Two similar skin infections in hunters who field dressed white-tailed deer led to the identification of a new parapoxvirus, which can mimic other infections and lead to diagnostic delays, according to researchers from the US Centers for Disease Control and Prevention (CDC).
In both cases, the hunters, one from Virginia and one from Connecticut, cut their fingers in November 2008 while field dressing deer that appeared healthy at the time of death, according to the researchers, who reported their findings in the Dec 30 issue of the New England Journal of Medicine (abstract here).
Patients with parapoxvirus infections typically have a single lesion, developing over 4 to 8 weeks, that progresses through four stages—papule, vesicle, shallow annular ulcer, and scab—that heals with little or no scarring.
Infections can recur, and smallpox vaccination doesn't block parapoxvirus infection. The group noted that human infections are likely underreported, because many patients may not seek medical care because of the usually self-limited nature of the disease.
The clinical course was similar for both patients. About 7 weeks after the field dressing injury the hunters sought medical care for a nodule at the wound site that didn't heal. In the case of the Virginia patient, doctors removed and biopsied the lesion, but it recurred about a month later. The Connecticut hunter was treated with antibiotics, and his doctors biopsied the lesion. In both instances, specimens were sent to the CDC for evaluation.