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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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