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Patient Case: ORF Virus Infection

Patient Case: ORF Virus Infection

Discussion

A 35-year-old male livestock farmer presents to the clinic with a painful lesion on his right index finger. He reports that the lesion started as a small red bump about a week ago after handling a recently sick sheep on his farm. Over the past few days, the lesion has enlarged, becoming a firm, dome-shaped nodule with a central crust. He denies fever, lymphadenopathy, or systemic symptoms.

On examination, a single, well-demarcated, erythematous lesion with a weeping surface is noted on the finger. There is mild surrounding swelling, but no signs of deep tissue infection. Given his occupational exposure and the characteristic lesion, ORF virus infection (contagious ecthyma) is suspected. The patient is reassured about the self-limiting nature of the disease and advised on wound care and hand hygiene to prevent secondary bacterial infection

Questions
  1. What is the most likely mode of transmission for ORF virus infection in this patient?
    a) Inhalation of respiratory droplets
    b) Direct contact with infected animals or contaminated surfaces
    c) Consumption of undercooked meat
    d) Mosquito bites
  2. Which of the following is a characteristic feature of an ORF lesion?
    a) Deep ulceration with purulent discharge
    b) Dome-shaped nodule with a weeping surface and central crust
    c) Multiple vesicles at different stages of development
    d) Scaly, hyperkeratotic plaques with intense itching
  3. What is the typical course of ORF virus infection?
    a) Spontaneous resolution within 3-6 weeks without scarring
    b) Progressive tissue necrosis requiring surgical excision
    c) Chronic infection with recurring outbreaks
    d) Rapid systemic spread leading to severe complications
  4. What is the most appropriate management approach for ORF in an otherwise healthy individual?
    a) Oral antiviral therapy
    b) Surgical excision of the lesion
    c) Supportive care and wound management
    d) High-dose corticosteroids
Reveal answers

Answers

  1. (b) Direct contact with infected animals or contaminated surfaces
    • ORF is a zoonotic infection primarily transmitted through direct contact with infected sheep and goats or contaminated equipment, commonly affecting farmers and veterinarians.
  2. (b) Dome-shaped nodule with a weeping surface and central crust
    • ORF lesions typically progress through six stages, with the most characteristic appearance being a raised, nodular lesion with a moist surface and central crusting.
  3. (a) Spontaneous resolution within 3-6 weeks without scarring
    • ORF is usually self-limiting, resolving within a few weeks without significant complications or scarring, though secondary bacterial infection can sometimes occur.
  4. (c) Supportive care and wound management
    • Treatment is primarily supportive, including wound care and pain management. Antibiotics are only needed if a secondary bacterial infection develops.