Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of cutaneous herpes simplex and varicella zoster virus infections

Özcan, Atilla; Şenol, Mustafa; Saǧlam, Hülya; Seyhan, Muammer; Durmaz, Rıza; Aktaş, Elif; Özerol, İbrahim Halil

doi:10.1111/j.1365-4632.2007.03337.x

Cited by 52 publications

(47 citation statements)

References 21 publications

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“…The most reliable and sensitive laboratory method for confirming varicella is the detection of VZV DNA in samples (vesicular swabs or scabs) obtained from skin lesions by using PCR (102,128). A number of VZV PCR methods have been reported in the literature (17,36,37,71,77,81,95,102,105,128), including several that are designed to distinguish vaccine strain Oka from wild-type strains of VZV (17,71,77,81,105).…”

Section: Continued On Following Pagementioning

confidence: 99%

Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics

Schmid¹,

Jumaan

2010

Clin Microbiol Rev

112

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SUMMARY The licensure and recommendation of varicella vaccine in the mid-1990s in the United States have led to dramatic declines in varicella incidence and varicella-related deaths and hospitalizations. Varicella outbreaks remain common and occur increasingly in highly vaccinated populations. Breakthrough varicella in vaccinated individuals is characteristically mild, typically with fewer lesions that frequently do not progress to a vesicular stage. As such, the laboratory diagnosis of varicella has grown increasingly important, particularly in outbreak settings. In this review the impact of varicella vaccine on varicella-zoster virus (VZV) disease, arising complications in the effective diagnosis and monitoring of VZV transmission, and the relative strengths and limitations of currently available laboratory diagnostic techniques are all addressed. Since disease symptoms often resolve in outbreak settings before suitable test specimens can be obtained, the need to develop new diagnostic approaches that rely on alternative patient samples is also discussed.

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Section: Continued On Following Pagementioning

confidence: 99%

Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics

Schmid¹,

Jumaan

2010

Clin Microbiol Rev

112

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“…23 PCR is both highly sensitive and specific and has recently been recognized as the test of choice for diagnosing breakthrough varicella. 23,24 Measurement of serum IgG antibody against varicella is only useful to provide proof of immunity to natural infection and does not have adequate sensitivity to detect change in IgG antibody titer of vaccinated individuals after breakthrough varicella. 25 The limited availability of the PCR test for varicella may explain in part the fact that many HCPs did not select PCR as their first-choice test.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, Attitudes, and Practices for Diagnosing Breakthrough Varicella in the Outpatient Setting

et al. 2012

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Objectives. We assessed provider knowledge, attitudes, and practices for the management of breakthrough varicella and identified barriers to implementation of laboratory testing and reporting.Methods. We surveyed 145 health-care providers (HCPs) from 30 pediatric practices in Philadelphia who did not have a history of laboratory testing for breakthrough varicella. The self-administered survey instrument collected information on clinicians' practices for management of children presenting with rash, infection-control strategies, reporting to public health agencies, and laboratory testing.Results. Among the 144 HCPs who completed the survey, 73 (51%) had practiced for more than 10 years. While 115 HCPs (80%) would elect to evaluate a child with rash in the office, only 19 (13%) would submit diagnostics. When patients had a known recent exposure to varicella, 84 HCPs (58%) would use laboratory tests: 40% would use direct fluorescent antibody staining on a specimen from a cutaneous lesion, 24% would use polymerase chain reaction on a lesion specimen, 21% would use acute and convalescent serology, and 10% would use other tests. While waiting for test results, 82 HCPs (57%) would advise that the child be kept at home, 39 (27%) would notify the local health department, and 33 (23%) would inform the school nurse.Conclusion. As varicella becomes increasingly uncommon, laboratory confirmation becomes more critical for appropriate diagnosis, similar to poliomyelitis and measles. Our findings suggest that HCPs need further education regarding laboratory confirmation, containment, and reporting of breakthrough varicella.

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“…Cells taken by scraping the base of the vesicles or pustules of skin lesions during the rash are placed on slides and, after Giemsa-Wright, hematoxylin-eosin or Papanicolaou staining, are examined by means of light microscopy for the cytopathic alterations typical of herpesvirus (multinucleated giant cells, syncytia and ballooning cell degeneration). Although this test is easy to perform, rapid and cheap, its sensitivity is limited (only 40%-50% in comparison with cell cultures) [422,427] . It is also influenced by the stage of the lesion as it is more sensitive to material taken from fresh vesicles rather than from pustules or scabs [421,428] and, above all, cannot distinguish the lesions caused by HSV and those caused by VZV [429] .…”

Section: Tzanck Smear Testsmentioning

confidence: 99%

“…Microbiology laboratory in mother-child VZV infection Molecular biology tests: Molecular biology tests based on in vitro nucleic acid amplification (PCR) are now considered the new platinum tests [20,30,429,449,450] . Various types of PCR are used to diagnose varicella and herpes zoster [13,421,422,[450][451][452][453][454][455][456] , including nested PCR, which is particularly sensitive, but susceptible to contamination leading to false positive results [348] . However, the latest real-time PCR tests are not only rapid, easy to perform, and as sensitive as nested PCR, but have also reduced the risk of contamination [348] .…”

Section: Direct Fluorescent Antibody Assaymentioning

confidence: 99%

“…Cytology (the Tzanck test) was initially important as it can detect the cytopathic effect of herpesvirus infection morphologically [420][421][422][423][424][425][426] . Cells taken by scraping the base of the vesicles or pustules of skin lesions during the rash are placed on slides and, after Giemsa-Wright, hematoxylin-eosin or Papanicolaou staining, are examined by means of light microscopy for the cytopathic alterations typical of herpesvirus (multinucleated giant cells, syncytia and ballooning cell degeneration).…”

Section: Tzanck Smear Testsmentioning

confidence: 99%

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Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn. Core tip: Although varicella during pregnancy is infrequent and congenital varicella syndrome (CVS) is rare, every available means should be used to prevent and diagnose them. Microbiology laboratories can be crucial in these situations: Evaluating a mother's immune status with sensitive and specific tests for the detection of antibodies; allowing a rapid diagnosis with molecular biology tests when a clinical manifestation may be due to different etiologies; following pregnant women with varicella for the prenatal diagnosis of CVS with close collaboration between molecular biology investigators and specialists in imaging diagnostics.De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World

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Comparison of the Tzanck test and polymerase chain reaction in the diagnosis of cutaneous herpes simplex and varicella zoster virus infections

Cited by 52 publications

References 21 publications

Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics

Impact of Varicella Vaccine on Varicella-Zoster Virus Dynamics

Knowledge, Attitudes, and Practices for Diagnosing Breakthrough Varicella in the Outpatient Setting

Microbiology laboratory and the management of mother-child varicella-zoster virus infection

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