Contagious Importance Contagious ecthyma is a highly contagious, zoonotic, viral skin disease that affects Ecthyma sheep, goats and some other domesticated and wild animals. The skin lesions are painful and often occur on the mouth and muzzle, where they can cause anorexia or starvation. Orf, Lesions on the udder may result in the abandonment of offspring, and foot lesions can Ecthyma Contagiosum, cause transient lameness. Secondary bacterial infections can occur and, in rare cases, the lesions may extend into the internal organs. Although contagious ecthyma usually Contagious Pustular Dermatitis, resolves spontaneously and the mortality rate is generally low, deaths can occur from Contagious Pustular Stomatitis, sequelae such as secondary infections or failure to nurse. The economic impact can be Infectious Labial Dermatitis, significant. Severe generalized infections have also been described occasionally. Soremouth, Most infections in humans are localized and heal spontaneously; however, large, Scabby Mouth poorly healing lesions can occur in people who are immunosuppressed. Etiology Last Updated: September 2015 Contagious ecthyma results from infection by the orf virus, a member of the genus Parapoxvirus in the subfamily Chordopoxvirinae and family Poxviridae. Species Affected Contagious ecthyma mainly occurs in sheep and goats. This disease has also been observed in other ungulates including alpacas, reindeer (Rangifer tarandus), Japanese serows (Capricornis crispus), musk oxen (Ovibos moschatus), bighorn sheep (Ovis canadensis), Sichuan takin (Budorcas taxicolor tibetana), deer, pronghorn (Antilocapra americana) and wapiti/ elk (Cervus canadensis), and it is suspected to occur in some wild chamois (Rupicapra rupicapra). Limitations in diagnostic testing can sometimes result in a virus being identified initially as orf virus, but later reassigned to another species of parapoxvirus. For example, a disease initially described as contagious ecthyma in camels is now attributed to pseudocowpox virus. Rare cases of contagious ecthyma have been reported in dogs and cats. Rabbits and mice could be infected experimentally by some groups, but not others; their susceptibility might be influenced by factors such as the viral strain or dose. Zoonotic potential Orf has been reported in people who handled infected animals or their tissues. Geographic Distribution Contagious ecthyma has been found worldwide in all countries that raise sheep. Transmission Orf virus occurs in skin lesions and scabs. It can be transmitted by direct contact or on fomites, and is thought to enter the skin through cuts and abrasions. Whether saliva can transfer the agent in animals with oral lesions, such as reindeer, is still uncertain. Orf virus can be carried by clinically normal sheep; it is reported to remain viable on the wool and hides for approximately one month after the lesions have healed. This virus is very resistant to inactivation in the environment, and has been recovered from dried crusts for several months or years in the laboratory, with one account of survival for up to 12 years. Survival may be shorter in wet conditions. Humans can become infected by contact with infected animals or contagious ecthyma vaccines, which contain live virus. The vaccine viruses are also contagious when shed from recently immunized animals. Person-to-person transmission has reported in very rare instances, which included direct contact with lesions or a fomite that contacted both lesions and broken skin. Nosocomial transmission was responsible for one outbreak in a burn ward. Disinfection Sodium hypochlorite and two quaternary ammonium-based commercial disinfectants were effective against orf virus in a recent study, but ethanol was ineffective. Other disinfectants that have been suggested for poxviruses include detergents, alkalis, Virkon® and glutaraldehyde. In an early study, orf virus was inactivated by heating at 59°C for 30 minutes. www.cfsph.iastate.edu Email: [email protected] © 2005-2015 page 1 of 5 Contagious Ecthyma Infections in Animals locally in all three cats after excision and/or amputation of the affected digit, and resulted in eventual euthanasia. There Incubation Period is an additional report of a cat with multiple scabs on the face The incubation period is thought to be short. Clinical and back, which healed within 2 weeks, and were associated cases have been reported in sheep and goats 2 to 3 days with a parapox-like virus; however, the identity of the virus after exposure. Experimental infections in reindeer became in this case is uncertain. apparent in approximately 5 days. In the 1970s, contagious ecthyma was suspected in a pack of dogs that had been periodically fed entire, Clinical Signs unskinned carcasses from sheep and other animals. The Small ruminants and other ungulates dogs developed circular areas of acute, most dermatitis with ulcers and scabs, mainly around the head. The outcome was The signs of contagious ecthyma vary considerably in not described. These lesions occurred concurrently with a severity, from hyperemia and small pustules around the case of orf in the kennel huntsman, and were diagnosed by mouth and muzzle, to extensive proliferative and exudative inoculation into sheep, with electron microscopy to confirm lesions and scabs that may involve the mucosa as well as a parapoxvirus in lesions from the sheep. the skin. Initially, orf appears as papules, pustules and vesicles, typically found on and around the muzzle, mouth Mild to moderate skin lesions were reported in and nose, and sometimes on the ears, eyelids, feet, perineal experimentally infected rabbits, and consisted of self- region or other sites (e.g., the tail after docking). Lesions limited local erythema, macules, papules, small vesicles and may also occur inside the mouth, particularly in young pustules. Similar but very mild signs were reported in lambs and reindeer. Some reindeer were reported to have experimentally infected mice. oral lesions with no apparent cutaneous involvement. These Post Mortem Lesions Click to view images lesions can sometimes become very large. Rarely, lesions Lesions seen at necropsy generally resemble those in may extend into the esophagus, stomach, intestines or the live animal. Histopathological findings include respiratory tract. Nursing lambs can transmit the virus to ballooning degeneration of keratinocytes and eosinophilic their dam, resulting in lesions on the teats and udder. The cytoplasmic inclusions. Rarely, lesions have also been skin lesions eventually develop into thick, brown, rapidly reported in the esophagus, rumen, omasum, lungs, heart and growing scabs over areas of granulation, inflammation and lower intestinal tract. ulceration. The scabs are often friable and bleed easily. Papillomatous growths may also be seen. In addition to skin lesions, Boer goats with severe infections had severe to moderate lymphadenopathy of the Contagious ecthyma lesions are painful and can result draining lymph nodes in areas of affected skin. Suppurative in anorexia or even starvation. Young animals may refuse arthritis, chronic fibrinous pneumonia and premature to nurse, and lesions on the udder of the dam can cause it to thymic involution were reported in these animals. abandon its offspring. Foot lesions can result in lameness. Complications can include secondary bacterial infections Diagnostic Tests (including Dermatophilus congolensis on the feet) and Infections in animals are usually diagnosed maggot or screwworm infestations. Contagious ecthyma symptomatically. The diagnosis can be confirmed by can also predispose animals to bacterial mastitis, including electron microscopy of the scabs, which should be collected gangrenous mastitis. Uncomplicated cases of contagious from animals in an early stage of the disease; however, this ecthyma usually resolve within 1 to 2 months. technique cannot distinguish the orf virus from other Severe cases, with more generalized and/or persistent parapoxviruses. Histopathology is also helpful. PCR tests lesions, have been reported in some individual animals or may be available from some laboratories. A loop-mediated herds/flocks. In one unusual case, Boer and Boer cross isothermal amplification assay has also been published. goats developed multifocal, severe proliferative dermatitis Virus isolation is uncommonly used, but can be accompanied by chronic pneumonia, arthritis and moderate attempted in a variety of cell cultures or embryonated eggs. to severe lymphadenopathy. The disease persisted for three However, orf virus grows slowly and cannot always be months until the animals were euthanized. isolated. Serological tests that have been described include Other species serum neutralization, ELISAs, agar gel immunodiffusion In 2008, three cases of contagious ecthyma were (AGID), complement fixation and agglutination. Antibody reported in cats that had been exposed to farms with infected reactions are generally short-lived. small ruminants. In all three cases, the lesions occurred on Treatment the feet. One lesion was red and friable, with a cauliflower- like appearance. The second cat had a swollen, proliferative, Treatment for contagious ecthyma consists of ulcerated lesion between the digits, and the third developed a supportive care, which may include tube feeding, together proliferative, ulcerated lesion on a digit. The lesions recurred with antibiotics as needed for secondary infections. © 2005-2015 www.cfsph.iastate.edu Email: [email protected] page 2 of 5 Contagious Ecthyma