Abstract：
Poxviridae family includes several viruses that infecting humans usually causes skin lesions only, but in some cases their clinical course is complicated by viral pneumonia (with or without bacterial superinfections). Historically variola virus has been the poxviridae most frequently associated with the development of pneumonia with many large outbreaks worldwide before its eradication in 1980. It is still considered a biological threat for its potential in biological warfare and bioterrorism. Smallpox pneumonia can be severe with the onset of acute respiratory distress syndrome (ARDS) and death. Vaccinia virus, used for vaccination against smallpox exceptionally, in immunocompromised patients, can induce generalized (with also lung involvement) severe disease after vaccination. MPXV virus occasionally can cause pneumonia particularly in immunocompromised patients. The pathophysiology of poxviridae pneumonia is still an area of active research; however, in animal models these viruses can cause both direct damage to the lower airways epithelium and a hyperinflammatory syndrome, like a cytokine storm. Multiple mechanisms of immune evasion have also been described. The treatment of poxviridae pneumonia is mainly based on careful supportive care. Despite the absence of randomized clinical trials in patients with poxviridae pneumonia there are antiviral drugs, such as tecovirimat, cidofovir and brincidofovir, FDA-approved for use in smallpox and also available under an expanded access protocol for treatment of MPXV. There are 2 (replication-deficient modified vaccinia Ankara and replication-competent vaccinia virus) smallpox vaccines FDA-approved with the first one also approved for prevention of MPXV in adults that are at high risk of infection.
摘要：
痘病毒科包括几种感染人类的病毒，通常只会引起皮肤损伤，但在某些情况下，他们的临床过程是复杂的病毒性肺炎（有或没有细菌超感染）。从历史上看，天花病毒是与肺炎发展最频繁相关的痘病毒科，在1980年根除之前，全球范围内爆发了许多大型疫情。由于其在生物战和生物恐怖主义中的潜力，它仍然被认为是生物威胁。天花肺炎可随着急性呼吸窘迫综合征（ARDS）的发作和死亡而严重。痘苗病毒,特别用于天花疫苗接种，在免疫功能低下的患者中，接种疫苗后可诱发全身性（也有肺部受累）严重疾病。MPXV病毒偶尔会引起肺炎，特别是在免疫功能低下的患者中。痘病毒科肺炎的病理生理学仍然是一个活跃的研究领域；然而，在动物模型中，这些病毒可导致下气道上皮的直接损伤和高炎症综合征，就像细胞因子风暴一样。免疫逃避的多种机制也已被描述。痘病毒科肺炎的治疗主要基于精心的支持护理。尽管缺乏痘病毒科肺炎患者的随机临床试验，但仍有抗病毒药物，比如tecovirimat，西多福韦和布列西多福韦，FDA批准用于天花，也可以在扩展的治疗MPXV的访问协议下使用。FDA批准了2种（复制缺陷型修饰的安卡拉牛痘和具有复制能力的牛痘病毒）天花疫苗，第一种也被批准用于预防感染高风险的成年人的MPXV。
