DMCA
and Clinical Criteria for Investigating Smallpox
BibTeX
@MISC{Herpeticum_andclinical,
author = {Eczema Herpeticum and David A. Boyd and Leonard C. Sperling and Scott A. Norton},
title = {and Clinical Criteria for Investigating Smallpox},
year = {}
}
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Abstract
Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, a patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox. After the 2001 anthrax bioterrorism incidents, public health officials became concerned about bioterrorist threats of smallpox. The Centers for Disease Control and Prevention (CDC), along with interested partners, developed a clinical algorithm for rapid evaluation of patients with acute generalized vesiculopustular rash illness (AGV-PRI) (1). In a surveillance system designed to detect an index case of smallpox, high specificity is critical to minimize false-positive reports of a disease that no longer exists in nature (2). CDC’s algorithm emphasizes 3 major clinical features of smallpox: febrile prodrome, typical appearance of characteristic lesions, and uniform lesion morphology (Table). The algorithm stratifies AGVPRI cases into high, moderate, and low likelihood of smallpox (3). Passive and active surveillance has stratified no case to high risk (4). We describe a patient whose illness fulfilled CDC’s high-risk criteria for smallpox, although he actually had eczema herpeticum. The Case A 45-year-old man with a lifelong history of atopic dermatitis had a year-long unremitting exacerbation for which he had started systemic therapy. After treatment with cyclosporine for several weeks, laboratory abnormalities and nonspecific neurologic signs prompted a switch to methotrexate. Within 4 weeks, he was hospitalized (in an overseas US military hospital) for generalized umbilicated papulopustules accompanied by profound hypothermia, hypotension, and mental status changes. He had large pustules on his trunk, inner thighs, and upper extremities
Keyphrases
clinical criterion investigating smallpox eczema herpeticum rapid evaluation acute generalized vesiculopustular rash illness large pustule typical appearance disease control mental status change clinical algorithm laboratory abnormality public health official atopic dermatitis overseas u military hospital umbilicated papulopustules systemic therapy high-risk criterion high specificity inner thigh lifelong history characteristic lesion upper extremity high risk interested partner tzanck preparation herpetic infection rapid diagnosis case 45-year-old man false-positive report several week algorithm stratifies agvpri case index case surveillance system nonspecific neurologic sign febrile prodrome low likelihood uniform lesion morphology anthrax bioterrorism incident year-long unremitting exacerbation active surveillance profound hypothermia major clinical feature bioterrorist threat
