Smallpox laboratory tests: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
This chart describes the laboratory testing protocol for a patient that presents with generalized [[vesicular]] or [[pustular]] [[rash]] illness. It is also based upon the risk level the patient has of developing acquiring smallpox. | There are laboratory tests to specifically diagnose the smallpox virus. However, due to the risk of false-positive results and the social damage these would bring, those specific tests must be used only in certain occasions.<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid15546084">{{cite journal| author=Seward JF, Galil K, Damon I, Norton SA, Rotz L, Schmid S et al.| title=Development and experience with an algorithm to evaluate suspected smallpox cases in the United States, 2002-2004. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 10 | pages= 1477-83 | pmid=15546084 | doi=10.1086/425500 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15546084 }} </ref><ref name="pmid14625530">{{cite journal| author=Besser JM, Crouch NA, Sullivan M| title=Laboratory diagnosis to differentiate smallpox, vaccinia, and other vesicular/pustular illnesses. | journal=J Lab Clin Med | year= 2003 | volume= 142 | issue= 4 | pages= 246-51 | pmid=14625530 | doi=10.1016/S0022-2143(03)00146-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14625530 }} </ref><ref name="Madeley2003">{{cite journal|last1=Madeley|first1=CR|title=Diagnosing smallpox in possible bioterrorist attack|journal=The Lancet|volume=361|issue=9352|year=2003|pages=97–98|issn=01406736|doi=10.1016/S0140-6736(03)12241-6}}</ref> | ||
The importance of case confirmation using laboratory diagnostic tests differs depending on the epidemiological situation. Because of the low predictive value of a positive lab test result in the absence of a known smallpox outbreak, in the pre-outbreak (pre-event) setting, laboratory testing should be reserved for cases that meet the clinical case definition and are thus classified as being a potential high risk for smallpox. | |||
This chart describes the laboratory testing protocol for a patient that presents with generalized [[vesicular]] or [[pustule|pustular]] [[rash]] illness. It is also based upon the risk level the patient has of developing acquiring smallpox. | |||
[[Image:Smallpox lab test.jpg]] | [[Image:Smallpox lab test.jpg]] | ||
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''Note: Generic orthopox PCR and negative stain electron microscopy (EM) identification of a pox virus in a clinical specimen are suggestive of an'' 'orthopox ''' virus infection but not diagnostic for smallpox.'' | ''Note: Generic orthopox PCR and negative stain electron microscopy (EM) identification of a pox virus in a clinical specimen are suggestive of an'' 'orthopox ''' virus infection but not diagnostic for smallpox.'' | ||
==References== | ==References== | ||
Revision as of 01:15, 11 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Laboratory Findings
There are laboratory tests to specifically diagnose the smallpox virus. However, due to the risk of false-positive results and the social damage these would bring, those specific tests must be used only in certain occasions.[1][2][3][4]
The importance of case confirmation using laboratory diagnostic tests differs depending on the epidemiological situation. Because of the low predictive value of a positive lab test result in the absence of a known smallpox outbreak, in the pre-outbreak (pre-event) setting, laboratory testing should be reserved for cases that meet the clinical case definition and are thus classified as being a potential high risk for smallpox.
This chart describes the laboratory testing protocol for a patient that presents with generalized vesicular or pustular rash illness. It is also based upon the risk level the patient has of developing acquiring smallpox.
Laboratory Confirmation
Laboratory Criteria for Confirmation
- Polymerase chain reaction (PCR) identification of variola DNA in a clinical specimen, OR
- Isolation of smallpox (variola) virus from a clinical specimen (WHO Smallpox Reference laboratory or laboratory with appropriate reference capabilities) with variola PCR confirmation.
Laboratory diagnostic testing for variola virus should be conducted in a CDC Laboratory Response Network (LRN) laboratory utilizing LRN-approved PCR tests and protocols for variola virus. Initial confirmation of a smallpox outbreak requires additional testing at CDC.
Note: Generic orthopox PCR and negative stain electron microscopy (EM) identification of a pox virus in a clinical specimen are suggestive of an 'orthopox ' virus infection but not diagnostic for smallpox.
References
- ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
- ↑ Seward JF, Galil K, Damon I, Norton SA, Rotz L, Schmid S; et al. (2004). "Development and experience with an algorithm to evaluate suspected smallpox cases in the United States, 2002-2004". Clin Infect Dis. 39 (10): 1477–83. doi:10.1086/425500. PMID 15546084.
- ↑ Besser JM, Crouch NA, Sullivan M (2003). "Laboratory diagnosis to differentiate smallpox, vaccinia, and other vesicular/pustular illnesses". J Lab Clin Med. 142 (4): 246–51. doi:10.1016/S0022-2143(03)00146-X. PMID 14625530.
- ↑ Madeley, CR (2003). "Diagnosing smallpox in possible bioterrorist attack". The Lancet. 361 (9352): 97–98. doi:10.1016/S0140-6736(03)12241-6. ISSN 0140-6736.