For most dermatological conditions, diagnosis may be established on the basis of physical examination and clinical history without the collection of diagnostic specimens. Important characteristics to be noted on physical examination include the nature of the skin lesions (erythematous, macular, papular, maculopapular, vesicular, bullous, petechial, purpuric, etc.) and the anatomic distribution of spread (central, peripheral, diffuse, etc.) In cases of indeterminate diagnoses, unusual presentations, and some rare conditions, collection of specimens from rashes and/or skin lesions may be necessary. In the case of vesicular rashes, specimens for microscopy and culture are taken directly from vesicles. In other exanthemata (macular and/or papular), the diagnosis may be more readily established from alternative specimens (e.g. blood cultures, serology). In suspected cutaneous anthrax or bubonic plague, specimens from the skin lesions (scars and buboes, respectively) and blood cultures may be taken.
If cutaneous anthrax is suspected, the vesicular fluid under the scar is a better diagnostic specimen than a piece of the scar.
Specimens for bacteriological analysis should be transported in Stuart’s or Amies medium. Swabs for suspected viral pathogens should be transported in virus transport medium. Other specimens should be handled as described in the relevant section.
If processing takes longer than 2 hours, bacteriology specimens can be maintained at ambient temperature for 24 hours. Specimens for virus isolation may be refrigerated at 4-8oC, and transported to the laboratory as rapidly as possible. In some instances, the outbreak investigation team may bring liquid nitrogen for specimen preservation. If this is the case, follow the instructions of the experienced laboratorian as to appropriate use. If there are any questions regarding handling and transport, check with the laboratory which will be receiving the specimens. In any outbreak investigation, it should be considered essential to consult the receiving laboratory about the handling of most specimen types before setting out into the field.