Human Orf Virus transmitted to humans through contact with an infected animal
Orf Virus, also known as contagious ecthyma, is a zoonotic infection caused by a dermatotropic parapoxvirus that commonly infects sheep and goats; it is transmitted to humans through contact with an infected animal or fomites. In humans, orf manifests as an ulcerative skin lesion sometimes resembling bacterial infection or neoplasm. Human infection typically is associated with occupational animal contact and has been reported in children after visiting petting zoos and livestock fairs (1). Cases lacking these exposure histories might be misdiagnosed, leading to unnecessary treatment of orf lesions, which do not usually require any specific treatment (2). This report describes four cases of human orf associated with household meat processing or animal slaughter, highlighting the importance of nontraditional risk factors. Orf should be included in the differential diagnosis of patients with clinically compatible skin lesions and a history of household meat processing or animal slaughter. Persons and communities with these exposure risks also should receive counseling regarding the use of nonpermeable gloves and hand hygiene to prevent infection.
Patient A. In April 2009, a woman aged 63 years punctured her right hand on a bone of a recently slaughtered goat near her home in Greece. She subsequently noted a small, pink and white papule at the site of injury that enlarged over the following week. The papule became tender and developed an erythematous border.
Two weeks later, the woman traveled to Pennsylvania to visit her son. By that time, a large bulla had developed at the wound site. On May 14, she went to an emergency department (ED) where a 3 cm bulla with a necrotic core was noted on her right palm (Figure 1). She had no fever, lymphedema, pain, or tenderness. Cultures were negative for bacteria and fungae. Histopathologic examination of the bulla roof revealed areas of necrosis and reticular degeneration of the epidermis with eosinophilic cytosolic inclusions typical of poxvirus infection. Bulla fluid and roof samples sent to CDC were positive by quantitative polymerase chain reaction (qPCR) for orf virus DNA. The outcome of patient A’s infection is unknown.
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