A military patient is brought to the ED with a high fever, malaise, body aches, and red bumps all over his face and on his distal extremities. The patient says the rash started in the mouth about two days ago, during a work trip. The patient denies having had chickenpox as a child. The nurse suspects which of the following diagnoses?


•This patient has symptoms that are characteristic of smallpox, a potential agent of bioterrorism. Smallpox sores start in the mouth and spread quickly over the face and then to the distal extremities. They are raised, hard pustules that later scab over.

•The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. Prolonged face-to-face contact is generally required to spread smallpox from one person to another. Smallpox also can be spread through contact with infected bodily fluids or contaminated bedding or clothing. A person becomes most contagious with the onset of rash, which starts in the mouth and face and spreads, first as bumps, then pustules and scabs. The infected person is contagious until the last smallpox scab falls off.

•Any case of suspected Smallpox requires an immediate report to the State Health Department and the CDC, and immediate isolation with both Airborne and Contact Precautions in addition to Standard Precautions.

Incorrect options:

•Chickenpox, conversely, spreads over the trunk first, and the rash is characterized by softer fluid-filled vesicles.

•Shingles causes an area of tingling or pain on one side of the body, often the back or trunk. It is accompanied by a rash in that area that forms blisters and then scabs and clears up.

•Rubella (German Measles) is characterized by a fine, pink rash that begins on the face and quickly spreads to the trunk and then the extremities, before disappearing in the same order in which it.appeared

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