The primary risk factor is some form of immunodeficiency (hypogammaglobulinemia, T-cell defect, HIV, immunosuppression, etc).
Clinical features:
(1) The patient is given the vaccinia vaccine.
(2) Secondary skin lesions appear to 6 to 14 days later and cover a large area.
(3) The patient develops systemic symptoms (fever, chills, etc) and appears toxic.
(4) The skin lesions may enlarge, ulcerate and become necrotic.
(5) The infection may follow a prolonged course.
(6) Multi-organ failure may occur.
The mortality rate may be high if the patient is not treated appropriately.
Therapy may entail:
(1) administration of hyperimmune antivaccinial gamma-globulin (if available)
(2) antiviral agents (such as methisazone).
