eMedicine Specialties > Infectious Diseases > Viral Infections

Parapoxviruses: Treatment & Medication

Author: Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Coauthor(s): Adam M Rotunda, MD, Fellow, Department of Dermatology, David Geffen School of Medicine at University of California at Los Angeles
Contributor Information and Disclosures

Updated: May 15, 2009

Treatment

Medical Care

The overall benign nature of this infection is reflected by the success of any of the following treatment methods:

  • Waiting for the lesion or lesions to regress
  • Performing an excision
  • Using direct idoxuridine application with eye involvement
  • Administering antimicrobials for bacterial superinfection

Medication

Limited information is available for specific antiviral therapy of human Parapoxvirus infections. However, anecdotal information suggests a possible role of topical idoxuridine in ophthalmic involvement.

Ophthalmic antivirals

Therapy of viral infections begins with mechanical debridement of the involved rim and a rim of normal epithelium. This is followed by the topical instillation of antiviral medications.


Idoxuridine (Herplex)

One of the first halogenated pyrimidine derivatives used for their antiviral effect. Used primarily in herpetic keratitis but was replaced by newer better-tolerated agents and for epithelial infections (especially initial attacks). Infections characterized by the presence of a dendritic shape respond better to this medication than stromal infections. Blocks reproduction of herpes simplex virus by producing incorrect DNA copies, preventing the virus from infecting or destroying tissue.

Adult

Initial: 1 gtt into infected eye(s) q1h during the day and q2h at night; continue until definite improvement occurs (usually within 7 d)
Reduce to 1 gtt q2h during the day and q4h at night; to minimize recurrences, continue therapy at reduced dosage for 3-7 d after healing appears complete; not to exceed 21 d
Alternative treatment: Instill 1 gtt q1min for 5 min and repeat q4h (day and night)

Pediatric

Administer as in adults

Coadministration with boric acid–containing solutions may result in a precipitate formation, which may cause irritation

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Local effects in the eye may occur, including chemical conjunctivitis, punctate keratitis, and, rarely, allergic blepharodermatitis; because some strains of herpes simplex appear to be resistant, undertake another form of therapy if no lessening of fluorescein staining in 14 d; do not exceed recommended frequency and duration of administration

More on Parapoxviruses

Overview: Parapoxviruses
Differential Diagnoses & Workup: Parapoxviruses
Treatment & Medication: Parapoxviruses
Follow-up: Parapoxviruses
References
Further Reading
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References

  1. Abrahao JS, Campos RK, Trindade GS, Guedes MI, Lobato ZI, Mazur C, et al. Detection and phylogenetic analysis of Orf virus from sheep in Brazil: Case Report. Virol J. May 4 2009;6(1):47. [Medline].

  2. Radtke MA, Günzl HJ, Siemann-Harms U, Augustin M, Coors EA. [Expanding papillomatous nodule on forearm with acute lymphangitis : Case of diagnosis.]. Hautarzt. Apr 24 2009;[Medline].

  3. Mast J, Demeestere L. Electron tomography of negatively stained complex viruses: application in their diagnosis. Diagn Pathol. Feb 10 2009;4:5. [Medline].

  4. Ceovic R, Pasic A, Lipozencic J, Marinovic-Kulisic S, Budimcic D, Sviben M, et al. Milker's nodule--case report. Acta Dermatovenerol Croat. 2007;15(2):88-91. [Medline].

  5. Baxby D, Bennett M. Poxvirus zoonoses. J Med Microbiol. Jan 1997;46(1):17-20, 28-33. [Medline].

  6. Bowman KF, Barbery RT, Swango LJ, Schnurrenberger PR. Cutaneous form of bovine papular stomatitis in man. JAMA. Dec 18 1981;246(24):2813-8. [Medline].

  7. 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].

  8. Davis CM, Musil G. Milker''s nodule. A clinical and electron microscopic report. Arch Dermatol. Mar 1970;101(3):305-11. [Medline].

  9. de la Torre C. Gianotti-Crosti syndrome following milkers'' nodules. Cutis. Nov 2004;74(5):316-8. [Medline].

  10. 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].

  11. Leavell UW Jr, McNamara MJ, Muelling R, et al. Orf. Report of 19 human cases with clinical and pathological observations. JAMA. May 20 1968;203(8):657-64. [Medline].

  12. Muller G, Groters S, Siebert U, et al. Parapoxvirus infection in harbor seals (Phoca vitulina) from the German North Sea. Vet Pathol. Jul 2003;40(4):445-54. [Medline].

  13. Robinson AJ, Petersen GV. Orf virus infection of workers in the meat industry. N Z Med J. Feb 9 1983;96(725):81-5. [Medline].

  14. Schmidt E, Weissbrich B, Brocker EB. Orf followed by erythema multiforme. Eur Acad Dermatol Venereol. 2006;20:612-3.

  15. Schuler G, Honigsmann H, Wolff K. The syndrome of milker's nodules in burn injury: evidence for indirect viral transmission. J Am Acad Dermatol. Mar 1982;6(3):334-9. [Medline].

  16. Shelley WB, Shelley ED. Farmyard pox: parapox virus infection in man. Br J Dermatol. Jun 1983;108(6):725-7. [Medline].

  17. Slattery WR, Juckett M, Agger WA. Milkers' nodules complicated by erythema multiforme and graft-versus-host after allogenic hematopoietic stem cell transplantation for multiple myeloma. Clin Infect Dis. 2005;40:e63-6.

  18. Smith KJ, Skelton HG 3d, James WD, Lupton GP. Parapoxvirus infections acquired after exposure to wildlife. Arch Dermatol. Jan 1991;127(1):79-82. [Medline].

  19. Tompkins DM, Sainsbury AW, Nettleton P. Parapoxvirus causes a deleterious disease in red squirrels associated with UK population declines. Proc Biol Sci. 2002;269:529-33.

  20. Wilkinson JD. Orf: a family with unusual complications. Br J Dermatol. Oct 1977;97(4):447-50. [Medline].

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Further Reading

Related eMedicine topics

Poxviruses

Orf

Milker's Nodules

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Keywords

viral infection, virus, poxviruses, Parapoxvirus, Poxviridae, Poxvirus, orf, ecthyma contagiosum, bovine papular stomatitis, pseudocowpox, milker's nodule, paravaccinia, farmyard pox

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Contributor Information and Disclosures

Author

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Adam M Rotunda, MD, Fellow, Department of Dermatology, David Geffen School of Medicine at University of California at Los Angeles
Disclosure: Nothing to disclose.

Medical Editor

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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

CME Editor

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.

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