Pseudocowpox - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Skin lesion Pseudocowpox or the "Milker's nodules" is a disease caused by Pseudocowpox virus of the genus Parapoxvirus. It produces mild infections of the teats of cows and ulcers in the mouths of calves. Human disease is contracted through direct transmission. Two weeks following the exposure to a infected cattle, patient develops small, red, raised, flat-topped spots. Within another week, they develop into slightly tender blisters or nodules (lumps). The top of the nodules often develops a grayish skin and a small crust. The nodules are usually on the hands, particularly the fingers, but occasionally the face. They are usually solitary and rarely can be numerous. The lesions may or may not be painful. Skin lesion
Pseudocowpox or the "Milker's nodules" is a disease caused by Pseudocowpox virus of the genus Parapoxvirus. It produces mild infections of the teats of cows and ulcers in the mouths of calves. Human disease is contracted through direct transmission. Two weeks following the exposure to a infected cattle, patient develops small, red, raised, flat-topped spots. Within another week, they develop into slightly tender blisters or nodules (lumps). The top of the nodules often develops a grayish skin and a small crust. The nodules are usually on the hands, particularly the fingers, but occasionally the face. They are usually solitary and rarely can be numerous. The lesions may or may not be painful.
Itch The pseudocowpox nodules sometimes may itch. Itch
The pseudocowpox nodules sometimes may itch.
Ulceration Central ulceration or crust may occur in some nodules which may resolve spontaneously over 4-6 weeks. Ulceration
Central ulceration or crust may occur in some nodules which may resolve spontaneously over 4-6 weeks.
Nonspecific symptoms Some patients may show nonspecific symptoms such as fever, diarrhea or abdominal cramping. Nonspecific symptoms
Some patients may show nonspecific symptoms such as fever, diarrhea or abdominal cramping.
At risk population The virus transmit from direct contact when an individual in contact with an infected animal. So, the disease is more common among milkers, farm workers caring for dairy cattle, stockyard workers, butchers, and veterinarians. At risk population
The virus transmit from direct contact when an individual in contact with an infected animal. So, the disease is more common among milkers, farm workers caring for dairy cattle, stockyard workers, butchers, and veterinarians.

Clinicals - Examination

Fact Explanation
Skin lesion The lesion begins as an erythematous maculopapular rash, commonly on fingers and occasionally over the face. These are 0.5-1.5 cm in diameter, firm, movable and dome-shaped. They are red or purplish red in color and may show a central ulceration which happens to be a grayish crust. The lesions may be tender, solitary or multiple, and may show secondary bacterial infections. Skin lesion
The lesion begins as an erythematous maculopapular rash, commonly on fingers and occasionally over the face. These are 0.5-1.5 cm in diameter, firm, movable and dome-shaped. They are red or purplish red in color and may show a central ulceration which happens to be a grayish crust. The lesions may be tender, solitary or multiple, and may show secondary bacterial infections.
Lymphadenopathy Rarely localized tender lymph node enlargement can be observed. Lymphadenopathy
Rarely localized tender lymph node enlargement can be observed.

Investigations - Diagnosis

Fact Explanation
Viral culture Viral cultures take time. Even though it can not differentiate between orf and milker's nodule. Viral culture
Viral cultures take time. Even though it can not differentiate between orf and milker's nodule.
Polymerase chain reaction (PCR) PCR may be performed on biopsy material or cell culture. This is diagnostic of pseudocowpox virus. Polymerase chain reaction (PCR)
PCR may be performed on biopsy material or cell culture. This is diagnostic of pseudocowpox virus.
Electron microscopy Electron microscopic evaluation of crust or biopsy material may reveal viral particles. Still the definitive diagnosis of pseudocowpox virus can not be made. Electron microscopy
Electron microscopic evaluation of crust or biopsy material may reveal viral particles. Still the definitive diagnosis of pseudocowpox virus can not be made.
Skin biopsy for histology A shave biopsy is performed for hematoxylin and eosin tissue histology. The characteristic pathological features are epidermal hyperplasia, marked swelling of the dermis, intra epidermal and subepidermal blistering, and a dense mixed inflammatory infiltrate. Skin biopsy for histology
A shave biopsy is performed for hematoxylin and eosin tissue histology. The characteristic pathological features are epidermal hyperplasia, marked swelling of the dermis, intra epidermal and subepidermal blistering, and a dense mixed inflammatory infiltrate.

Management - Supportive

Fact Explanation
Antiviral treatment Antiviral medications are not routinely indicated. Antiviral treatment
Antiviral medications are not routinely indicated.
Antibiotics Topical or systemic antibiotics are only used in case of secondary bacterial infection. Antibiotics
Topical or systemic antibiotics are only used in case of secondary bacterial infection.
Surgical options Superficial shave excision has been found to be effective as it reduces the viral load by a considerably high number and hence, speed up the healing process. Curettage and cautery can be started in conjunction with shave excision. Surgical options
Superficial shave excision has been found to be effective as it reduces the viral load by a considerably high number and hence, speed up the healing process. Curettage and cautery can be started in conjunction with shave excision.
Prevention Animals who are infected with the virus should be detected early and isolated. The infections can be identified when animals with typical lesions of circinate or horseshoe-shaped crusted erosions around moist surfaces of the mouth and nose or papules and erosions around the teats. Gloves should be worn if milking. Prevention
Animals who are infected with the virus should be detected early and isolated. The infections can be identified when animals with typical lesions of circinate or horseshoe-shaped crusted erosions around moist surfaces of the mouth and nose or papules and erosions around the teats. Gloves should be worn if milking.

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