Generalized Vesicular or Pustular Rash Illness Protocol.ppt

* Generalized Vesicular or Pustular Rash Illness Protocol Laboratory Testing for Varicella: Collect at least 3 good specimens from each patient Direct fluorescent antibody DFA —rapid, depends on adequate specimen see below Indirect fluorescent antibody IFA —rapid, depends on adequate specimen see below Polymerase chain reaction PCR --available in research labs, some tertiary care centers Serologic testing: an IgG collected at time of rash provides evidence of prior varicella, and makes acute varicella infection unlikely but does not rule out herpes zoster in persons at risk of dissemination. IgM is not useful for diagnosis. VZV culture—results delayed, useful only if processed in-house EM electron microscopy —can identify herpes viruses How to Collect a Specimen for DFA or IFA Testing Unroof open vesicle or pustule with a sterile lancet Swab base of vesicle vigorously with a sterile swab Smear swab onto 3 areas or wells of a microscope slide Allow slide to air dry Transport to lab for immediate fixing and staining VZV positive specimens are seen with varicella chickenpox and herpes zoster shingles The hospital lab performs _________________ test For DFA/IFA , call ________________ specimen is tested at outside lab CRITERIA FOR DETERMINING RISK OF SMALLPOX High Risk for Smallpox ? report immediately Febrile prodrome see below AND Classic smallpox lesions see below and photo at right AND Lesions in same stage of development see below Moderate Risk for Smallpox ? urgent evaluation Febrile prodrome see below AND One MAJOR smallpox criterion see below OR Febrile prodrome see below AND 2. 4 MINOR smallpox criteria see below Low Risk for Smallpox ? manage as clinically indicated No viral prodrome OR Febrile prodrome and 4 MINOR smallpox criteria no major criteria see below Pruritis; in scabies, look for burrows vesicles and nodules also occur ; flea bites are pruritic, patient usually unaware of flea exposure Scabies; insect