![]() This observation correlates with published case reports ( 4, 5, 12, 13), but it is still surprising, given that clinical improvement was not seen in 5 patients with HPV-6–positive condylomas who received the same vaccine ( 14). The patient in our study was free of warts 3 months after the last dose of qHPV vaccine, even though HPVXS2 is not closely related to the vaccine virus types ( Figure 2). However, virus loads remain low to moderate, and the infection in immunocompromised persons is clinically inapparent in most cases. Thus, immunocompromised persons seem to have difficulties in clearing HPVXS2. HPVXS2 was found more frequently on normal skin of HIV-positive than HIV-negative men. These virus loads are in line with those in warts induced by other HPV types ( 11). HPVXS2 DNA loads were well above 1.0 HPV/β-globin in the patient who had received a splenectomy and in an HIV-positive woman with HPVXS2 monoinfection. In our study, HPVXS2 was identified in disseminated warts from a patient who had had a splenectomy and in benign skin warts from 3 HIV-positive patients. HPVXS2 fragments were previously identified in hyperkeratotic benign papillomas, squamous cell carcinomas, and dermatitis on 3 renal transplant recipients at consecutive visits and in different parts of the body ( 6). Virus loads of >1.0 HPV/β-globin were found on normal skin of 10 of 34 HPVXS2-positive HIV-positive men (range 0.002–35.0 HPV/β-globin median 0.107 HPV/β-globin interquartile range 1.266 HPV/β-globin). Virus loads were low (0.014 and 0.023 HPV/β-globin) in the 2 HPVXS2-positive HIV-negative controls. The results showed grouping of HPVXS2 within the alpha-2 species ( Figure 2), and in each case, the L1 ORF was 350 cells/μL to be HPVXS2-positive, but the difference was not statistically significant (25.0% vs. Cary, NC, USA) was used to determine the organization of the predicted open reading frames (ORFs) and perform phylogenetic analyses. MacVector software version 12.7.3 (MacVector, Inc. The phylogenetic analysis is based on the. Phylogenetic tree based on selected human papillomavirus (HPV) major capsid protein gene (L1) open reading frames the tree shows the grouping of HPVXS2. Leon-Rot, Germany) and ligated into pJET1.2/blunt (Fermentas): fragment 1, XS2-M19fw 5′-GAATTGAGTCTTGCACCAGAGG-3′ and XhoIrev 5′-ATCTCGAGTCGCTGTCGCTTT-3′ fragment 2, XS2-M15fw 5′-GTATCTAGCACACGAGAAGTAC-3′ and XS2–6413rev 5′-ATGGTGTCCCCGACAACCC-3′ fragment 3, XS2–6258fw 5′-CACCATGTAAACAGACTGCGTC-3′ and XS2-M8rev 5′-ACCCAAATTGTTCTTTAAACTTACC-3′.įigure 2. KC138720) were amplified by using Phusion HotStart II HF DNA Polymerase (Fermentas, St. Three overlapping PCR fragments covering the entire genome of HPVXS2 (7,830 bp GenBank accession no. Sequences of the PCR products were analyzed by using BLASTn ( ) and were 100% homologous to a 261-bp fragment named HPVXS2 ( 6). A2/A4 PCR ( 6) was used to amplify HPV DNA from all biopsy specimens obtained before vaccination. Histopathologic analysis revealed features typical of benign cutaneous warts, including acanthosis, parakeratosis, and numerous koilocytes ( Figure 1), similar to warts caused by HPV-3 ( 8). DNA extraction and HPV typing were performed as described ( 6, 7). ![]() Analysis revealed features typical of benign cutaneous warts.įor virologic analyses, 20 biopsy specimens from the patient’s fingers, backs of hands, and forearms and 1 specimen each from the cheek and back were available (all were collected before the patient received the first dose of qHPV vaccine). Histopathologic findings for a representative biopsy of skin lesions (erythematous warts) from a female patient before she was administered human papillomavirus vaccine. During October 2005–December 2009, the patient received topical and ablative treatments for the warts (salicylic acid, podophyllotoxin, 5-fluoruracil cream, imiquimod 5% cream, cryosurgery, surgical curettage, electrocautery, and CO 2 laser therapy), but clinical improvement was not sustained.įigure 1. Immunophenotyping revealed a markedly decreased CD4/CD8 ratio ( Table). In February 2010, after a 12-year history of slowly progressing cutaneous warts, the patient sought medical care for numerous, flat, erythematous warts that were coalescing into large plaques on her forearms, backs of hands, and fingers ( Technical Appendix Figure). Six cycles of chemotherapy were administered during November 2002–March 2003. In October 2002, breast cancer was detected in the patient the breast was surgically removed, and lymph node dissection was performed. In 1979, a 41-year-old, White woman received a diagnosis of B cell chronic lymphocytic leukemia and was treated with chlorambucil and prednisolone, followed by radiation therapy and splenectomy, resulting in a durable, complete remission of the leukemia.
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