The syndrome of milker's nodules in burn injury: evidence for indirect viral transmission.

Four patients with first- to second-degree burns developed multiple unusual nodular lesions confined to the burned areas 2 to 3 weeks after the accident. Electron microscopy disclosed viral particles within epidermal cells. These were identified as subgroup II poxvirus. Viral culture established the diagnosis of paravaccinia (milker's nodule) infection. Since none of the patients had had direct contact with infected animals, but had been in contact with contaminated objects, an indirect viral transmission, previously not reported for milker's nodules, appears the most likely mode of infection.