Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion, affecting the skin and mucous membranes. Both males and females are affected, although it predominantly affects females in their fifth and sixth decades of life. Approximately 1.4 to 3.7% of PV cases occur in the pediatric population (≤18 years of age), and may be classified into childhood/pediatric PV, which affects individuals under 12 years old, and juvenile/adolescent PV, affecting those between 12 and 18 years old. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. A systematic literature search was conducted on MEDLINE/PubMed, Web of Science, EMBASE, SCOPUS, and Cochrane Library databases to evaluate the efficacy of rituximab (RTX) in childhood and juvenile PV patients. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was employed to assess the risk of bias in case reports and series, while the Cochrane ROBINS-I tool was utilized for evaluating observational studies or non-randomized intervention studies. A total of 18 studies encompassing 46 juvenile or childhood PV patients in the pediatric and adolescent age groups were included for qualitative synthesis. The studies included nine case reports, two case series, five retrospective studies, one prospective study, and one open-label pilot study. Almost all cases of childhood and juvenile PV achieved either complete or partial remission after undergoing RTX treatment during the final follow-up periods. Furthermore, most cases reported no relapse, and only minor adverse events were noted in the RTX treatment group. Despite its potential benefits, the utilization of RTX in pediatric patients raises concerns due to the scarcity of evidence and the absence of controlled studies specific to this age group. Further exploration is necessary to establish a standardized treatment regimen for RTX in pediatric PV, which involves identifying the optimal dosage, frequency, treatment cycle duration, and maintenance therapy duration.
Contagious ecthyma (CE), also known as ORF is a highly contagious zoonotic viral skin disease that affects humans, sheep, goats and other domesticated and wild animals. As reported here-in, the objective of this study was to investigate a suspected outbreak of both sheeppox and ORF diseases in a sheep herd during the winter of 2020 in Northwest Morocco. The affected sheep showed nodules and proliferative scabby skin lesions around the mouth and hairless area of the body. Samples of skin crust were collected for virus identification and isolation. A virus was isolated in Vero cells, lamb testis and heart cells and the cytopathic effect was characterized by cells aggregation, ballooning, and detachment. Initially, the suspensions of skin crust were positive for sheeppox virus (SPPV) by PCR. Subsequent testing of the isolated virus from skin crust of affected animals indicated that the virus was SPPV-negative and ORFV-positive by PCR. Furthermore, nucleotide sequences of the B2L aligned with reference ORFV isolates for genetic analysis. Phylogenetic analyses results confirmed that the isolated virus was ORFV and that the virus was closely related to ORFV strains isolated in Sudan and Malaysia. In conclusion, this study is the first reported detection of ORFV in Morocco, and therefore, poses as an imminent threat to the health of humans, domestic and wild animals.