Laboratory diagnosis of herpes zoster

Sauerbrei, Andreas; Eichhorn, U.; Schacke, Michael; Wutzler, Peter

doi:10.1016/s1386-6532(99)00042-6

Cited by 124 publications

(89 citation statements)

References 13 publications

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“…34 In herpes zoster cases, anti-VZV IgM can be found in 30-40%, usually with lower magnitude and shorter duration, 35,36 implying that the negative IgM results observed in our study do not rule out VZV reactivation nor reinfection, especially as serum samples were taken independently of clinical symptoms of herpes zoster. Besides, a positive IgM test could not have been used to distinguish reliably between primary and recurrent VZV infection.…”

Section: Discussionmentioning

confidence: 63%

Serological evidence of increased susceptibility to varicella-zoster virus reactivation or reinfection in natalizumab-treated patients with multiple sclerosis

et al. 2015

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Background: Serious adverse drug reactions of disease-modifying drugs in multiple sclerosis (MS) therapy may include enhanced susceptibility to reactivation of neurotropic herpes viruses like varicella-zoster virus (VZV) and the John Cunningham (JC) polyomavirus. Objective: Because symptomatic reactivation of these viruses are rare events, we determined the incidence of rises in anti-VZV IgG antibody levels as a potential marker for enhanced susceptibility to subclinical and symptomatic reactivation of neurotropic viruses. Methods: Anti-VZV IgG levels were measured in paired serum samples taken 6-8 months apart from natalizumab-treated MS patients, healthy blood donors and human immunodeficiency virus (HIV) infected patients. Results: The incidence of significant rises in anti-VZV IgG levels in natalizumab-treated MS patients was 4.26 per 100 person-years, which was significantly higher than in healthy blood donors. Retrospective evaluation of the available medical records of patients with rises of anti-VZV IgG levels did not reveal herpes zoster (i.e. shingles) manifestations. Conclusions:The increased incidence of significant rises of anti-VZV IgG levels in natalizumab-treated MS patients might indicate an association of natalizumab treatment of MS with an elevated risk of a subclinical VZV reactivation and/or reinfection events. Whether this is predictive of an increased risk of herpes zoster or even symptomatic reactivation of other neurotropic viruses remains to be determined in larger prospective studies.

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Section: Discussionmentioning

confidence: 63%

Serological evidence of increased susceptibility to varicella-zoster virus reactivation or reinfection in natalizumab-treated patients with multiple sclerosis

et al. 2015

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“…A polymerase chain reaction on VZV-DNA from vesicle fl uid would be preferred in such a situation. 17,18,21 Of the 272 blood samples, 260 (96%) were suitable for serological analysis, so this diagnostic method proved logistically feasible in primary care, as has previously been described for a variety of infectious diseases, including measles, toxoplasmosis, hepatitis C, and human immunodefi ciency virus infection. 16,[22][23][24] Although our study shows that the value of dried blood spot for serological verifi cation of herpes zoster is limited, the logistic advantages of this method, such as ease of collection, transport, and storage, are evident.…”

Section: Clinic a L Diagnosis Of Her Pes Zos T Ermentioning

confidence: 85%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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PURPOSE Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice.METHODS Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confi rmation of herpes zoster.RESULTS Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confi rmed serologically (positive predictive value of clinical judgment 90.8%; 95% confi dence interval, 87.3%-94.3%). Independent clinical variables for serologically confi rmed herpes zoster were severity and duration of rash at fi rst examination.CONCLUSION Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster. INTRODUCTIONH erpes zoster is a common disease, with a reported incidence varying from 2.2 to 4.8 per 1,000 persons per year. [1][2][3] It is due to a localized recrudescence of the varicella-zoster virus in sensory ganglia, where the virus has remained dormant since the primary infection (chickenpox). Age and immunity-attenuating diseases are well-known risk factors for herpes zoster. 4 The most frequent complications of herpes zoster include postherpetic neuralgia and, in cases of ophthalmic herpes zoster, sight-threatening eye problems.Because the typical unilateral rash helps family physicians diagnose herpes zoster clinically, suspected cases of herpes zoster are rarely investigated serologically or virologically. False-positive diagnosis of herpes zoster, however, is reported to occur in up to 13% of patients 5,6 and may result in unnecessary prescription of antiviral medications, erroneous referral, and unnecessary invasive interventions for the prevention of postherpetic neuralgia. 7 Serological analysis is one method to confi rm the diagnosis of herpes zoster, 8 but few studies have assessed its value in family practice. Moreover, such analysis in primary care can be fraught with logistic problems. In remote areas laboratory facilities may not be accessed easily, and for research purposes uniform analysis techniques at a central location may 306CLINIC A L DIAGNOSIS OF HER PES ZOS T ER be preferred over analy...

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“…In general, neither direct or capture IgM tests are as sensitive as molecular biology tests [5,30,410,443,446] , and they may also be non-specific in the presence of high IgG titres [5,30,348] . It is probable that the time of sampling may be important because Leung et al [474] found that only 25% of their PCR-positive patients with varicella showed IgM in samples taken 0-3 d after the onset of the rash, whereas other authors found that the percentage rose to 48% after four days [85] or 77% after 1-7 d [410] . Samples may therefore be IgM negative if they are taken too soon.…”

Section: Direct Fluorescent Antibody Assaymentioning

confidence: 98%

“…In the acute phase, IgM antibodies appear 1-7 d after the rash, peak after 14 d (range 7-30), and generally disappear during convalescence, although they may persist for several months [82][83][84] . They may also be found during re-infection and reactivation, appearing 8-10 d after the rash and peaking after 18-19 d in 50% of herpes zoster cases [30,82,85] . However, IgM is not always found in cases of full-blown varicella and so their absence does not indicate the absence of infection [30] .…”

Section: Natural Immunitymentioning

confidence: 99%

“…However, IgM is not always found in cases of full-blown varicella and so their absence does not indicate the absence of infection [30] . IgA antibodies have the same trend as IgM and, in the case of re-exposure or reactivation, reappear (or increase) in 50%-99% of cases of herpes zoster [83,85,86] . IgG antibodies appear about 9-10 d after the beginning of the rash, peak after about 60-70 d, and then decrease to lower levels for the rest of the infected subject's lifetime [82,87] .…”

Section: Natural Immunitymentioning

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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Laboratory diagnosis of herpes zoster

Cited by 124 publications

References 13 publications

Serological evidence of increased susceptibility to varicella-zoster virus reactivation or reinfection in natalizumab-treated patients with multiple sclerosis

Serological evidence of increased susceptibility to varicella-zoster virus reactivation or reinfection in natalizumab-treated patients with multiple sclerosis

Clinical Diagnosis of Herpes Zoster in Family Practice

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

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