Parapoxviruses Clinical Presentation

  • Author: Luke Bloomquist, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 6, 2011
 

History

Most patients report direct contact when feeding or treating animals or when visiting or working on farms, although indirect contact with contaminated fomites also causes infection. Parapoxvirus species are quite resistant to heat, cold, and drying and may persist on fences, feeding troughs, and barn beams for days to months. Patients often have a history of trauma, frequently minor; lesions occur at the site of trauma. Human-to-human transmission is exceedingly rare.

According to some sources, human infections occur with higher frequency in the spring and autumn, corresponding with the lambing and calving seasons. Young animals are more susceptible to infection and infected animals are more likely to require assistance with feeding, which necessitates close contact with the infected animal by the human caretaker.

Other reports suggest a higher incidence during the winter, presumably from the use of gorse, a prickly animal feed that may cause trauma and facilitate infection in an animal.[11]

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Physical

Parapoxvirus lesions progress through 6 stages, each lasting approximately 6 days, as follows:

  1. The maculopapular stage, characterized by a discrete erythematous macule(s) or papule(s), follows an incubation period of 3-7 days. These lesions are usually located on the fingers, hands, or forearms; however, several reports show involvement of the face, neck, ear, and periocular area.
  2. The target stage is next; lesions have a red center, a white middle ring, and a red halo.
  3. The acute stage occurs by weeks 2-3. The lesion appears nodular and weeping.
  4. The regenerative stage occurs by weeks 3-4. The lesion becomes ulcerated and thin-crusted.
  5. The papillomatous stage develops by weeks 4-5.
  6. The regressive stage with thick dry crusting and reduction in elevation occurs by week 6, and then the lesion resolves without scarring.[17]

Unusual presentations include giant orf, widespread papulovesicular or bullous lesions, or hemorrhagic pustular nodules. These can occur in immunosuppressed or, rarely, otherwise healthy individuals.[18]

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Causes

Direct contact with infected animals, either alive or dead, is most typical but is not required for infection; transmission also occurs from contaminated fomites such as shears, feeding troughs, barn doors, and fences.[19] Skin trauma, even trivial, is a risk factor for infection.

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Contributor Information and Disclosures
Author

Luke Bloomquist, MD  Combat Aviation Brigade Surgeon, 1st Armored Division, Fort Bliss, Texas

Luke Bloomquist, MD is a member of the following medical societies: American Academy of Family Physicians and Society of US Army Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Gary P Holmes, MD, FSHEA, FIDSA  Joint Associate Professor, Department of Epidemiology and Biostatistics, Texas A&M University School of Rural Public Health

Gary P Holmes, MD, FSHEA, FIDSA is a member of the following medical societies: American Society for Microbiology, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Pranatharthi Haran Chandrasekar, MBBS, MD  Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Larry I Lutwick, MD, and Adam M Rotunda, MD, to the development and writing of this article.

References

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