Only four survivors, however, are documented among the nearly 20 cases identified, and all four had significant neurologic residua. Immune globulin from vaccinated laboratory workers or survivors of infection has been recommended, as has high-dose acyclovir or ganciclovir. Monkey handlers should wear protective clothing and a face mask. These viruses are all members of the poxvirus family, Poxviridae, and have structures resembling those of smallpox and vaccinia viruses. Cowpox is caused by vaccinia virus and produces vesicular lesions on the hands.
Generalized infections are rare.
Milkers' nodules are produced by the paravaccinia virus. Like cowpox virus, this agent is also endemic in cows and can be spread to humans. Granulomas and ulcers are seen on the udders of infected cows. In humans, painless, reddish-blue papular lesions appear on the fingers and hands and gradually grow larger over a period of 1 to 2 weeks. The lesions resolve without vesiculation or scarring.