Progressive Vaccinia: Clinical Manifestations


Evolution of Progressive Vaccinia

1.	Primary vaccination site does not heal
2.	Lesion is

	•	Ulcerative or
	•	Vesiculo-pustular with central necrosis

3.	Lesion expands circumferentially with extensive necrosis
4.	Viremic or secondary inoculation lesions undergo same evolution with massive involvement
5.	Coalescent lesions cover large portions of body with extensive destruction of normal tissue
6.	Normally there is no

	•	Lymphadenopathy
	•	Splenomegaly or
	•	Other signs of inflammatory response

7.	If allowed to progress, patient may experience:

	•	Toxic or septicemic shock/disseminated intravascular coagulation
	•	Superimposed systemic fungal symptoms
	•	Parasitic infection symptoms
	•	Bacterial infections, bacteremia, septicemia

8.	If viable unmatched lymphocytes have been administered, graft-versus-host disease may occur, with splenomegaly, hepatomegaly, skin rash, DIC and signs of inflammatory response to vaccination sites