Milker's Nodule Research Articles

A Case of Milker's Nodule, an Occupational Dermatosis from Infected Cattle.

A Case of Milker's Nodule, an Occupational Dermatosis from Infected Cattle.

Enhancing diagnostic accuracy in common human poxvirus infections during mpox outbreak: A dermoscopy review.

Poxviruses belong to the Poxviridae family, a group of pathogens known for their high infectivity in humans, posing significant health threats. One of the most well-known representatives of poxvirus infections is smallpox, which has been successfully eradicated. However, in recent years, there has been a resurgence in cases of mpox, another member of the Poxviridae family, raising concerns about the potential for a global pandemic or a worldwide health crisis. While the typical clinical presentation of mpox and other poxvirus infections often involves cutaneous lesions, there have been reports of various atypical and non-classic clinical manifestations. Dermoscopy has emerged as a crucial diagnostic tool, aiding dermatologists in clinical practice to make informed decisions. In this summary, we provide an overview of the clinical and dermoscopic features of representative cutaneous lesions associated with human poxvirus infections, including mpox, orf, milker's nodule, and molluscum contagiosum.

Milker's Nodule (Pseudocowpox) in a Female Patient Following a Calf Bite.

Milker's Nodule (Pseudocowpox) in a Female Patient Following a Calf Bite.

Milker's nodule

Milker's nodule is caused by a cylindrical parapoxvirus that is most commonly endemic in cattle. It affects those in close contact with animals harboring the virus. We report a 30-year-old female, milkmaid who presented with painful raised lesions over the right hand of 8-day duration. No lymphadenopathy was noted. Skin biopsy revealed epidermal hyperkeratosis, parakeratosis, and acanthosis with dense inflammatory infiltrate in the papillary dermis. The patient was treated with a course of antibiotics for the secondary infection, as there was no specific treatment for the same.

Milker's nodule: an occupational infection and threat to the immunocompromised.

Milker's nodule virus, also called paravaccinia virus, is a DNA virus of the parapoxvirus genus transmitted from infected cows to humans. It results from contact with cattle, cattle by-products or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers and agricultural tourists. The viral infection begins 5-15days after inoculation as an erythematous-purple, round nodule with a clear depressed centre and a surrounding erythematous ring. While familiar to those in farming communities, the presence of the nodule may be concerning to others, particularly the immunosuppressed. Milker's nodules are self-limited in immunocompetent individuals and heal without scarring within 8weeks. Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct contact. While complications are rare, haematopoietic stem cell transplant recipients are at risk of graft-versus-host disease, as the parapoxvirus may trigger these complications in immunocompromised individuals. In addition, paravaccinia may serve as the antigen source for the development of erythema multiforme. The unique structure and replication process of viruses in the Poxvirus family, while includes the Parapoxvirus genus, have been a focus for treatment of infections and cancer. Manipulation of these viruses has demonstrated promising therapeutic possibilities as vectors for vaccines and oncologic therapy.

Dermoscopic features and types of orf and milker's nodule.

IntroductionOrf and milker’s nodule are zoonotic cutaneous diseases generated by parapoxviruses. Contribution of dermoscopy to the diagnosis of these diseases has not been studied in the medical literature as to our knowledge.AimTo investigate whether dermoscopy is a valuable diagnostic tool in orf and milker’s nodule diagnosis or not.Material and methodsIn this study, macroscopic and dermoscopic features have been evaluated by including 46 lesions of 32 patients who have orf and milker’s nodule.Results56.5% (26) of lesions were orf, while 43.5% (20) of lesions were milker’s nodule (MN). Non-vascular dermoscopic structures have been determined as follows: blue-gray area (23.1% of orf, 35% of MN), orange-yellow streaks (19.2% of orf, 19.2% of MN), grayish-whitish streaks (26.9% of orf, 55% of MN), central yellow-white area (26.9% of orf, 35% of MN), crust (46.2% of orf, 40% of MN), erosion-ulceration (69.2% of orf, 55% of MN), yellow-white globule (11.5% of orf, 15% of MN), and yellow-white ring (57.7% of orf, 35% of MN). Limitations: Lack of PCR analysis, based of patient anamnesis types of orf and milker’s nodule.ConclusionsNo significant dermoscopic differences have been determined between orf and milker’s nodule patients’ lesions. In our opinion, dermoscopy may be a useful tool to develop diagnosis of these diseases.

Milker's nodule: viral zoonosis among agricultural workers in a tertiary care hospital from rural Tamilnadu

Milker’s nodule caused by pox virus is not so uncommon among animal handlers in rural Tamilnadu. It is an occupational hazard. Diagnosis by clinical acumen. No special laboratory test needed, managed symptomatically. It leaves behind no major sequelae.

The Munich Outbreak of Cutaneous Cowpox Infection: Transmission by Infected Pet Rats

Cowpox virus infection of humans is an uncommon, potentially fatal, skin disease. It is largely confined to Europe, but is not found in Eire, or in the USA, Australasia, or the Middle or Far East. Patients having contact with infected cows, cats, or small rodents sporadically contract the disease from these animals. We report here clinical aspects of 8 patients from the Munich area who had purchased infected pet rats from a local supplier. Pet rats are a novel potential source of local outbreaks. The morphologically distinctive skin lesions are mostly restricted to the patients' necks, reflecting the infected animals' contact pattern. Individual lesions vaguely resemble orf or Milker's nodule, but show marked surrounding erythema, firm induration and local adenopathy. Older lesions develop eschar, leaving slow-healing, deep ulcerative defects after eschar separation. Severe flu-like illness may be present in the acute phase. Smallpox-vaccinated patients tend to develop less severe reactions and heal more quickly. The differential diagnosis may include other localized orthopoxvirus infections, herpes simplex, bacterial infection, anthrax, foreign body granuloma, and primary tuberculosis. Dermatologists should be aware of the diagnostic and therapeutic algorithms for handling this disease.

Molekularbiologische Diagnostik von Parapockenerkrankungen

BACKGROUND: The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non-specific necrotic ulcer. The histology may also be non-specific, especially with older lesions. Negative-staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time-consuming viral culture are also rarely used in Europe. PATIENTS AND METHODS: The diagnostic procedure in two patients with ecthyma contagiosum and milker's nodule using polymerase chain reaction specific for orthopox, parapox and Orf virus is explained. Diagnostics included bacterial culture, viral culture, histology and EM. In addition to these, a polymerase chain reaction (PCR) was performed in both cases. RESULTS: The patient with ecthyma contagiosum was negative for ortho-, parapox-, and orf-virus on PCR, whereas the patient with milker's nodule had a PCR positive for parapoxvirus. CONCLUSIONS: PCR is a simple, fast, and standardized method of diagnosis that can distinguish between the subgroups of parapoxviruses. A diagnosis can be made even in cases of ambiguous history or unspecific clinical presentation. The method is limited by the necessity to sample native material or to use neutrally buffered formalin in case of PCR from paraffin material.

Molecular diagnostics of parapox virus infections

The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non-specific necrotic ulcer. The histology may also be non-specific, especially with older lesions. Negative-staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time-consuming viral culture are also rarely used in Europe. The diagnostic procedure in two patients with ecthyma contagiosum and milker's nodule using polymerase chain reaction specific for orthopox, parapox and Orf virus is explained. Diagnostics included bacterial culture, viral culture, histology and EM. In addition to these, a polymerase chain reaction (PCR) was performed in both cases. The patient with ecthyma contagiosum was negative for ortho-, parapox-, and orf-virus on PCR, whereas the patient with milker's nodule had a PCR positive for parapoxvirus. PCR is a simple, fast, and standardized method of diagnosis that can distinguish between the subgroups of parapoxviruses. A diagnosis can be made even in cases of ambiguous history or unspecific clinical presentation. The method is limited by the necessity to sample native material or to use neutrally buffered formalin in case of PCR from paraffin material.

Histopatología de las infecciones víricas cutáneas más frecuentes

We describe the histopathological characteristics of viral skin infections. Herpes simplex virus and varicella-zoster virus produce an intraepidermal vesicle with variable degrees of epithelial necrosis. Typical findings include keratinocytes with ballooned nuclei with a ground-glass appearance and giant multinucleated keratinocytes. In the endothelial cells of the dermal blood vessels, cytomegalovirus produces large eosinophilic nuclear inclusions surrounded by a clear halo. Human herpes virus 8 is etiologically associated with Kaposi sarcoma. In its early stages, this tumor contains blood vessels with a fine endothelium passing through the dermal collagen bundles. In the plaque and nodular stages, the vessel lumens are more clearly visible and there is a progressive increase in the number of neoplastic spindle cells with a low degree of pleomorphism and atypia, and occasional mitoses. The infiltrate is made up of lymphocytes and plasma cells. Contagious ecthyma and milker's nodule give rise to an acanthotic epidermis with ballooned keratinocytes containing eosinophilic cytoplasmic viral inclusions. Molluscum contagiosum shows lobules of epithelium that open onto the epidermal surface and characteristic inclusion bodies. Acanthosis, papillomatosis, and hyperkeratosis are observed in common warts, with confluence of the epidermal ridges in the centre of the lesion and koilocytes.

Human Vaccinia virus and Pseudocowpox virus co-infection: Clinical description and phylogenetic characterization

Background Occupational exanthematic diseases represent an important cause of public health impact and economical losses. Among the viral exanthematic diseases, two caused by poxviruses are noteworthy: the bovine vaccinia (BV), caused by the Vaccinia virus (VACV); and the milker's nodule, in which the agent is the Pseudocowpox virus (PCPV). Both agents are zoonotic and have been associated with several cases of bovine infection. In Brazilian rural areas BV has been highly prevalent, particularly in milk herds. Farmers, milkers and their close contacts developed lesions on the hands, forearms, legs and face accompanied by several systemic symptoms. Although VACV and PCPV present with similar epidemiological and transmission patterns, no VACV and PCPV co-infection cases have to date been described. Objectives To describe the first case of zoonotic VACV and PCVP co-infection, based on serological and molecular methods. Study design and results In this work we report a case of a Brazilian rural worker who presented with a large severely ulcerated-pustule skin lesion, associated with fever, headache, malaise, myalgia and axillary, inguinal and cervical limphadenopathy. The worker declared occupational contact with cattle that had notable injuries on their teats. Human and bovine clinical samples were collected and submitted to serological and molecular tests. PCR and phylogenetic analysis revealed the presence of VACV DNA and PCPV DNA in the patient's lesion. Serological tests indicated anti-VACV neutralizing antibodies and molecular assays showed the presence of VACV and PCPV DNA in the patient sera. VACV and PCPV also were detected in dairy cattle. Conclusion Together, these results indicate a case of zoonotic VACV/PCPV co-infection. Epidemiological surveillance and appropriate medical treatment are essential for the control of both diseases, especially in the most severe cases, as described in the present study.

Milker′s nodule

Milker's nodule virus is a parapox virus that is endemic in cattle. The virus can be grown in tissue culture of both bovine and human cell lines. We report a 53-year-old male, milker who presented with multiple painful nodules on both hands for one month. The nodules were tender and showed central umblication and surrounding rim of erythema. Both epitrochlear and axillary lymph nodes were enlarged on both sides and were non-tender. The skin biopsy revealed marked edema in the epidermis with monouclear inflammatory cell infilitration in the upper dermis. The diagnosis was made on clinical basis. As there was no specific treatment the patient was managed only with antibiotics for secondary infection. The lesions partially resolved after two weeks. This case in reported for its occupational importance.

Large CD30‐positive cells in benign, atypical lymphoid infiltrates of the skin

Cutaneous infectious and inflammatory diseases may contain a significant number of CD30-positive cells, thus mimicking lymphomatoid papulosis (LyP) or anaplastic large cell lymphoma. We reviewed our cases of non-neoplastic skin conditions with large, CD30-positive cells and searched the literature for similar cases. A total of 28 cases were included in the study: Milker's nodule (n = 8), Herpes simplex virus infection (n = 7), lymphomatoid drug reaction (n = 3), molluscum contagiosum (n = 3), nodular scabies (n = 2), leishmaniasis (n = 1), syphilis (n = 1), pernio (n = 1), ruptured infundibular cyst (n = 1) and pseudolymphoma in a scar (n = 1). CD30-positive cells were often arranged in clusters and revealed both Golgi and membrane positivity, similar to what was observed in LyP and CD30+ anaplastic large T-cell lymphoma. Analysis of our data and of those published in the literature shows that viruses and drugs are the most common cause for occurrence of large CD30-positive cells in cutaneous pseudolymphomatous infiltrates. Arrangement of these large, CD30-positive cells in small clusters is not unique to cutaneous CD30-positive lymphomas, and in many cases a precise diagnosis can be made only upon accurate clinicopathological correlation or using ancillary methods such as polymerase chain reaction analysis for viral DNA.

Simultaneous Erythema Nodosum and Erythema Multiforme After Local Lidocaine Injection

To report a case of simultaneous erythema nodosum and erythema multiforme after local lidocaine injection. A 33-year-old female experienced coexisting erythema nodosum and erythema multiforme after lidocaine spray was used for upper gastrointestinal endoscopy. The reaction was exacerbated after localized injection of 2% lidocaine for a skin biopsy. An objective causality assessment revealed that an adverse drug reaction was highly probable. Lidocaine is the most frequently used local anesthetic agent. The coexistence of erythema nodosum and erythema multiforme has been reported in lepromatous leprosy, Yersinia enterocolítica and Yersinia pseudotuberculosis gastrointestinal infection (both with diarrhea), histoplasmosis, hepatitis C, and milkeŕs nodule, but not with lidocaine. If clinicians observe similar lesions after lidocaine exposure, they should suspect an adverse drug reaction and exercise caution in the administration of amide anesthetics to patients with a documented history of adverse reaction to lidocaine.

Milker's nodule in a healthy young woman

Milker's nodules (pseudocowpox) are harmless skin lesions most commonly seen in persons whose occupation regularly brings them into close contact with cattle. They are caused by the paravaccinia virus, a member of the poxvirus family. Awareness of their clinical and histopathologic features is important, especially with today's heightened awareness of the threat of biologic warfare, to distinguish them from more worrisome entities such as tularemia and anthrax.

Milker's nodule--a report of 15 cases in the county of North Jutland.

No abstract available.

Some enzymatic activities associated with purified parapoxvirions.

Purified virions of milker's nodule virus, a parapoxvirus, were shown to contain an RNA polymerase, a nucleotide phosphohydrolase, and a protein kinase associated with or encapsulated within the DNA-containing core of the virus. In vitro, the activated viral RNA polymerase transcribed only 7 to 8% of the genome, in the form of 8S to 14S polyadenylated RNA molecules which were complementary to sequences present in milker's nodule virus DNA but not vaccinia virus DNA or DNA prepared from the host cells in which the virus was propagated. Sodium dodecyl sulfate-polyacrylamide gel electrophoretic analysis showed that in vitro, the activated viral protein kinase phosphorylated viral polypeptides of 95, 60, 33.5, 15, and 13.8 kilodaltons.

Viral Blisters

These fluid -filled cavities that develop in the superficial layers of skin or mucous membranes form tense, circumscribed elevations on a hyperemic base that wither, dry, and crust over after a few days or rupture to form shallow ulcers. With the exception of smallpox, healing rarely leaves permanent scars. The many causes of viral blisters- varicella, herpes zoster, herpes simplex, herpangina, hand, foot, and mouth disease, echovirus exanthems, vesicular stomatitis, variola, vaccina, cowpox, monkeypox, milker's nodule, and orf- are discussed.

The syndrome of milker's nodules in burn injury: Evidence for indirect viral transmission

Four patients with first- to second-degree burns developed multiple unusual nodular lesions confined to the burned areas 2 to 3 weeks after the accident. Electron microscopy disclosed viral particles within epidermal cells. These were identified as subgroup II poxvirus. Viral culture established the diagnosis of paravaccinia (milker's nodule) infection. Since none of the patients had had direct contact with infected animals, but had been in contact with contaminated objects, an indirect viral transmission, previously not reported for milker's nodules, appears the most likely mode of infection.