* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Erythema multiforme as a result of Orf disease
Survey
Document related concepts
West Nile fever wikipedia , lookup
Meningococcal disease wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Neglected tropical diseases wikipedia , lookup
Chagas disease wikipedia , lookup
Onchocerciasis wikipedia , lookup
Marburg virus disease wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Leptospirosis wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Oesophagostomum wikipedia , lookup
Schistosomiasis wikipedia , lookup
Visceral leishmaniasis wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Leishmaniasis wikipedia , lookup
Transcript
Erythema multiforme as a result of Orf disease Abstract: Orf is a mucocutaneous disease occurs by contact of nonintact skin through of contaminated saliva of sheep. Erythema multiforme and or Stevens-Johnson syndrome,s common causes are herpes simplex virus,mycoplasma pneumonia and drugs (8). But its evolution following Orf is rarely seen at clinical practice.In this study we present two cases of erythema multiform following orf. 1-A 45 year old woman admitted in our emergency room with Erythema multiforme and orf lesions in her hand that completely relieved after supportive therapy. 2-The second was a 32 years old woman admitted to our hospital with erythema multiforme lesions and related finger nodules. The systemic eruptions were cured within 6 days and Orf lesions for 5 weeks. Key words: Orf , Erythema multiforme Introduction: Orf is a mucocutaneous disease caused by parapoxviruses, containing double-stranded DNA. (1,2) Other names of it included sheep pox, ecthyma contagiosum contagious pustules. (3) Transmission to humans occurs by contact of nonintact skin through of contaminated saliva of sheep and goats and their inanimate objects (4) .In humans, the incubation period varies from 3 to 10 days and then evolves single or multiple lesions, which arise mostly in the hands and face.At the onset of the disease , primary lesions are the papules that gradually progresses to the nodular patterns. The nodules change into tubercule or crusted form within 4-6 weeks ( 5) .The lesions may complicated to lymphangitis or secondary bacterial infections. rare systemic complications such as erythema multiforme, maculopapular rash , generalized lymphadenopathy are seen during the course of the disease (6, 7).In this study we present two cases of erythema multiform following orf. Case presentation: 1-A 45 year old woman admitted in our emergency room with chief complaint of generalized erythema , low fever , and mild itching . several target lesions and purple nodules with a brief fluctuation were found in the first phalange of right index finger and in the third phalange of right finger. She noted that she cleaned KALE-PACHE 30 days ago. Finger lesions appeared 3 days after that and gradually enlarged. Warm compresses and low dose of corticosteroids administered . the generalized eruptions were disappeared within five days with complete recovery of them after 6 weeks(figure-1). 2-The second was a 32 years old woman admitted to our hospital with erythema multiforme lesions and related finger nodules. She remembered exposure to the head of a sheep and bite of the finger. Three days after that,the lesions was appeared on her first phalange of right thumb. After ten days,generalized erupotions were appeared throughout of her body. Supportive therapy with low doses of corticosteroid were given.The systemic eruptions were cured within 6 days and Orf lesions for 5 weeks(figure-2). (figure-1) (figure-2) Discussions: Erythema multiform is caused by several etiologic reasons, the most common is herpes simplex virus,mycoplasma pneumonia and drugs(8). But its evolution following orf is rarely seen at clinical practice.In this study we present two cases of erythema multiforme following Orf.During Eid-Ul-Adha more than million sheeps kill and slaughter by muslim countries. Slaughtering and providing of sheep by sheeperd or housewife and minimal trauma to the hand of them may cause Orf.Diagnosis of Orf disease usually based on physical examination and the history of infected animal exposure (9).In most cases, the lesions are self-limited and only topical treatment with preservatives added to prevent bacterial infections is sufficient(10).Enhanced immune response to the virus may explain the incidence of erythema multiforme in some people(11).many literatures reported instances or erythema multiforme following Orf disease who didn’t take any antibiotic and have no disease contribute to erythema multiforme (12,13,14,15) .Therefore Orf seems can trigger immune system and cause skin reactions. But more investigation needs to prove this idea.In two patients presented with low-dose corticosteroid , supportive care, erythema multiforme were improved waste and waste fingers were cleared within a few weeks without obvious scarring. Conclusion: So in endemic regions erythema multiforme should be considered in the differential diagnosis of patient with erythema multiform or Stevens-Johnson syndrome as the possible cause the disease.Finally , Orf is a self limited disease. But early diagnosis can prevent unnecessary interventions.A careful history of the patient can help in the diagnosis of the disease.Having knowledge about rare diseases, such as bullous pemphigoid or erythema multiforme like lesions help doctors to diagnose and treat these complications in a timely manner. Acknowledgments: We thank to all staffs at the Rohani Hospi-tal, Babol, for their help and assistance. Conflict of interest: None. Funding Support: None. Author’s Contributions:None. References: 1)Haig DM,Mercer AA.Ovine diseases:orf.vet Res.1998;29:311-26. 2)Shahriar Alian,Fatemeh Ahangarkani,sara arabsheybani.A Case of Orf Disease Complicated with Erythema Multiforme and Bullous pemphigoid like Eruptions.Hindaiwi publishing carporation case report of infectious Disease.Volume 2012,Article ID 105484,4 pages. 3)James WD,Berger T,Elston DM,et al.Andrew’s diseases of the skin,loth edn.saundes company,2006:393-394. 4)LOC,Gleenn M.Human orf in Los Angeles.Country.West J Med 1996;I64:77-78. 5)Unal G.Gundesos,Ustunturk M.Human Orf: echtyma contagiosum report of five cases.Turk J Med sci 2002;32:173-175. 6)omer cuskon,hanefi cem gul,aybars bilgeturk,et al. Human Orf complicated with erythema multiforme. DOI: 10.1111/j.1365-4632.2008.03845.x · Source: PubMed 7)Assier H,bastuji-Grain S,Revuz J,Roujeau JC.Erythema multiforme with mucous membrane involvement and steven-johnson syndrome are clinically different disorders with distinct causes.Arch Dermatal 1995;131:539-543. 8) W. R. Slattery, M. Juckett, W. A. Agger,et al.Milkers’ nodules complicated by erythema multiforme and graftversus-host disease after allogenic hematopoirtic stem cell transplantation for multiple myeloma.clinical infectious disease,vol.40,No.7,pp.e63-e66,2005. 9)Perihan ozturk,hamide sayar,tugba karakas,et al.erythema multiforme as a result of orf disease.doi : 10.2478/v10162-012.0013-4 10)Aygun G, Cavuslu S, Cingil H, Birinci U. Erythema Multiforme ile Komplike Olmuş Bir Orf Olgusu. [A case of orf complicated with erythema multiforme]. Klimik Dergisi. 2000;13:39-40. Turkish. 11)Schmidt E, Weissbrich B, Bröcker E-B,et al. Orf followed by erythema multiforme. J Eur Acad Dermatol Venereol. 2006;20:612-3. 12 R. H. JOSEPH1,2*, F. A. HADDAD3, A. L. MATTHEWS4 ,et al.erythema multiforme after orf virus infection : a report of two cases and literature review.epidemiol.infect.(2015),143,385-39. 13)agger.wa,Webster sb,et al.human orf infection complicated by erythema multiforme.cutis 1983;31:334-338. 14)azizzadeh m.case report of orf followed by erythema multiforme.journal of semnan university of medical science 2007;9:1-2. 15)coskum o.human orf complicated with erythema multiforme.international journal of dermatology 2008;47;1333-1334.