eMedicine Specialties > Dermatology > Viral Infections

Orf: Follow-up

Author: Lana H Hawayek, MD, Assistant Professor of Dermatology, University of Cincinnati, Veterans Affairs Medical Center; Consulting Staff, University Dermatology Consultants
Coauthor(s): Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Aug 18, 2008

Follow-up

Deterrence/Prevention

  • The best preventive measure in animals is orf vaccination every 6-8 months. Veterinary vaccines for orf virus use nonattenuated, live virus preparations. Recently vaccinated animals pose an increased risk to humans. Once an animal is infected, it should be put in isolation.
  • Humans infected with orf do not need to be isolated because no human-to-human transmission occurs.
  • Patients who are immunosuppressed or persons with compromised skin barriers (eg, trauma, skin disease) must avoid contact with infected animals because they have an increased susceptibility for contracting the orf infection.

Complications

  • Toxic erythema
  • Erythema multiforme18,19
  • Growth of the skin lesion to a giant size
  • Widespread papulovesicular eruption of the skin and the mucosae
  • Unusual localization of the infection (ocular or perianal)
  • Bullous pemphigoid20
  • Orf-induced immunobullous disease (reported in 2008)21

Prognosis

  • The prognosis of orf is excellent. The orf lesions usually heal completely with no scarring in about 35 days.

Patient Education

  • Most patients infected with orf are farmers or people who handle animals; therefore, they are usually familiar with the disease. Those who are unacquainted with this condition must be reassured. They must also be informed that recurrences may occur and result in lesions that are less pronounced than the primary infection.

Miscellaneous

Special Concerns

  • Pregnancy and fetal development have not been reported to be adversely affected by this viral infection.22
 


More on Orf

Overview: Orf
Differential Diagnoses & Workup: Orf
Treatment & Medication: Orf
Follow-up: Orf
Multimedia: Orf
References
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References

  1. Buchan J. Characteristics of orf in a farming community in mid-Wales. BMJ. Jul 27 1996;313(7051):203-4. [Medline].

  2. Paiba GA, Thomas DR, Morgan KL, Bennett M, Salmon RL, Chalmers R, et al. Orf (contagious pustular dermatitis) in farmworkers: prevalence and risk factors in three areas of England. Vet Rec. Jul 3 1999;145(1):7-11. [Medline].

  3. Bodnar MG, Miller OF 3rd, Tyler WB. Facial orf. J Am Acad Dermatol. May 1999;40(5 Pt 2):815-7. [Medline].

  4. Groves RW, Wilson-Jones E, MacDonald DM. Human orf and milkers' nodule: a clinicopathologic study. J Am Acad Dermatol. Oct 1991;25(4):706-11. [Medline].

  5. Centers for Disease Control and Prevention. Human orf mimicking cutaneous anthrax---California. MMWR. 1973;22:108.

  6. Sanchez RL, Hebert A, Lucia H, Swedo J. Orf. A case report with histologic, electron microscopic, and immunoperoxidase studies. Arch Pathol Lab Med. Feb 1985;109(2):166-70. [Medline].

  7. Torfason EG, Gunadóttir S. Polymerase chain reaction for laboratory diagnosis of orf virus infections. J Clin Virol. Feb 2002;24(1-2):79-84. [Medline].

  8. Olson VA, Laue T, Laker MT, Babkin IV, Drosten C, Shchelkunov SN, et al. Real-time PCR system for detection of orthopoxviruses and simultaneous identification of smallpox virus. J Clin Microbiol. May 2004;42(5):1940-6. [Medline].

  9. Gallina L, Dal Pozzo F, Mc Innes CJ, Cardeti G, Guercio A, Battilani M, et al. A real time PCR assay for the detection and quantification of orf virus. J Virol Methods. Jun 2006;134(1-2):140-5. [Medline].

  10. Erbagci Z, Erbagci I, Almila Tuncel A. Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream: report of four complicated cases. J Dermatolog Treat. 2005;16(5-6):353-6. [Medline].

  11. Lederman ER, Green GM, DeGroot HE, Dahl P, Goldman E, Greer PW, et al. Progressive ORF virus infection in a patient with lymphoma: successful treatment using imiquimod. Clin Infect Dis. Jun 1 2007;44(11):e100-3. [Medline].

  12. Ara M, Zaballos P, Sánchez M, Querol I, Zubiri ML, Simal E, et al. Giant and recurrent orf virus infection in a renal transplant recipient treated with imiquimod. J Am Acad Dermatol. Feb 2008;58(2 Suppl):S39-40. [Medline].

  13. Geerinck K, Lukito G, Snoeck R, De Vos R, De Clercq E, Vanrenterghem Y, et al. A case of human orf in an immunocompromised patient treated successfully with cidofovir cream. J Med Virol. Aug 2001;64(4):543-9. [Medline].

  14. De Clercq E. Clinical potential of the acyclic nucleoside phosphonates cidofovir, adefovir, and tenofovir in treatment of DNA virus and retrovirus infections. Clin Microbiol Rev. Oct 2003;16(4):569-96. [Medline].

  15. Shelley WB, Shelley ED. Surgical treatment of farmyard pox. Orf, milker's nodules, bovine papular stomatitis pox. Cutis. Feb 1983;31(2):191-2. [Medline].

  16. Degraeve C, De Coninck A, Senneseael J, Roseeuw D. Recurrent contagious ecthyma (Orf) in an immunocompromised host successfully treated with cryotherapy. Dermatology. 1999;198(2):162-3. [Medline].

  17. Ocampo Candiani J, González Soto R, Welsh Lozano O. Orf nodule: treatment with cryosurgery. J Am Acad Dermatol. Aug 1993;29(2 Pt 1):256-7. [Medline].

  18. Ferrando MF, Léauté-Labrèze C, Fleury H, Taïeb A. Orf and erythema multiforme in a child. Pediatr Dermatol. Mar-Apr 1997;14(2):154-5. [Medline].

  19. Mourtada I, Le Tourneur M, Chevrant-Breton J, Le Gall F. [Human orf and erythema multiforme]. Ann Dermatol Venereol. Apr 2000;127(4):397-9. [Medline].

  20. Murphy JK, Ralfs IG. Bullous pemphigoid complicating human orf. Br J Dermatol. May 1996;134(5):929-30. [Medline].

  21. White KP, Zedek DC, White WL, Simpson EL, Hester E, Morrison L. Orf-induced immunobullous disease: A distinct autoimmune blistering disorder. J Am Acad Dermatol. Jan 2008;58(1):49-55. [Medline].

  22. Taieb A, Guillot M, Carlotti D, Maleville J. Orf and pregnancy. Int J Dermatol. Jan-Feb 1988;27(1):31-3. [Medline].

  23. Centers for Disease Control and Prevention. Orf virus infection in humans--New York, Illinois, California, and Tennessee, 2004-2005. MMWR Morb Mortal Wkly Rep. Jan 27 2006;55(3):65-8. [Medline].

  24. Deane D, McInnes CJ, Percival A, Wood A, Thomson J, Lear A, et al. Orf virus encodes a novel secreted protein inhibitor of granulocyte-macrophage colony-stimulating factor and interleukin-2. J Virol. Feb 2000;74(3):1313-20. [Medline].

  25. Ghislain PD, Dinet Y, Delescluse J. Orf contamination may occur during religious events. J Am Acad Dermatol. May 2000;42(5 Pt 1):848. [Medline].

  26. Inceoglu F. Orf (ecthyma contagiosum): an occasional diagnostic challenge. Plast Reconstr Surg. Sep 2000;106(3):733-4. [Medline].

  27. Mayet A, Sommer B, Heenan P. Rapidly growing cutaneous tumour of the right temple: Orf. Australas J Dermatol. Nov 1997;38(4):217-9. [Medline].

  28. Peeters P, Sennesael J. Parapoxvirus Orf in kidney transplantation. Nephrol Dial Transplant. Feb 1998;13(2):531. [Medline].

  29. Roingeard P, Machet L. Images in clinical medicine. Orf skin ulcer. N Engl J Med. Oct 16 1997;337(16):1131. [Medline].

  30. Yirrell DL, Vestey JP, Norval M. Immune responses of patients to orf virus infection. Br J Dermatol. Apr 1994;130(4):438-43. [Medline].

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Further Reading

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Keywords

orf, viral infection, zoonotic infection, animal-borne disease, ecthyma contagiosum, ecthyma infectiosum, infectious pustular dermatitis, contagious pustular dermatitis, sheep-pox, lip scab of sheep, sore mouth disease, scabby mouth disease

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Contributor Information and Disclosures

Author

Lana H Hawayek, MD, Assistant Professor of Dermatology, University of Cincinnati, Veterans Affairs Medical Center; Consulting Staff, University Dermatology Consultants
Lana H Hawayek, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Nelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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