Incubation period: 3 to 7 days
Clinical features:
(1) The patient has a history of recent exposure to white-tailed deer.
(2) Skin lesions develop at sites exposed to deer body fluids, usually on the hands
(3) The lesions slowly evolve from papule to vesicle to ulcer to scab followed by healing. Patients often present with erythematous to violaceous non-healing nodules.
(4) Variable fever may be present.
Usually lesions are limited but may be extensive if the patient is immunocompromised.
Biopsy of the lesion shows intracytoplasmic viral inclusions within squamous cells of the epidermis.
PCR and genetic analysis may be necessary to identify the virus.
Differential diagnosis:
(1) anthrax
(2) infection with orf or other parapoxviruses
(3) infection with other pathogens associated with outdoor activities
