Eczema
vaccinatum demands urgent treatment with Vaccinia Immune Globulin.
Mortality has generally been prevented if patients are treated
promptly and adequately. However, even if there is a delay
in recognition, prompt institution of VIG should be undertaken.
Normally, the initial dose of intramuscular VIG (IM-VIG) is
0.6-1.0 ml per kg body weight. However, if the lesions are
extensive when first seen, as much as 5-10 ml per kg of IM-VIG,
divided into multiple doses, and given over several days should
be administered.
The current IM-VIG is an experimental drug and is only available
under the IND protocol. Intravenous VIG (IV-VIG) may be available
in the near future. Specific recommendations for its use should
be followed.
With bacterial infection, appropriate antibiotic treatment
should be guided by most probable organisms (staphylococcus
aureus, streptococci, and enteric bacteria) and subsequently
by results of culture and sensitivity. Fungal infections should
be treated by the appropriate antifungal agent. It is recommended
that an infectious disease specialist be consulted. For treatment
of the underlying atopic dermatitis, a dermatologist should
be consulted.
If septic shock supervenes
then all appropriate measures should be employed based on
clinical observations and laboratory data.
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