Molluscum contagiosum virus (MOCV) is an important human pathogen causing a high disease burden worldwide. It is the last exclusively human-infecting poxvirus still circulating in its natural reservoir-a valuable model of poxviral evolution. Unfortunately, MOCV remains neglected, and little is known about its evolutionary history and circulating genomic variants, especially in non-privileged countries. The design weaknesses of available MOCV detection/genotyping assays surfaced with recent accumulation of abundant sequence information: all existing MOCV assays fail at accurate genotyping and capturing sub-genotype level diversity. Because complete MOCV genome characterization is an expensive and labor-intensive task, it makes sense to prioritize samples for whole-genome sequencing by diversity triage screening. To meet this demand, we developed a novel assay for accurate MOCV detection and genotyping, and comprehensive sub-genotype qualification to the level of phylogenetic groups (PGs). The assay included a novel set of oligonucleotide primers and probes, and it was implemented using digital polymerase chain reaction (dPCR). It offers sensitive, specific, and accurate detection, genotyping (MOCV1-MOCV3), and PG qualification (PG1-6) of MOCV DNA from clinical samples. The novel dPCR assay is suitable for MOCV diversity triage screening and prioritization of samples for complete MOCV genome characterization.

Molluscum contagiosum is a common skin infection affecting different body areas, including the face. Previous data have shown cases of atypical lesions, notably on the face, and it was thought relevant to further examine differences between facial and non-facial lesions. All cases of children (0-18) diagnosed with molluscum contagiosum from 2013-2022 at the paediatric dermatology clinic of Soroka University Medical Center were retrospectively reviewed, and 615 children were included in the study. Facial lesions tended to be found in younger children (p = 0.018). Non-facial lesions were more erythematous (p < 0.001), itchier (p < 0.001), and showed similar patterns of ulceration (p = 0.078) and purulence (p = 0.779). The average lesion diameter was similar in patients with or without facial lesions (p = 1). Children with facial lesions were treated differently from patients without facial lesions (p < 0.001); however, there were no differences in treatment response. This research challenges assumptions concerning the severity of facial lesions, including eyelid lesions, by revealing that, overall, they exhibit less inflammation than non-facial lesions. Despite the potential for greater psychosocial burdens and impacts on self-esteem associated with lesions on the sensitive facial area, this study provides evidence that they are not inherently more worrisome and can be managed similarly to lesions found elsewhere in the body.

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The family Poxviridae is a large family of viruses with a ubiquitous distribution, subdivided into two subfamilies: Chordopoxvirinae (poxviruses of vertebrates) and Entomopoxvirinae (poxviruses of insects). Only three species from the first subfamily, Orthopoxvirus (OPV), Molluscipoxvirus and Parapoxvirus, can infect the human being. In the paediatric population, viruses belonging to the first two subfamilies have the greatest importance. Following the eradication of smallpox in 1980, vaccination of the general population was discontinued after careful consideration of the risks and benefits. However, nearly all children and most of the world\'s population had little to no protection against OPV. The aim of this chapter is to review the current evidence on the aetiology, clinical manifestations, diagnosis and management of Poxviridae infections in children.

Molluscum contagiosum virus is a poxvirus belonging to the Poxviridae family, which includes Orthopoxvirus, Parapoxvirus, Yantapoxvirus, Molluscipoxvirus, Smallpox virus, Cowpox virus and Monkeypox virus. MCV belongs to the genus Molluscipoxvirus and has a tropism for skin tissue. MCV infects keratinocytes and, after an incubation period of 2 weeks to 6 weeks, causes a breakdown of the skin barrier with the development of papules of variable size depending on the proper functioning of the immune response (both adaptive and acquired). MCV only infects humans and does not cause viraemia. MCV encodes for several inhibitory proteins responsible to circumvent the immune response through different signalling pathways. Individuals who can be infected with MCV are children, immunocompromised individuals such as organ transplant recipients and Human Immunodeficiency Virus (HIV)-infected individuals. Current treatments to manage MCV-induced lesions are different and include the use of immunomodulators, which, however, do not provide an effective response.

Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or skin-colored papules, with a shiny surface and central umbilication, generally clustered and randomly distributed over the skin surface. Dermoscopy reveals yellowish-white polylobulated structures with peripheral telangiectasia. Diagnosis is usually clinical supported by dermoscopy. However, in some cases, inflammatory manifestations can be associated with this infection and can mimic other dermatological conditions, making the diagnosis difficult and leading to unnecessary treatments. The objective of this article is to describe the main skin reactions associated with MC infection in order to provide a diagnostic and initial management tool for clinicians dealing with these conditions. Reported manifestations include the BOTE sign, perilesional eczema, Gianotti-Crosti syndrome-like reaction, ID reaction, erythema annulare centrifugum, erythema multiforme, folliculitis, white halo, and atypical manifestations (giant, disseminated, necrotic, polypoidal, and nodular lesions, pseudocysts, abscesses). In pediatric patients with the clinical manifestations described above, infection by molluscum contagiosum pox virus should be considered among the differential diagnoses, and referral to a dermatologist should be made in selected cases.

Background/Objectives: Cidofovir, an antiviral drug approved for cytomegalovirus retinitis, has emerged as an alternative treatment option for virally induced cutaneous and mucocutaneous conditions, as well as being trialed as a treatment for select neoplasms. In this review, we highlight the existing evidence, clinical uses, and rationale of using cidofovir for the treatment of cutaneous pathologies. Methods: A PubMed database literature search was conducted to identify relevant articles for inclusion in this review. Results: Cidofovir has several cutaneous applications in various formulations including intravenous, topical, and subcutaneous administrations. Primarily through case reports, case series, and retrospective reviews, cidofovir has demonstrated efficacy in treating a variety of virally induced conditions-verruca vulgaris, herpes simplex virus, molluscum contagiosum-as well as in adjuvant treatment for select neoplasms. The drug has shown efficacy in immunocompromised and immunocompetent adults and children alike. Conclusions: The body of literature supports the use of cidofovir as an effective and well-tolerated treatment for many viral cutaneous pathologies, and encourages further study for its use as an adjuvant therapy for neoplastic disease.

We recently developed compound FC-7269 for targeting the Molluscum contagiosum virus processivity factor (mD4) and demonstrated its ability to inhibit viral processive DNA synthesis in vitro and cellular infection of an mD4-dependent virus (Antiviral Res 211, 2023,105520). However, despite a thorough medicinal chemistry campaign we were unable to generate a potent second analog as a requisite for drug development. We overcame this impasse, by conjugating a short hydrophobic trivaline peptide to FC-7269 to produce FC-TriVal-7269 which significantly increased antiviral potency and reduced cellular toxicity.

Molluscum contagiosum is a benign cutaneous viral infection caused by a poxvirus, commonly seen in children and adolescents. It typically produces benign, self-limiting eruptions on the skin and mucous membranes, usually on the face, trunks, limbs, and genital areas. The eyelid is the most common site of ocular lesions, less commonly conjunctiva.Eyelid Lesions are typically small papules (two to six mm) with central depressions, or maybe non-umbilicated. Patients with immunodeficiency may have an atypical giant lesion or widely disseminated lesions. We present a case of eyelid molluscum contagiosum presenting with an unusually large nodule with two depressions associated with chronic follicular conjunctivitis in a three-year-old otherwise healthy child. Eyelid lesions were removed surgically. The conjunctival follicular reaction was completely resolved after one month of surgical excision. A histopathological examination confirmed the diagnosis.

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