Laboratory diagnosis of herpes zoster
Introduction
Herpes zoster caused by reactivation of latent varicella-zoster virus (VZV) is usually a clinical diagnosis. Laboratory tests may be helpful in patients with an atypical rash, common in immunosuppression (Schiller et al., 1991). For patients with life-threatening diseases, it is particularly important to achieve a rapid diagnosis, as effective treatment is available. Most laboratories use serological IgM and/or IgA antibody determination and look for a rise in IgG titers. Significant antibody response takes, however, several days and depends on a functioning immune system. Cross-reactions with herpes simplex virus (HSV) antibodies have also been reported (Bernstein et al., 1990). Serological methods have thus become less useful when rapid decision as regards antiviral chemotherapy is necessary.
An early and accurate diagnosis of zoster may be possible by identification of the etiological agent. However, as VZV is extremely labile and cell-associated virus isolation in cell culture cannot been considered a routine method. Further techniques such as electron microscopy and detection of viral antigens have other disadvantages. Molecular virological procedures, particulary polymerase chain reaction (PCR), are becoming increasingly the standard methods for rapid diagnosis of viral diseases.
This study evaluates PCR techniques for diagnosis of zoster using different VZV-specific oligonucleotides. The results are compared with those obtained by conventional virological and serological methods.
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Patients
One hundred patients with the clinical diagnosis of zoster were enrolled. Their ages ranged between 6 and 87 years (mean 56 years). An underlying immunosuppressive disease was known in 23 patients. Zoster was localized in dermatomes of the chest (33 cases), head (28 cases), neck (19 cases), waist (nine cases) and pelvis (one case). Disseminated infections were observed in eight immunosuppressed patients. In two cases, the affected dermatomes were not recorded by the physician.
Forty patients
Results
PCR results confirmed the clinical diagnosis of zoster in 95 of 100 cases tested. There were some differences depending on which oligonucleotides and PCR procedure were used. With primers of VZV gene 28 (Fig. 1), viral DNA could be detected in 90% of samples. Using primers of gene 29, 86 patients had positive results including five negative with primers for gene 28, and with primers of gene 4, viral DNA was amplified in 72 cases (Table 2). In the five PCR-negative cases, we also failed to
Discussion
Zoster is caused by endogenous reactivation of VZV latent within sensory ganglia after primary infection. With an increasing elderly population and more patients having immune deficits due to various diseases and/or medication, zoster has become a significant medical problem (Thomsen, 1994). The incidence of zoster increases with advancing age up to 10-fold, and in patients who have malignancies up to 50- or 100-fold (Hope-Simpson, 1965, Balfour, 1988). Zoster is often complicated by
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