from humans in the Western Hemisphere. 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. The virus was identified by detection of monkeypox-specific DNA sequences in tissues or isolates from six patients and the prairie dog. Monkeypox virus was recovered in cell cultures of seven samples from patients and from the prairie dog. We found immunohistochemical or ultrastructural evidence of poxvirus infection in skin-lesion tissue from four patients. All patients reported having direct contact with ill prairie dogs before experiencing a febrile illness with skin eruptions.
The initial Wisconsin cases evaluated in this outbreak occurred in five males and six females ranging in age from 3 to 43 years. Histopathological and electron-microscopical examinations, microbiologic cultures, and molecular assays were performed to identify the etiologic agent. We reviewed medical records, conducted interviews and examinations, and collected blood and tissue samples for analysis from 11 patients and one prairie dog. Zoonotic transmission of a bacterial or viral pathogen was suspected. The most trusted, influential source of new medical knowledge and clinical best practices in the world.ĭuring 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.
BUILDING ENVELOPE MILWAUKEE LICENSE
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