Bedside Diagnostics for Infections: A Guide for Dermatologists
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REVIEW ARTICLE
Bedside Diagnostics for Infections: A Guide for Dermatologists Frank T. Winsett1 · Shaunak G. Patel2 · Brent C. Kelly1
© Springer Nature Switzerland AG 2020
Abstract In dermatology, there are many bedside diagnostic tests that may aid in more rapid diagnosis and early initiation of appropriate therapy. When performed correctly, these bedside diagnostic tests can provide both sensitive and specific results. We discuss bedside diagnostic tests, such as the Tzanck smear, potassium hydroxide (KOH) preparation, and mineral oil preparation, with a specific focus on their use in diagnosing infectious dermatoses.
Key Points
1 Introduction
Bedside diagnostic techniques for cutaneous infections may lead to early diagnosis and prompt initiation of the appropriate therapy.
Infectious dermatoses constitute a major part of clinical practice in dermatology, both in the clinic and on inpatient wards. Rapid and accurate diagnosis is key to promptly initiating the appropriate therapy. Bedside diagnostic tests, when performed correctly, can provide both sensitive and specific results. When caring for critically ill patients on inpatient wards, prompt diagnoses are crucial and potentially lifesaving. Furthermore, bedside diagnostic tests may allow physicians in resource-poor areas to provide high-quality care. While many of these tests require a certain amount of training and skill to produce reliable results, in the right hands they may be of great value. We discuss bedside diagnostic tests for the diagnosis of infectious dermatoses.
With training, many bedside diagnostic tests are easy to perform and may have sensitivities comparable to those of more advanced methods. In the USA, Clinical Laboratory Improvement Act (CLIA) laboratory regulations must be considered and may limit the use of bedside diagnostic tests in clinical practice.
2 Tzanck Smear Overview
* Brent C. Kelly [email protected] Frank T. Winsett [email protected] Shaunak G. Patel [email protected] 1
Department of Dermatology, University of Texas Medical Branch, 301 University Blvd, 4.112 McCullough Building, Galveston, TX 77555‑0783, USA
School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
2
The Tzanck smear, first described in 1947 by Dr. Tzanck, is a cytologic test best known for aiding in the diagnosis of Herpesviridae infections [1]. However, the Tzanck smear is a rapid bedside test that can be used to aid in the diagnosis of many infectious and noninfectious dermatologic diseases [2–4]. While the sensitivity and specificity of Tzanck smears is user dependent, competency in performing and interpreting Tzanck smears can be achieved with training and practice [5]. A Tzanck smear should be prepared from a recent lesion or intact vesicles for greatest diagnostic sensitivity [6]. For vesiculobullous diseases, such as herpes infection, it begins with unroofing intact vesicles or removing overlying crust from the desired lesion [6]. The base of the lesion is then Vol.:(0123456789)
scraped firmly, typically with
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