View source for Medicine:Orf (disease)

{{short description|Human disease}}
{{Infobox medical condition (new)
| name  = Orf
| synonyms  =Contagious pustular dermatitis, contagious ecthyma, infectious labial dermatitis, ecthyma contagiosum, thistle disease, scabby mouth<ref name=Winter_Charnley>{{cite book|author1=Winter, Agnes |author2=Charmley, Judith |title=The Sheep Keeper's Veterinary Handbook|publisher=Crowood Press Ltd (Marlborough, UK)|year=1999|isbn=978-1-86126-235-6}}</ref>
| image  = Orf virus infection on thumb.jpg
| caption   = A thumb with two denuded orf lesions, following a bite by a sheep
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'''Orf''' is a farmyard pox, a type of [[Biology:Zoonosis|zoonosis]].<ref name=Kassa2021/> It causes small pustules in the [[Biology:Skin|skin]] of primarily [[Biology:Sheep|sheep]] and goats, but can also occur on the hands of humans.<ref name=Kumar2020>{{cite book |last1=Barlow |first1=Gavin |last2=Irving |first2=William L. |last3=Moss |first3=Peter J. |editor1-last=Feather |editor1-first=Adam |editor2-last=Randall |editor2-first=David |editor3-last=Waterhouse |editor3-first=Mona |title=Kumar and Clark's Clinical Medicine |date=2020 |publisher=Elsevier |isbn=978-0-7020-7870-5 |page=517 |edition=10th |chapter-url=https://books.google.com/books?id=sl3sDwAAQBAJ&pg=PA517 |language=en |chapter=20. Infectious disease  }}</ref> A pale halo forms around a red centre.<ref name=Goldman2020>{{cite book |last1=Petersen |first1=Brett W. |last2=Damon |first2=Inger K. |editor1-last=Goldman |editor1-first=Lee |editor2-last=Schafer |editor2-first=Andrew I. |title=Goldman-Cecil Medicine |date=2020 |publisher=Elsevier |location=Philadelphia |isbn=978-0-323-53266-2 |pages=2184–2185 |edition=26th |volume=2 |chapter-url=https://books.google.com/books?id=7pKqDwAAQBAJ&dq=tanapox&pg=PA2184 |language=en |chapter=348. Smallpox, monkeypox and other poxvirus infections}}</ref> It may persist for several weeks before crusting and then either resolves or leaves [[Medicine:Granuloma|a hard lump]].<ref name=Goldman2020/> There is usually only one lesion, but there may be many, and they are not painful.<ref name=Goldman2020/> Sometimes there are [[Medicine:Lymphadenopathy|swollen lymph glands]].<ref name=Goldman2020/>

It is caused by a ''[[Biology:Parapoxvirus|Parapoxvirus]]''.<ref name=Andrew2020>{{cite book |last1=James |first1=William D. |last2=Elston |first2=Dirk |last3=Treat |first3=James R. |last4=Rosenbach |first4=Misha A. |last5=Neuhaus |first5=Isaac |title=Andrews' Diseases of the Skin: Clinical Dermatology |date=2020 |publisher=Elsevier |location=Edinburgh |isbn=978-0-323-54753-6 |page=389 |edition=13th |chapter-url=https://books.google.com/books?id=UEaEDwAAQBAJ&dq=human&pg=PA389 |language=en |chapter=19. Viral diseases }}</ref> It can occur in humans who handle infected animals or contaminated objects.<ref name=Kassa2021>{{cite journal |last1=Kassa |first1=T |title=A Review on Human Orf: A Neglected Viral Zoonosis. |journal=Research and Reports in Tropical Medicine |date=2021 |volume=12 |pages=153–172 |doi=10.2147/RRTM.S306446 |pmid=34267574 |pmc=8275206 |doi-access=free }}</ref> One third of cases may develop erythema multiforme.<ref name=Goldman2020/> Once resolved, a person can still be infected again.<ref name=Goldman2020/>

Generally, treatment options are limited.<ref name=Goldman2020/> Injecting the lesion with [[Chemistry:Cidofovir|cidofovir]] or applying [[Chemistry:Imiquimod|imiquimod]] has been tried.<ref name=Goldman2020/> It is sometimes necessary to cut them out.<ref name=Goldman2020/> The vaccine used in sheep to prevent orf is live and has been known to cause disease in humans.<ref name=Goldman2020/>

The disease is endemic in livestock herds worldwide.<ref name=Kassa2021/> A recent outbreak emerged in southwest Ethiopia between October 2019 and May 2020.<ref name=Kassa2021/>

==Humans==
Orf is a zoonotic [[Disease|disease]], meaning humans can contract this disorder through direct contact with infected sheep and goats or with fomites carrying the orf virus.<ref name="Orf Virus (Sore Mouth Infection)">{{cite web|title=Orf Virus (Sore Mouth Infection)|url=https://www.cdc.gov/poxvirus/orf-virus/people.html|website=Centers for Disease Control and Prevention|access-date=15 June 2017}}</ref> It causes a purulent-appearing papule locally and generally no systemic symptoms. Infected locations can include the finger, hand, arm, face and even the penis (caused by infection either from contact with the hand during urination or from bestiality). Consequently, it is important to observe good personal hygiene and to wear gloves when treating infected animals.<ref name=Winter_Charnley/> It may appear similar to [[Medicine:Cowpox|cowpox]] and [[Medicine:Pseudocowpox|pseudocowpox]].<ref name=Kassa2021/>
{{virusbox
| image   = Orf virus 2.jpg
| parent = Parapoxvirus
| species  = Orf virus
}}

While orf is usually a benign self-limiting illness which resolves in 3-6 weeks, in the immunocompromised it can be very progressive and even life-threatening. One percent topical [[Chemistry:Cidofovir|cidofovir]] has been successfully used in a few patients with progressive disease. Serious damage may be inflicted on the eye if it is infected by orf, even among healthy individuals. The virus can survive in the soil for at least six months.<ref name=Couch>{{Cite thesis|last=Couch|first=Alan John|year=1983|title=The Development of, and Host Response to, Ovine Contagious Pustular Dermatitis|publisher=University of New England, Armidale, N.S.W.|type=BS|doi=10.6084/m9.figshare.96642}}</ref>

==Other animals==
Orf is primarily a disease of sheep and goats although it has been reported as a natural disease in [[Biology:Human|human]]s, [[Biology:Steenbok|steenbok]] and alpacas, chamois and tahrs, [[Biology:Reindeer|reindeer]], musk oxen, [[Biology:Dog|dog]]s, [[Biology:Cat|cat]]s, mountain goats, [[Biology:Bighorn sheep|bighorn sheep]], [[Biology:Dall sheep|dall sheep]], and [[Biology:Red squirrel|red squirrel]]s.<ref name=Couch/>

===Sheep and goats===
It has been recorded since the late 19th century and has been reported from most sheep-or goat-raising areas, including those in Europe, the Middle East, the United States, Africa, Asia, South America, Canada, New Zealand and Australia.<ref name=Couch/> Orf is spread by [[Medicine:Fomite|fomite]]s and direct contact. In some environments, infection is injected by scratches from [[Thistle|thistle]]s<ref name=Winter_Charnley/> of both growing and felled plants. Symptoms include papules and pustules on the lips and muzzle, and less commonly in the mouth of young lambs and on the eyelids, feet, and [[Biology:Teat|teat]]s of ewes. The lesions progress to thick crusts which may bleed. Orf in the mouths of lambs may prevent suckling and cause weight loss, and can infect the udder of the mother ewe, thus potentially leading to [[Medicine:Mastitis|mastitis]].<ref name=Winter_Charnley/> Sheep are prone to reinfection.<ref name=Fenner_1993>{{cite book|author1=Fenner, Frank J. |author2=Gibbs, E. Paul J. |author3=Murphy, Frederick A. |author4=Rott, Rudolph |author5=Studdert, Michael J. |author6=White, David O. |title=Veterinary Virology (2nd ed.)|publisher=Academic Press, Inc|year=1993|isbn=978-0-12-253056-2}}</ref> Occasionally the infection can be extensive and persistent if the animal does not produce an immune response.<ref name=Winter_Charnley/>

[[Image:sheep with orf.jpg|thumb|left|A sheep with orf infection on nose and lips]]

A live virus [[Biology:Vaccine|vaccine]] (ATCvet code: {{ATCvet|I04|AD01}}) is made from scab material and usually given to ewes at the age of two months, but only to lambs when there is an outbreak.<ref name=Carter>{{cite web|author1=Carter, G.R. |author2=Wise, D.J. |year=2006|title=Poxviridae|work=A Concise Review of Veterinary Virology|url=http://www.ivis.org/advances/Carter/Part2Chap10/chapter.asp?LA=1|access-date=2006-06-13}}</ref> The vaccine can cause disease in humans.
<ref>{{cite web | url=https://www.sciencedirect.com/topics/immunology-and-microbiology/orf-virus | title=Orf Virus - an overview &#124; ScienceDirect Topics }}</ref><ref>{{cite web | url=https://www.clinicalkey.com.au/#!/content/book/3-s2.0-B9780323376921001647 | title=ClinicalKey }}</ref>

In sheep and goats, the lesions mostly appear on or near the hairline and elsewhere on the lips and muzzle. In some cases the lesions appear on and in the nostrils, around the eyes, on the thigh, coronet, [[Medicine:Vulva|vulva]], udder, and axilla. In rare cases, mostly involving young lambs, lesions are found on the tongue, gums, roof of the mouth and the oesophagus. It has also been reported a number of times to cause lesions in the rumen. In one case it was shown that a severe form of orf virus caused an outbreak involving the gastrointestinal tract, lungs, heart, as well as the buccal cavity, cheeks, tongue and lips. Another severe case was reported pharyngitis, genital lesions and infection of the hooves which led to lameness and, in some cases, sloughing of the hoof.<ref name=Couch/>

More typically, sheep will become free of orf within a week or so as the disease runs its course. Sheep custodians can assist by ensuring infected lambs receive sufficient milk and separating out the infected stock to slow down cross-transmission to healthy animals. It is advisable for those handling infected animals to wear disposable gloves to prevent cross infection and self-infection. A veterinarian must be contacted if there is a risk of misdiagnosis with other, more serious conditions.<ref name=Winter_Charnley/>

== See also ==
* Ecthyma
* List of cutaneous conditions
* List of immunofluorescence findings for autoimmune bullous conditions
* [[Chemistry:Imiquimod|Imiquimod]]
* [[Chemistry:Cidofovir|Cidofovir]]

== References ==
{{Reflist}}
== External links ==
{{Medical resources
| DiseasesDB = 9262
| ICD10   = {{ICD10|B|08|0|b|00}} (ILDS B08.040)
| ICD9  = {{ICD9|051.2}}
| ICDO  =
| OMIM  =
| MedlinePlus  =
| eMedicineSubj = article
| eMedicineTopic = 1133450
| MeshID   = D004474
}}
{{Viral cutaneous conditions}}
{{Taxonbar|from=Q2029700}}

{{DEFAULTSORT:Orf (Disease)}}
[[Category:Chordopoxvirinae]]
* [https://www.farmhealthonline.com/disease-management/sheep-diseases/orf/ Farm Health Online: Disease Management of Orf Virus in Sheep]

{{Sourceattribution|Orf (disease)|1}}