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Letters to the Editor doi: 10.1111/ajd.12216
67
(a)
Dear Editor, Orf from deer: An Australian case Orf, also known as contagious ecthyma, is a rare zoonotic viral infection caused by a member of the genus Parapoxvirus in the family Poxviridae. The genus Parapoxvirus (family Poxviridae, subfamily chordopoxvirinae) comprises several members: orf virus, bovine papular stomatitis virus, pseudocowpox virus (PCPV), and parapox of red deer in New Zealand virus.1 Cases of orf in deer have been reported from Italy, Finland and Norway,1–3 but have never been previously reported in Australia, where the common source of infection is from contact with sheep and goats (orf virus) and cattle (bovine papular stomatitis virus and PCPV virus). We report a case of orf in an 8-year-old Australian boy, most likely contracted from deer. The patient presented with a solitary 8 mm nodule over the thenar eminence of his left hand, present for 3 weeks (Fig. 1). He was otherwise completely well. The nodule was excised, with histopathology demonstrating papillomatosis, parakeratosis and prominent intracytoplasmic inclusions in the superficial keratinocytes, strongly suggestive of orf infection. A polymerase chain reaction on fresh tissue was not performed. On taking further history the family revealed that 2 weeks prior to the onset they had visited a large Australian zoo. During the visit the child had physical contact with several deer. No cattle, sheep or goats were present at the zoo. The two species of deer present at the zoo were chital and fallow deer. The family, who reside in suburban Sydney, specifically denied any contact with sheep, goats, cows or other livestock in the preceding 12 months. On later discussion with the zookeepers it was revealed that deer are no longer kept at the zoo. Records of visible orf lesions in the deer could not be obtained. Deer parapoxvirus infections have been widely reported in red deer in New Zealand and Italy, reindeer in northern Europe and in white-tailed deer in North America.1 The transmission of deer parapoxvirus to humans, however, is reported in two articles involving three patients from North America.4,5 The affected patient in each case was involved in the handling of deer carcasses, using bare hands, with both intact and non-intact skin. Parapoxvirus infection can be an occupational risk for farmers, animal health-care providers and others who work closely with animals. It has also been reported in Muslim populations following the religious feast Eid al-Adha, in which sheep are sacrificed. In our case, the clinical history of animal exposure, evolution of the lesion over time and characteristic histopathology are strongly suggestive of a diagnosis of orf. In the absence of other animal contact, it is likely that the child’s encounter with the deer is the probable source of infection. In reporting this case we wish to highlight the fact
(b)
Figure 1 (a) Erythematous tender lesion over left thenar eminence at time of presentation; (b) papillomatosis, parakeratosis, and prominent intracytoplasmic inclusions in the superficial keratinocytes.
that orf can be transmitted to humans from contact with deer, and note that this has not previously been reported in Australia.
REFERENCES 1. 2.
3.
Scagliarini A, Vaccari F, Turrini F et al. Parapoxvirus infections of red deer, Italy. Emerg. Infect. Dis. 2011; 17: 684–7. Klein J, Tryland M. Characterisation of parapoxviruses isolated from Norwegian semi-domesticated reindeer (Rangifer tarandus tarandus). Virol. J. 2005; 2: 79. Tikkanen MK, McInnes CJ, Mercer AA et al. Recent isolates of parapoxvirus of Finnish reindeer (Rangifer tarandus tarandus) are closely related to bovine pseudocowpox virus. J. Gen. Virol. 2004; 85 (Pt 6): 1413–8.
Abbreviations PCPV
pseudocowpox virus
© 2015 The Australasian College of Dermatologists
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68 4. 5.
Letters to the Editor Kuhl JT, Huerter CJ, Hashish H. A case of human orf contracted from a deer. Cutis 2003; 71: 288–90. Roess AA, Galan A, Kitces E et al. Novel deer-associated parapoxvirus infection in deer hunters. N. Engl. J. Med. 2010; 363: 2621–7. 1
2
Stephen Donoghue, Steven Mann and Samuel Zagarella1,3 1 Department of Dermatology, Concord General Repatriation Hospital, 2Histopath Pathology and 3 University of Sydney, Sydney, New South Wales, Australia
doi: 10.1111/ajd.12225 Dear Editor, Calcific uraemic arteriolopathy in a patient with end-stage renal failure and chronic plaque psoriasis: could TNF-α inhibition help ameliorate disease progression? Calcific uraemic arteriolopathy (CUA, previously named calciphylaxis) is a life-threatening disorder with a very high mortality rate (usually due to sepsis), with a median survival of only 2.64 months after diagnosis.1 We present
Conflict of interest: none
Figure 1 Timeline of key events in this case (a), along with graphs showing serum parathyroid hormone (b, shown in orange). (c) calcium (purple) and phosphate (green) in this patient, throughout the course of the presentation with calcific uraemic arteriolopathy (CUA). Shaded areas indicate the normal reference ranges for serum parathyroid hormone, calcium and phosphate. © 2014 The Australasian College of Dermatologists
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
Letters to the Editor doi: 10.1111/ajd.12216
67
(a)
Dear Editor, Orf from deer: An Australian case Orf, also known as contagious ecthyma, is a rare zoonotic viral infection caused by a member of the genus Parapoxvirus in the family Poxviridae. The genus Parapoxvirus (family Poxviridae, subfamily chordopoxvirinae) comprises several members: orf virus, bovine papular stomatitis virus, pseudocowpox virus (PCPV), and parapox of red deer in New Zealand virus.1 Cases of orf in deer have been reported from Italy, Finland and Norway,1–3 but have never been previously reported in Australia, where the common source of infection is from contact with sheep and goats (orf virus) and cattle (bovine papular stomatitis virus and PCPV virus). We report a case of orf in an 8-year-old Australian boy, most likely contracted from deer. The patient presented with a solitary 8 mm nodule over the thenar eminence of his left hand, present for 3 weeks (Fig. 1). He was otherwise completely well. The nodule was excised, with histopathology demonstrating papillomatosis, parakeratosis and prominent intracytoplasmic inclusions in the superficial keratinocytes, strongly suggestive of orf infection. A polymerase chain reaction on fresh tissue was not performed. On taking further history the family revealed that 2 weeks prior to the onset they had visited a large Australian zoo. During the visit the child had physical contact with several deer. No cattle, sheep or goats were present at the zoo. The two species of deer present at the zoo were chital and fallow deer. The family, who reside in suburban Sydney, specifically denied any contact with sheep, goats, cows or other livestock in the preceding 12 months. On later discussion with the zookeepers it was revealed that deer are no longer kept at the zoo. Records of visible orf lesions in the deer could not be obtained. Deer parapoxvirus infections have been widely reported in red deer in New Zealand and Italy, reindeer in northern Europe and in white-tailed deer in North America.1 The transmission of deer parapoxvirus to humans, however, is reported in two articles involving three patients from North America.4,5 The affected patient in each case was involved in the handling of deer carcasses, using bare hands, with both intact and non-intact skin. Parapoxvirus infection can be an occupational risk for farmers, animal health-care providers and others who work closely with animals. It has also been reported in Muslim populations following the religious feast Eid al-Adha, in which sheep are sacrificed. In our case, the clinical history of animal exposure, evolution of the lesion over time and characteristic histopathology are strongly suggestive of a diagnosis of orf. In the absence of other animal contact, it is likely that the child’s encounter with the deer is the probable source of infection. In reporting this case we wish to highlight the fact
(b)
Figure 1 (a) Erythematous tender lesion over left thenar eminence at time of presentation; (b) papillomatosis, parakeratosis, and prominent intracytoplasmic inclusions in the superficial keratinocytes.
that orf can be transmitted to humans from contact with deer, and note that this has not previously been reported in Australia.
REFERENCES 1. 2.
3.
Scagliarini A, Vaccari F, Turrini F et al. Parapoxvirus infections of red deer, Italy. Emerg. Infect. Dis. 2011; 17: 684–7. Klein J, Tryland M. Characterisation of parapoxviruses isolated from Norwegian semi-domesticated reindeer (Rangifer tarandus tarandus). Virol. J. 2005; 2: 79. Tikkanen MK, McInnes CJ, Mercer AA et al. Recent isolates of parapoxvirus of Finnish reindeer (Rangifer tarandus tarandus) are closely related to bovine pseudocowpox virus. J. Gen. Virol. 2004; 85 (Pt 6): 1413–8.
Abbreviations PCPV
pseudocowpox virus
© 2015 The Australasian College of Dermatologists
bs_bs_banner
68 4. 5.
Letters to the Editor Kuhl JT, Huerter CJ, Hashish H. A case of human orf contracted from a deer. Cutis 2003; 71: 288–90. Roess AA, Galan A, Kitces E et al. Novel deer-associated parapoxvirus infection in deer hunters. N. Engl. J. Med. 2010; 363: 2621–7. 1
2
Stephen Donoghue, Steven Mann and Samuel Zagarella1,3 1 Department of Dermatology, Concord General Repatriation Hospital, 2Histopath Pathology and 3 University of Sydney, Sydney, New South Wales, Australia
doi: 10.1111/ajd.12225 Dear Editor, Calcific uraemic arteriolopathy in a patient with end-stage renal failure and chronic plaque psoriasis: could TNF-α inhibition help ameliorate disease progression? Calcific uraemic arteriolopathy (CUA, previously named calciphylaxis) is a life-threatening disorder with a very high mortality rate (usually due to sepsis), with a median survival of only 2.64 months after diagnosis.1 We present
Conflict of interest: none
Figure 1 Timeline of key events in this case (a), along with graphs showing serum parathyroid hormone (b, shown in orange). (c) calcium (purple) and phosphate (green) in this patient, throughout the course of the presentation with calcific uraemic arteriolopathy (CUA). Shaded areas indicate the normal reference ranges for serum parathyroid hormone, calcium and phosphate. © 2014 The Australasian College of Dermatologists
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
