Clinical Q&A: Treating cardiac failure and the parapox virus

Our experts answer queries on congestive cardiac failure and orf

Should patients with congestive cardiac failure or left ventricular failure restrict salt and fluid intake?

There is little evidence that fluid restriction is valuable in patients with stable congestive cardiac failure of left ventricular failure. The NICE guideline notes that fluid restriction may cause dehydration in some and exacerbate confusion in the elderly. Salt restriction can help prevent hypertension and is commonly recommended to control fluid status, but again NICE offers a caveat that it may make food less palatable.

Dr Sarah Jarvis is a GP trainer in west London and fellow of the RCGP, and has an interest in heart failure

Occasionally I see a case of orf among my farming patients. Is there an effective treatment for this condition?

Orf is usually a disease of sheep and goats, and is caused by the  parapox virus. Humans acquire the disease through direct contact with infected animals.

The lesions (ecthyma contagiosum) usually appear on hands and arms. They last several weeks and are painful. The virus is identified by electron microscopy or tissue culture.

Orf regresses spontaneously. Surgical intervention delays healing and aggravates the lesion. The antiviral drug cidofovir has been used with success. Topical idoxuridine has been used with varying results.

Dr Peter Wilson, consultant microbiologist, Middlesex, Hospital, London

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