0071643192.pdf

EMS AND DISASTER MEDICINE

■ Begins in mouth

■ Predilection for face, then spreads distally

■ Involves palms and soles

■ Changes from vesicular to pustular with all lesions in same stage

Hemorrhagic Smallpox

■ Quicker and more toxic course
■ Petechiae and hemorrhage (not pox)
■ Ninety percent mortality

Malignant Smallpox

■ Also quicker and more toxic course
■ Lesions are flatter and never progress to pustules.

DIAGNOSIS

■ CDC clinical diagnosis algorithm (see Table 20.9):
■ Major criteria:
■ Febrile prodrome
■ Classic smallpox lesions
■ Lesions in same stage of development
■ Minor criteria:
■ Centrifugal distribution of pustules
■ Toxic appearance
■ First lesions in mouth, face, or forearms
■ Slow evolution of lesions
■ Pustules on the palms and soles
■ Three major →presumed disease.
■ Two major or one major and four minor →probable disease.
■ Fewer than four minor →disease not likely.
■ Laboratory PCR identification of variola DNA in a clinical specimen

Classic smallpox lesions

change from maculopapules

→vesicles→pustules with

all lesions in the same stage

of development.

TABLE 20.9. CDC Clinical Criteria for Diagnosing Smallpox

Major criteria

Febrile prodrome

Classic smallpox lesions

Lesions in the same stage of development

Minor criteria

Centrifugal distribution of pustules

Toxic appearance

First lesions in mouth, face, or forearms

Slow evolution of lesions

Pustules on the palms and soles

Three major→presumed disease

Two major or one major and four minor→probable disease

Fewer than four minor →disease not likely