The
individual lesions appear identical to a primary vaccination
and undergo identical evolution. Because most individuals
have large contiguous patches of skin in the affected
areas, confluent lesions are the rule. These often cover
the entire face, antecubital fossa or behind the knee
in the popliteal fossa. Confluent lesions may also appear
on other areas of the body. Individual lesions may occur
as a result of autoinoculation after the initial transfer,
or by viremic spread.
Untreated patients become quite ill and evidence systemic
symptoms. If unrecognized and untreated, the patient
will manifest severe systemic symptoms resembling septic
shock, and death ensues.
Bacterial infection of the lesions may occur. The lesions
will appear similar to those described under
Bacterial Infection of Site, but will be more extensive
and necrotic. Bacteremia and septicemia may result from
local contamination or frank infection of the site,
at which time the patient will experience fever, chills,
obtundation, and even coma. Abscesses may occur by extension
from infected sites.
Successfully treated individuals will heal as with normal
primary vaccinations, with evolution of the individual
lesions through the scarring phase. Scarring may be
extensive depending on extent of the infected area and
the normal tendency for the body to clear the lesions
by scar formation.
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