FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 347:690-691 August 29, 2002 Number 9 Next

PDF PDA Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Breman, J. G. PubMed Citation

To the Editor: In Table 1 of their article, Breman and Henderson (April 25 issue)¹ list secondary syphilis as a maculopapular eruption, noting that it has frequently been confused with smallpox. In general, it is more difficult to differentiate chickenpox from smallpox than it is to distinguish secondary syphilis from smallpox. Osler described the consequences of a misdiagnosis: "[S]ometimes it is not easy to distinguish between them. . . . It is stated that the . . . starting-point in Montreal of the epidemic of 1885, was regarded as varicella and not isolated. If so, the mistake . . . led to one of the most fatal modern outbreaks of the disease."² In Arrowsmith, Sinclair Lewis (with the help of Paul de Kruif) depicted the converse misdiagnosis when his protagonist was ridiculed after sounding the smallpox alarm for patients who had only chickenpox.³ The Centers for Disease Control and Prevention has made available a poster, "Evaluating Patients for Smallpox,"⁴ designed to reduce the risk of either misdiagnosis.

Thomas D. Regan, B.S.
Scott A. Norton, M.D., M.P.H.
Walter Reed Army Medical Center
Washington, DC 20307
scott.norton{at}na.amedd.army.mil

References

1. Breman JG, Henderson DA. Diagnosis and management of smallpox. N Engl J Med 2002;346:1300-1308. [Free Full Text]
2. Osler W. The principles and practice of medicine. New York: Appleton, 1892:57-8.
3. Lewis S. Arrowsmith. New York: New American Library, 1980:186-7.
4. Health care providers. Atlanta: Centers for Disease Control and Prevention, 2002. (Accessed August 9, 2002, at http://www.cdc.gov/nip/smallpox/Providers.htm#Posters.)

PDF PDA Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Breman, J. G. PubMed Citation