PMC6852610_01
Vesicular lesions on two of the cases, Gauteng, South Africa, July 2017. (a, b) Vesicular lesions seen on one of the cases that initially presented with a maculopapular rash. (c, d) Vesicular lesions on the third case. This patient was not part of the initial cluster with a maculopapular rash.
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The rash subsequently evolved and became vesicular in two of the cases, affecting the limbs and hands in one of the cases (Figure 1).
Transmission electron microscopy of negatively-stained virions in vesicular fluid, Gauteng, South Africa, July 2017. (a) and (b) show typical Herpesviridae particles with an icosahedral nucleocapsid (2) surrounded by a loose envelope (1). During collection and processing of vesicular fluids, the fragile envelope frequently ruptures to release the nucleocapsid, which can be seen to be composed of characteristic cylindrical capsomers (inset b).
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Viral particles consistent with those of the Herpesviridae family were seen on electron microscopy of the vesicular fluid, while no virions were detected in the scab specimen (Figure 2).
Sequence of events during the investigation, Gauteng, South Africa, July 2017.
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A timeline showing the sequence of events in this investigation is shown in Figure 3.