666. Human Orf - An Under-recognized Zoonotic Infection
Session: Poster Abstract Session: Oh, Those Pesky Viruses!
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Human Orf (1).pdf (167.9 kB)
  • Background: Human orf infections are self-limiting, occupational zoonotic infections which are under-reported. It is endemic in many parts of the world. In the Middle-East it is commonly associated with animal slaughtering during religious festival.

    Methods: A case report

    Results: A 58-year-old Arab male presented to the dermatology clinic with a history of progressively enlarging reddish swelling over radial aspect of right index finger of 3 weeks duration, with minimal local discomfort. It initially began as a red small patch and rapidly worsened to occupy half the finger. Patient denied history of fever, night sweats, weight loss or other systemic symptoms. He did not have any pets at home. Patient recollected having slaughtered a sheep in observance of a ritual for the religious festival of Eid one week prior to the onset. Physical examination revealed a reddish, violaceous target-like plaque (2.5x2.5 size) (figure 1) with a central yellowish-white area which appeared pus filled, with a surrounding bulla, and a bright red rim. Aspiration attempted from the lesion did not yield any fluid or pus. Systemic examination was unremarkable. He was treated with oral amoxicillin-clavulanate, local fucidin ointment and saline compresses for presumed abscess, with a plan for follow up after two weeks. After a week, patient presented to the emergency department with rapid increase in size of the lesion, and axillary tenderness. The morphology of the lesion had changed and it had become more flattened out with a raw granulomatous appearing base (figure 2). Axillary lymphadenopathy of the same side with mild tenderness was noted. Routine labs were unremarkable. Radiograph of the hand did not show underlying bony involvement. At the next follow up one week later, the plaque was covered by a thin crust through which black dots were seen. (Figure 3) Based on the epidemiology and evolution of the skin lesion and associated examination findings, a clinical diagnosis of ‘orf’ was made. At 2-weeks follow-up visit the lesion had almost completely resolved.

    Conclusion: Human orf can occur outside the realm of occupational exposures. It is endemic but under-reported in Middle Eastern population. The characteristic evolution through different stages and self-limiting nature of the disease warrant no further investigations.

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    Ceena Neena Jacob, MD, Dermatology/Internal Medicine, Hamad Medical Corporation, Doha, Qatar

    Disclosures:

    C. N. Jacob, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.