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INTRODUCTION TO A CASE OF ORF DISEASE IN  BURN WOUND AT MOTAHARI INTRODUCTION TO A CASE OF ORF DISEASE IN  BURN WOUND AT MOTAHARI

INTRODUCTION TO A CASE OF ORF DISEASE IN BURN WOUND AT MOTAHARI - PowerPoint Presentation

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INTRODUCTION TO A CASE OF ORF DISEASE IN BURN WOUND AT MOTAHARI - PPT Presentation

HOSPITAL Mahnoush Momeni Assistant Professor of General Surgery Department of Plastic Surgery Burn Research Center Iran University of Medical Science Tehran Iran Faranak Alinejad Infectious Disease Specialist ID: 913355

disease orf burn wound orf disease wound burn human patient virus parapoxvirus lesion iran infection infectious infected center lesions

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Slide1

INTRODUCTION TO A CASE OF ORF DISEASE IN BURN WOUND AT MOTAHARI HOSPITAL

Mahnoush

Momeni

Assistant Professor of General Surgery, Department of Plastic Surgery .

Burn Research Center, Iran University of Medical Science, Tehran, Iran

Faranak

Alinejad

Infectious Disease Specialist

Burn Research Center, Iran University of Medical Science, Tehran, Iran

Slide2

The cause of Orf disease is a double -stranded DNA virus of the Parapoxvirus

family.

Human Orf disease is usually due to occupational hazard and mostly occurs in abattoir workers, veterinarians, and farm workers.

(1, 2)

Orf disease may also occur in some part of world like Iran, during the feast of sacrifice.

(3)

1-Afzali H,

Momen-Heravi

M, Human Orf

Disease:a

case series in Kashan City, Iran

Internatinal

Archives of Health Science 2015;2(3):129-132

2-Becher P,

Konig

M, Muller G, Siebert U, Thiel

HJ.Characterization

of

sealpox

virus,a

separate member of the

parapoxvirus

. Arch

Virol

. 2002; 147(6):1133-40

3-Uzel M,

Sasmaz

S,

Bakaris

S,

Cetinus

E,

Bilgic

E,

Karaguz

A, et al. A viral

infectin

of the hand commonly seen after the feast of sacrifice: Human Orf (

orf

of the hand).

Epidemiol

Infec

. 2005; 133(4):653-7

Slide3

Manifestations:Goats and S

heep

:

sore mouth, scabby mouth or contagious postural dermatitis.

(1

)

Human Infection

:

Isolated

lesion on arms and hands,

face

or

peri

anal area .

(4)

Benign

neoplastic lesions

Mostly

self-limited.

Fever

and lymphadenopathy.

(5

)

4-Bayindir Y,

Bayracdar

M,

Karadag

N,

Ozcan

H,

Kayabas

U,

Otulo

B, et al. Investigation and analysis of a human

orf

outbreak among people living on the same farm. New

Microbiologica

. 2011; 34(1):37-43

5-Taghipour M,

Babamahmoodi

F,

Arashnia

P,Taghipour

S Orf Virus in human (

EchtymaContagiosum

): A Report of Eight Cases in the North of Iran.

Int

J Med Invest 2015;

vol

4;

num

1; 183-186

Slide4

Orf lesions manifest in different pattern in the human body: Erythematous maculopapular lesion

Target

shape lesion with a red center.

Regeneration

stage

:dry

lesion with black dots

Papillomatous

and dry crust

. (6, 7

)

6-Zimmerman JL. Orf. JAMA. 1991;266(4):476

7-Mendez B, Burnett JW.

Orf.JAMA

. 991;266(4):476

Slide5

Diagnosis:History of contact with infected animalThe presentation of clinical lesion Viral culture (3)

Treatment

:

Supportive care with topical antibiotic

when the wound infected by bacteria, systemic antibiotic may be applied

Recovery often happens within 2-3 weeks.

Larger lesions sometimes need surgery.

(8)

Treatment with Imiquimode and ribavirin.

(9)

8-Buller RML. Poxviruses. In Cohen J, Powderly WG, Opal SM, eds. Infectious

Diseas

, 3rd

edn

.

Philadelphia:Mosby

Elsevier, 2010: 1577-1582

9-Mandell Douglas, Bennet John E, Dolin Raphael, Blaster Martin J,DNA virus Chapter, Mandell, Douglas, and

Bennettes

Principle and Practice of Infectious Disease, 8th

edn,Philadelphia

: Churchill Livingstone Elsevier, 2015: 1701

Slide6

Case: There was an 18 year old female shepherd who was burned 22% TBSA, on July 10th, 2015 while starting a campfire, and was admitted to the local hospital. Dressing was changed daily and early surgical debridement was performed, then upper extremity was skin grafted and it took, but later vegetative granulomatous ulceration appeared on improved as well as the grafted areas.

Slide7

Slide8

Lab test results: White

blood cell count

:

normal

Hemoglobin

levels

;a

little low.

Blood

culture

:negative

Wound at the time of admission

:

There was some vegetated granular

lesions

Slide9

Wound Management In Central Hospital:Wound disinfection with Dakin’s solutions

Excision after

4 days of dressing change.

Usage of Sulfamylon

(Mafenide) topical was used on excised

area

Wound coverage with

allograft 4 days later.

Replacement of allograft with autograft

after 12

days

Slide10

Slide11

The result of the first wound culture in Motahari hospital : Pseudomonas MDR

.

The histology

report of the previous hospital

:

hyperkeratosis

and pseudoeptheliamatous hyperplasia, dermal edema and congestion with dermal spindle cell proliferation.

The report of tissue culture of the patient in Motahari hospital

:

Granulation type hemangioma with ulceration.

Slide12

The report of tissue culture in Virus lab:

Viral DNA was extracted for a tissue biopsy using High Pure DNA extraction kit (ROCHE, Germany).

Sample was tested for camel pox, Capri pox, Sheep pox, Goat pox using PCR by specific printing.

The results showed that the PCR test for Parapoxvirus was

positive.

Slide13

Discussion:Orf disease is a disease of goat, sheep and cows . (1)

Individuals are infected  by direct contact with infected animals.

(5)

The disease occurs worldwide, but it has been reported more in Europe and New Zealand 

(

10)

The

virus survives in the skin of the animal up to one month after improvement.

(5

)

10-Damon IK. Other poxvirus that infect

humans:Parapoxvirus

,

Molluscomcontagiosum

, and

Yatapoxviruse

. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and

Bennettes

Principle and Practice of Infectious Disease, 7th

edn

. Philadelphia : Churchill Livingstone Elsevier, 2010:1933-1936

Slide14

Incubation period for Parapoxvirus in human is 3-7 days.

The course of Orf infection is 4-8 weeks.

Neither Orf infection, nor smallpox vaccination grant permanent immunity

.(11)

11-Amira

A.

Roess

, Ph.D.,

Anjela

Galan, M.D., Edward

Kitces

, M.D., Ph.D., Yu Li, Ph.D., Hui Zhao, M.D., Christopher D. “Novel Deer-Associated Parapoxvirus Infection in Deer Hunters.”

N

Engl

J Med 2010; 363:2621-2627

Slide15

In persons who work with animals the disease mostly appears as :A solitary lesion on the finger, forearm and/or hand lens-shaped nodule with red center and pale circle.

(12)

larger exudative lesions .

Black spots in regenerative phase.

Small papilloma.

Healed lesion.

(5)

The Orf disease is a self-limited diseases.

12-shirazi

MR,

Pedram

N,

Orf:Report

of eleven cases in five Iranian Families. Iranian Journal of Clinical Infectious Disease. 2007;2(2):83-85

Slide16

In our patient Partial thickness injuries converted to deep ones

and required skin grafting for coverage. The

lesions

spread

over

the entire

donor

site too and previous grafted area failed.

Slide17

Reports of Orf disease peaked the most in Norway during 1975 (13) and New Zealand in 1983 (14)

In Shamsedini’s et al. study, considers that in 15012 patients older than 20 years between 1991-1996 in a dermatology center, the Orf incidence has been reported about 0.4%

(15) 

Nedim

et al.   reported  5 cases of children Orf disease in farmers in western part of Ireland within a decade

.(16)

13-Johannessen

JV, Krogh HK, Solberg L,

Delan

A, van

Wijngaarden

H, Johansen B. Human

orf.Cutan

Pathol.1975;2(6):265-83

14-

Robinson

AJ,Petersen GV. Orf virus infection of workers in the meat industry. N Z Med J.1983;96(725):81-515-Shamsaldini S, Rezaei A. Incidence of orf disease in dermatology center clinic in Kerman. Razi J Med Sci.1999;5(2)30-5.[Persian]16-Nadeem M, Curran P, Cooke R, Ryan CA, Connolly K. Orf: Contagious pustular dermatitis. Ir Med J.2010;103(5):152-3

International Reports of Orf Disease

Slide18

Shirzad et al.  reported a patient with Orf disease, who had a history of cutting meat with an infected knife. The patient was infected following a finger injury. Contact with such a wound will transmit the disease. (12)Middli

et al. reported patients with Orf disease whom were infected by scissors, ointments and water tanks .

(17) 

Roess

et al

. Reported Deer-Associated Parapoxvirus Infection in Deer Hunters in North America

(11)

17-Midilli

K,

Erikilic

A,

Kuskuko

m,

Analay

H,

Benzonana

N. “Nosocomial outbreak of disseminated

orf infection in a burn unit, Gazinatep, Turkey, October to December 2012.”European Journal of Infectious disease epidemiology prevention and control 2013;18(11) International Reports of Orf Disease cont.

Slide19

CONCLUSION Orf disease could infect burn wound and even the healing area of superficial burn could be deepened and thus may require skin grafting.

In burn patient with a history of probable contamination, the disease should also be considered.

 

Manipulation of the disease in the early stages of the burn wound, could also potentially spread the disease and change the degree of the wound, as was the case in our patient.

Slide20

For prevention of nosocomial outbreak of Orf:Wound care and wound disinfection should be carried out impeccably

Isolation and disinfection of all the dressing tools should also be done precisely.

The proper training of wound care providers in burn units should be provided

Perfect wound disinfection must be performed to protect the patient from cross contamination following this phase.