Household Hazards

How everyday products make us sick.

Home Slaughter

An old disease makes a comeback.

Last month, the Centers for Disease Control highlighted an arcane household hazard. More or less retired from the U.S. scene, recently it has been making something a comeback. It’s a virus-caused infection which typically affects a finger or the palm and looks quite a bit nastier than it actually is. That – combined with its relative obscurity – can lead to unwarranted medical procedures. The name this infection goes by is “Orf.”

Orf is also called “contagious ecthyma,” so it is easy to see how the three letter moniker has stuck (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6114a3.htm). This name bears no relation to the Orff of Carmina Burana notoriety, even though this composition has been contagiously popular and, from another perspective, Orff himself has been criticized as being too closely aligned with the infamously virulent political regime under which he composed that work. Our orf is mainly a problem for animals, especially sheep and goats, among whom the infection can be endemic in certain parts of the world. Humans contract the disease from direct contact with infected livestock. An infectious disease that mainly troubles animals but from which human bystanders can be at risk, in medical jargon, is called a “zoonosis.”

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A zoonotic disease is most likely to be an occupational problem and some of these can quite serious. For example, “Q fever” is a zoonosis also of sheep that not only attacks agricultural workers and veterinarians, but can also be a hazard for laboratory workers (sheep are a favored model in which to study fetal physiology and the pregnant ewe can be a particularly strong source for infection spread). Q fever can be lethal. It was unknown until the 1930s – the Q in Q fever’s name standard for “query?” since it first emerged in Australia as a question mark, novel outbreak.

You don’t usually get zoonoses at the zoo – although the CDC warns that one exposure scenarios for orf can be a child’s visit to a petting zoo. The latest cases have all been linked to home butchering of meat, in particular in ritual slaughter - here both the Easter and the Eid-al-Adha lamb seem to ecumenical transmitters of disease. The resulting skin disease presents as a swollen and menacing looking collection of fluid under the skin or as an ulcerating lesion. Mistaken for a standard bacterial infection, it can be aggressively approached by surgical means, which is unwarranted with uncomplicated orf. Usually the problem resolves over time.

As with many things, the key is in prevention. Once orf has emerged, diagnosis depends on taking the sort of in-depth medical history taking for which there is too little time and even less inclination nowadays (a “social history” is often the first thing to be jettisoned under pressure). Perhaps it is fitting to close with a lyric fragment from Orff’s Ego sum abbas, “Goat of thy flock I am gold I am god; Flesh to thy bone - flower to thy rod.”

Paul D. Blanc, M.D., M.S.P.H., is Professor of Medicine and Endowed Chair in Occupational and Environmental Medicine at the University of California San Francisco.

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