Smallpox laboratory tests: Difference between revisions
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There are laboratory tests to specifically identify the [[smallpox virus]]. However, in a patient with low to medium level of suspicion of smallpox, a [[false-positive]] result would have a great personal and social impacts. Therefore these tests must be used cautiously, and according to certain guidelines.<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> | There are laboratory tests to specifically identify the [[smallpox virus]]. However, in a patient with low to medium level of suspicion of smallpox, a [[false-positive]] result would have a great personal and social impacts. Therefore these tests must be used cautiously, and according to certain guidelines.<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> | ||
[[ | ===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.'' | |||
===Laboratory Test Algorithm=== | |||
The algorithm below describes the laboratory protocol for a patient who presents with a generalized [[vesicular]] or [[pustule|pustular]] [[rash]]. This algorithm is based on the risk level of the patient to be [[infected]] with [[smallpox]].<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> | |||
[[Image:Smallpox lab test.jpg]] | |||
==References== | ==References== | ||
Revision as of 01:31, 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 identify the smallpox virus. However, in a patient with low to medium level of suspicion of smallpox, a false-positive result would have a great personal and social impacts. Therefore these tests must be used cautiously, and according to certain guidelines.[1][2][3][4]
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 anorthopox virus infection but not diagnostic for smallpox.
Laboratory Test Algorithm
The algorithm below describes the laboratory protocol for a patient who presents with a generalized vesicular or pustular rash. This algorithm is based on the risk level of the patient to be infected with smallpox.[1]
References
- ↑ 1.0 1.1 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.