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Annals of Family Medicine 5:305-309 (2007)
© 2007 Annals of Family Medicine, Inc.
doi: 10.1370/afm.707
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Clinical Diagnosis of Herpes Zoster in Family Practice

Wim Opstelten, MD, PhD1, Anton M. van Loon, PhD2, Margje Schuller, MSc2, Albert J. M. van Wijck, MD, PhD3, Gerrit A. van Essen, MD, PhD1, Karel G. M. Moons, PhD1 and Theo J. M. Verheij, MD, PhD1

1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
2 Department of Virology, Eijkman-Winkler Center, University Medical Center Utrecht, The Netherlands
3 Department of Anesthesiology, University Medical Center Utrecht, The Netherlands

CORRESPONDING AUTHOR: Wim Opstelten, MD, PhD Julius Center for Health Sciences and Primary Care University Medical Center Utrecht PO Box 85060 3500 AB Utrecht, The Netherlands w.opstelten{at}umcutrecht.nl

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 confirmation of herpes zoster.

RESULTS Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confirmed serologically (positive predictive value of clinical judgment 90.8%; 95% confidence interval, 87.3%–94.3%). Independent clinical variables for serologically confirmed herpes zoster were severity and duration of rash at first 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.

Key Words: Herpes zoster/diagnosis • serologic tests • dried blood spot • enzyme-linked immunosorbent assay • primary health care




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K. C. Stange
In This Issue: Clinical Diagnosis and Management
Ann. Fam. Med, July 1, 2007; 5(4): 290 - 291.
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