Cover Page
  • Authors: Rubins A.1, Rubins S.2, Handler N.1, Janniger C.3, Schwartz R.4, Septe M.4
  • Affiliations:
    1. Faculty of Medicine University of Latvia
    2. Faculty of Medicine University of Latvia 19 Raina Blvd. Riga, LV-1586, Latvia
    3. University of Nebraska Medical Center (UNMC), College of Medicine
    4. Rutgers, New Jersey Medical School
  • Issue: Vol 93, No 3 (2017)
  • Pages: 42-52
  • URL:
  • DOI:


Milker’s nodules, also called paravaccinia, is a DNA virus transmitted from infected cows to humans. It results from contact with cattle, cattle byproducts, or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers, and agricultural tourists. The viral infection begins 5—15 days after inoculation as an erythematous-purple, round nodule with a clear depressed center, 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 selflimited in immunocompetent individuals and heal without scarring within 8 weeks. Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct-contact. While complications are rare, hematopoietic 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.

About the authors

Andris Rubins

Faculty of Medicine University of Latvia

Author for correspondence.

Latvia MD, PhD; 19 Raina Blvd. Riga, LV-1586, Latvia

Silvestrs Rubins

Faculty of Medicine University of Latvia
19 Raina Blvd. Riga, LV-1586, Latvia


Latvia MD, PhD; 19 Raina Blvd. Riga, LV-1586, Latvia

Nancy S. Handler

Faculty of Medicine University of Latvia


Latvia BA; 19 Raina Blvd. Riga, LV-1586, Latvia

Camila K. Janniger

University of Nebraska Medical Center (UNMC), College of Medicine


United States MD; Omaha, NE 68198-5520, USA

Robert A. Schwartz

Rutgers, New Jersey Medical School


United States MD, MPH; 185, South Orange, Avenue, Newark, NJ 07103 USA

Marcis Septe

Rutgers, New Jersey Medical School


United States MD; 185, South Orange, Avenue, Newark, NJ 07103 USA


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