Swan-Neck Deformity and Paresthesia Following Giant Orf

Orf is a zoonotic infection caused by a parapoxvirus that primarily infects sheep and goats. Human orf infection can take place when abraded skin comes into contact with infected animals. It occurs most commonly on the index finger. The characteristic lesion resembles a tumor and resolves spontaneously, usually without any complications. However, rare complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, and bullous pemphigoid have been reported. Herein, we report a case of giant orf causing swan-neck deformity and paresthesia. These complications have not been previously reported in the literature.

Multiple finger nodules and an erythematous rash - a case study

A previously well male, 18 years of age, from a rural community, presented with three painful, itchy nodules on the fingers of his left hand, which had been present for 1 week. He had been prescribed amoxicillin clavulanate but presented again when there was no improvement after 4 days of taking antibiotics. Examination revealed three erythematous and umbilicated nodules without any halo, but with a central depression with exudate (Figure 1a). No specific treatment was instituted at this visit. One week later the patient re-presented with new erythematous lesions on the palms and dorsum of his hands. The original three lesions had improved and were drier than previously (Figure 1b, c). The new lesions disappeared after 2 weeks and the original lesions after 4 weeks, without any other treatment.

Progressive ORF virus infection in a patient with lymphoma: successful treatment using imiquimod

Orf virus is a parapoxvirus that infects small ruminants worldwide. We present the case report of a 73-year-old woman with non-Hodgkins lymphoma who developed progressive orf virus lesions that were unresponsive to surgical debridement and to cidofovir therapy. The patient's orf virus infection was successfully treated with topical imiquimod despite progression of her malignancy.

Two giant orf lesions in a heart/lung transplant patient

Orf is an infectious ulcerative stomatitis of sheep and goats. The responsible pathogen, parapoxvirus, may be transmitted to humans. Orf lesions are often atypical in immunocompromised individuals. The present report describes two very large exophytic lesions in a 31-year-old transplant patient receiving oral tacrolimus, mycophenolate mofetil and prednisone. Early surgical excision was successful, with no relapse after 14 months.

Teat disorders predispose ewes to clinical mastitis after challenge with Mannheimia haemolytica

In order to study the effects of sheep teat disorders on the protection of the mammary gland, we used a Mannheimia haemolytica isolate, which did not cause clinical mastitis when deposited into intact teats. In the first experiment, this was deposited into the duct of teats with orf (Group A, n=5) or papilloma (Group B, n=3). In the second, teats were chapped and then, the organism was deposited into the duct (Group C, n=7) or on the skin (Group D, n=4). Ewes with healthy teats were controls (Group E, deposition into duct, n=5; Group F, deposition on skin, n=2). The ewes in Groups A, B or C developed clinical mastitis 5 h later, whilst the ewes in Group D developed it 2 d later; no control ewe developed clinical mastitis. In ewes with teat lesions, the organism was isolated from secretion samples and the California Mastitis Test became positive 5 h after challenge; neutrophils and lymphocytes were seen in Giemsa-stained secretion films from Group A or B ewes, whilst macrophages, neutrophils and lymphocytes in films from Group C or D ewes; neutrophils were predominating in films from Group E or F ewes. Inside the teats of Group A, B, C or D ewes, folds, hyperaemia and mucosal thickness were seen; histologically, subepithelial leucocytic infiltration was seen. In Group A or B ewes, no evidence of lymphoid tissue at the teat duct-cistern border was found. In Group C or D ewes, intense erosion and ulceration of the teat skin and conspicuous lymphoid tissue at the teat duct-cistern border, were evident; lesions characteristic of haemorrhagic mastitis were in the mammary parenchyma. In control ewes, subepithelial leucocytic infiltration in the teat duct and lymphoid tissue as above, were evident. We postulate that teat lesions can be predisposing factor to mastitis, by adversely affecting defences and speeding the process of infection and making it more severe.

Contagious ecthyma associated with myiasis in sheep

A severe outbreak of contagious ecthyma (orf) is described in sheep in Saudi Arabia. In some of the affected sheep, the condition was highly aggravated by myiasis which appeared to have been favoured by the abundance of flies during the hot season. The outbreak is discussed in relation to the epidemiology of the disease in Saudi Arabia.

[Human orf and erythema multiforme]

BACKGROUND

Orf is a disease of sheep due to a parapoxvirus. Transmission in man is possible, and is generally benign, self-limited condition. Although, rare complications have been mentioned. We report a case of Orf with erythema multiforme in a young girl.

CASE REPORT

A 13-year-old girl presented to our department with an erythema multiform. The cutaneous examination revealed painless erythematous nodule of her right index finger developed 15 days after a contact with a lamb. The diagnosis of Orf complicated by erythema multiforme was made on the basis of her typical history. Lesions heal with symptomatic therapy in 15 days.

DISCUSSION

Orf presents in sheeps as a pustular dermatitis or a vesicular oral mucosal lesions, and in man as a single lesion on the site of infection. This lesion generally heals without complications, although secondary infection is not uncommon. Twenty one cases of erythema multiforme have been recorded following infection with the Orf virus. In typical cases, the diagnosis is established by a history of contact with infected animals and the appearance of the lesion. Electron microscopic examination can be helpful sometimes. Lesions regress in 4 to 5 weeks without specific treatment.

Ehrlichia (Cytoecetes) phagocytophila predisposes to severe contagious ecthyma (Orf ) in lambs

Eight lambs experimentally infected with Ehrlichia (Cytoecetes) phagocytophila 7 days before exposure to orf virus were compared with control lambs infected with orf virus alone. The dually infected animals differed from the controls in showing skin lesions of greater severity, prolonged viral shedding, and lower antibody titres. Infection with E. phagocytophila had no significant effect on virus-specific lymphocyte proliferation. Such proliferation was detected in the peripheral blood of all lambs as early as 7 days after exposure to orf virus.

Udder orf infection and its role in ovine clinical mastitis caused by Pasteurella haemolytica

During an experimental study of ovine subclinical mastitis caused by coagulase-negative staphylococci, an outbreak of contagious ecthyma occurred among ewes unvaccinated against parapox virus. The same group of ewes developed a high rate (43.7%) of clinical mastitis caused by Pasteurella haemolytica. The rate of clinical mastitis among ewes vaccinated against parapox virus was very low (3.7%) suggesting that the presence of orf in the unvaccinated ewes was contributing to the high rate of clinical mastitis. An examination of the iron, sodium, potassium and albumin concentration of milk collected from 16 unvaccinated and nine randomly selected vaccinated ewes before experimental infection with coagulase-negative staphylococci or their uninfected control mammary glands indicated significant differences in the iron (p < 0.0001) and sodium (p = 0.01) concentration. Increased iron concentration in the milk may have assisted in the development of udder infection caused by P. haemolytica as iron is easily utilised by this bacterium.

[Invasive Pseudomonas aeruginosa and Ecthyma gangrenosum infection in a child without risk factors]

BACKGROUND

Pseudomonas aeruginosa sepsis, well known in immunocompromised patients, is rare in previously healthy children.

CASE REPORT

A previously healthy 4 month-old boy was admitted with the suspicion of meningococcal septicemia. Three days prior to admission, he had developed high fever and two 4 cm-diameter skin lesions on his right leg, with dark red colour and a central haemorrhagic blister. He subsequently developed generalized seizures; meningitis and urinary tract infection were excluded. Despite topical therapy with an antistaphylococcal drug skin lesions extended, particularly at the level of the head. The patient was given oral amoxicillin-clavulanate, but his condition worsened; he was transferred to our intensive care unit with septic shock and a diagnosis of meningococcemia. Blood cultures grew Pseudomonas aeruginosa. Despite intensive therapy and appropriate antibiotic therapy, the patient died.

CONCLUSION

To allow early diagnosis and adequate treatment, it is mandatory to diagnose Ecthyma gangrenosum as the most frequent manifestation of invasive infection with Pseudomonas aeruginosa.

Bullous pemphigoid complicating human orf

We report five cases of human orf complicated by bullous pemphigoid. This is a previously unrecorded complication of orf. Knowledge of the association allows for better management in the affected patient.

Erysipeloid infection in a sheep farmer with coexisting orf

Erysipeloid is a rarely reported zoonotic infection caused by Erysipelothrix rhusiopathiae. We report a case of coexisting erysipeloid and orf infections in a sheep farmer, an association not previously recorded to our knowledge.

Recurrent orf in an immunocompromised host

A 30-year-old farmer with Nezelof's syndrome developed a giant orf on his hand. Recurrence followed surgical excision. Three excisions and split skin grafts were required before its eradication. He re-presented 8 years later with a further orf on the finger of his opposite hand. This lesion had not grown to the exuberant proportion of the previous lesion, but it defied repeated excisions, and various medical therapies including idoxuridine, interferon and transfer factor. Excision with hypochlorite dressings perioperatively and delayed split skin grafting led to eventual eradication.

Human orf infection complicated by erythema multiforme

A 35-year-old woman developed an orf infection of the fingers after contact with an infected goat. Following the primary orf infection, erythema multiforme developed and was controlled with prednisone. The association between erythema multiforme and orf is discussed; also, it is noted that orf is another viral condition that should be added to the agents that can initiate erythema multiforme.

First isolation of Peptococcus indolicus from a human clinical specimen

Peptococcus indolicus was isolated from a skin lesion of a sheepherder. A case report is given, and microbiological features of this organism are described.

Orf: a family with unusual complications

Three members of a farming family and their local postman contracted orf. One of those affected had had no direct contact with infected sheep. Two of the family developed a widespread papulo-vesicular eruption of the skin and mucosae with pyrexia, malaise and lymphadenopathy lasting 4-5 weeks. The eruption did not resemble erythema multiforme or the toxic erythemas usually associated with this infection.

'Giant' orf of finger in a patient with a lymphoma

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