Introduction to a case of orf disease in a burn wound at Motahari Hospital

Orf disease is caused by a double-stranded DNA virus of the Parapox family. Human infection is mostly due to occupational hazard and handling infected animals. Our patient was an 18-year-old woman who suffered burns in 2015. Total Burn Surface Area (TBSA) was 22% and cause of burn was flame. One week after hospital admission, she underwent skin grafts of her upper extremities. However, vegetative granulomatous ulcerations developed on the wound, resulting in the grafts failing to take. After careful investigation into the patient's history, we discovered that the water used to douse the flames was from a drinking trough for sheep. Suspecting Orf disease, we disinfected the wounds and dressing tools with Dakin's solution. We waited about 12 days to perform a new skin graft, and most of the grafted skin took. PCR test for Parapox virus was positive. Orf disease should be considered a distinct possibility in burn patients with a history of probable contamination. Manipulation of the disease in the early stages of burn wound could potentially spread it and change the degree of the wound, therefore being aware of this possibility can save the patient unnecessary pain and time. To prevent a nosocomial outbreak of Orf, wound care and wound disinfection should be scrupulously carried out. Isolation and disinfection of the entire dressing tool should be considered. Educating wound care providers in burn hospitals and scrupulous wound disinfection would protect the patient from cross contamination and allow skin grafts to take with ease, without the formation of ulcerations associated with Orf.