Cytologic diagnosis of herpes simplex virus infection

Alterations in epithelial cells infected with herpes simplex viruses (HSV) have been described repeatedly^1–7 since Tzank,⁸ in 1947, advocated the use of cytology for the diagnosis of these infections. In spite of successful use of this technique in the following years by Blank and his collaborators,^9,10 enthusiasm for this diagnostic method gradually waned because of the emergence of other, more sophisticated, laboratory tests for viral diagnosis (culture, serology, antibody determination, animal inoculation, electron microscopy, etc.).¹¹For the last 20 years, with the use of the Papanicolaou staining method, cytology has proven to be a fairly reliable, rapid, and simple method of diagnosis of HSV infections. The Pap stain gives better nuclear detail of the alcohol-fixed cells than the original Tzank smear, which was air-dried and Giemsa stained. This cytologic diagnosis has been and continues to be especially significant in detecting cervical herpetic infections through the use of Papanicolaou smears for cancer screening of asymptomatic women.¹²     

Current approaches to the diagnosis of herpes genitalis

The current methods of diagnosing and treating herpes genitalis in clinics for sexually transmitted diseases in England and Wales are reported. Virus cultures were used as a diagnostic test in some or all patients in nearly two-thirds of clinics. Darkground examinations were performed on all or selected patients in most clinics, but fewer than half the clinics performed them on three or more separate occasions. In over 80% of clinics attempts were made to see some or all contacts of patients with herpes. The treatments prescribed varied, the commonest being saline washes, idoxuridine, and oral antibiotics. Serological tests were repeated after the disappearance of the lesions in 90% of clinics, while in 60% of clinics women with herpes genitalis were advised to have cytological examination at regular intervals in future. The importance of excluding syphilis in patients presenting with genital ulceration, the most appropriate treatments for herpes, and the possible association between the disease and cervical carcinoma are discussed.     

Cytological diagnosis of subcutaneous fat necrosis of newborn: a case report

Cytological findings of subcutaneous fat necrosis of the newborn, a rare and transient disorder of neonates, is described in a 20-day-old male baby, who presented with a 2-week history of firm, erythematous nodules and plaques on the back and upper arms.     

Current approaches to the diagnosis of herpes genitalis.

The current methods of diagnosing and treating herpes genitalis in clinics for sexually transmitted diseases in England and Wales are reported. Virus cultures were used as a diagnostic test in some or all patients in nearly two-thirds of clinics. Darkground examinations were performed on all or selected patients in most clinics, but fewer than half the clinics performed them on three or more separate occasions. In over 80% of clinics attempts were made to see some or all contacts of patients with herpes. The treatments prescribed varied, the commonest being saline washes, idoxuridine, and oral antibiotics. Serological tests were repeated after the disappearance of the lesions in 90% of clinics, while in 60% of clinics women with herpes genitalis were advised to have cytological examination at regular intervals in future. The importance of excluding syphilis in patients presenting with genital ulceration, the most appropriate treatments for herpes, and the possible association between the disease and cervical carcinoma are discussed.     

Early diagnosis of herpes zoster by polymerase chain reaction

BACKGROUND: Herpes zoster is a common disease caused by the varicella-zoster virus. The use of virostatic agents as early as possible is necessary in shortening zoster-associated pain. OBJECTIVES: Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is often difficult. METHODS: In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63. RESULTS: Varicella-zoster virus DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin. CONCLUSIONS: PCR is the method of choice for the viral diagnosis in herpes zoster before blister eruption.     

Role of type specific herpes simplex virus serology in the diagnosis and management of genital herpes

OBJECTIVES: To investigate the indications for the use of a type specific antibody test for herpes simplex virus in a department of genitourinary medicine in the United Kingdom. METHOD: Retrospective analysis of case records of 127 patients who accepted the test during a 20 month period. RESULTS/CONCLUSION: The test contributed to patient management in 79% of patients with recurrent genital ulceration of unknown cause. It was also useful for counselling a number of patients with initial episodes of disease and the asymptomatic partners of some patients when the partners were shown to possess antibodies specific to herpes simplex virus type 2. When evaluating sexual partners, the test was difficult to interpret if an isolate from the index case had not been typed. Access to viral typing may therefore be a greater priority than serological testing. As adverse psychological sequelae may follow the identification of an asymptomatic chronic infection, guidelines for the use of a type specific serological test are proposed.


     

老年带状疱疹诊疗专家共识

老年人带状疱疹发病率高, 临床症状复杂且严重, 易罹患特殊类型带状疱疹。老年带状疱疹常累及周围运动神经、中枢神经、颅神经及内脏, 引发相关特殊症候。本共识针对老年带状疱疹特殊临床类型及带状疱疹后相关症候群等方面进行分类描述和分析;在系统性评估、排除禁忌证后, 建议早期给予高效抗病毒、抗炎、镇痛等治疗。本共识旨在提高对老年带状疱疹的重视及临床规范化诊疗水平。     

Rapid diagnosis of cutaneous herpes simplex infections using specific monoclonal antibodies

One hundred children with suspected herpes simplex virus (HSV) infection and 20 controls were studied to compare a rapid immunofluorescence (RIF) test for detection and typing of HSV from smears of lesions with standard viral culture. The RIF test was evaluated for ease of use and speed of diagnosis. RIF and/or culture were positive in 64% of patients. All infections diagnosed by RIF and culture were HSV type 1. In 92% of patients RIF and culture results were in concordance. In 57 cases, RIF and cultures were positive for HSV infection and in 35 cases RIF and cultures were negative for HSV infection. Three patients had inadequate samples for RIF and five children had positive RIF but were culture negative. All controls had negative results both by RIF test and culture. The RIF test demonstrated 100% sensitivity and 95% specificity. The RIF test was type specific, easy to perform and gave diagnosis of HSV infections within an hour of taking the clinical specimen. This study suggests the RIF test is as good, if not more sensitive, in the diagnosis of HSV infections as standard viral culture and has the advantage of speed of diagnosis.     

Virological diagnosis of herpes simplex virus infections (author's transl)

Culturing herpes simplex virus is rapid and economic for establishing an etiological diagnosis. Serological tests are only of limited value. Differentiation of type I and type II strains is necessary in the course of therapeutic studies. Analysis of the herpes simplex virus genom with restriction enzymes offers a novel tool for epidemiological and clinical investigations.     

Rapid detection of glycoprotein G gene for the diagnosis and typing of herpes simplex virus infection in genital herpes

OBJECTIVE: To develop a new, rapid, and convenient technique for the diagnosis and typing of herpes simplex virus (HSV) in genital herpes (GH). METHODS: Using samples from skin vesicle fluid and urogenital mucosal swabs of subjects with GH, conventional polymerase chain reaction (PCR) (directed to polymerase gene: PCRpG) were compared with a newly developed PCR (directed to HSV glycoprotein gene: PCRgG). Both PCR methods were compared with virus isolation culture (VI) with indirect immunofluorescent staining (IIF). RESULTS: 80 samples from 40 GH patients (25 males) were tested. Positive results were seen in 52.5% (42/80) using PCRgG compared with 40% (32/80) by VI. Most of PCRgG positive samples (95.1%) were caused by HSV-2 infection. In samples from healing lesions, HSV was detected more often by PCRgG, than by VI. The results of typing by PCRgG and IIF were highly consistent. CONCLUSION: PCRgG is more sensitive than VI and PCRgG in detecting HSV in urogenital samples from subjects with GH. PCRgG is a convenient technique for the rapid detection and typing of GH.     

Laboratory diagnosis of herpes simplex virus type 1 and type 2 infections

Herpes simplex virus (HSV) is known to infect several body sites. Most commonly HSV infection results in lesions around the mouth or in the genital area. Infection at these sites may also be subclinical. Over the past decade HSV has been increasingly recognized as an important cause of both mild and severe diseases in a wide range of patients. Two distinct types of HSV are known, HSV-1 and HSV-2, and many antigens are shared between the two. Infection with either type of virus can occur early in life, although infection with HSV-2 becomes common only after puberty. The most common manifestation of HSV-1 infection is the orofacial “fever blister,” while HSV-2 is most often responsible for genital lesions.^1,2 Either virus type can, however, cause disease in almost any site of the body and can recur frequently. This recurrence of disease from an inapparent or latent state makes HSV infection unique among the common viral infections.Mistakes in diagnosis of HSV infections based on clinical findings alone are not uncommon. Herpetic lesions have been confused with allergic reactions, drug reactions, and lesions due to other infectious agents. Besides the medical importance of HSV in special situations, the social impact of having “herpes” is of considerable concern is almost everyone. Therefore, precise diagnosis of HSV infection is of paramount importance, particularly since effective antiviral therapy is available for many forms of the disease.Morphologically, all herpesviruses are alike (Fig. 1); therefore, it is not possible to differentiate members of the group by their structure alone. Although rapid techniques for diagnosis of HSV infection are constantly being refined and improved, virus isolation in tissue culture is still the most definitive method of detecting HSV, and it is the most widely used. In this chapter detailed procedures for HSV isolation and typing are described, with brief reviews on methods that have been used in conjunction with virus isolation when cell culture facilities are not available.     

Polymerase chain reaction for diagnosis of genital herpes in a genitourinary medicine clinic

BACKGROUND: Polymerase chain reaction (PCR) has well established advantages over culture for diagnosis of herpes viruses, but its technical complexity has limited its widespread application. However, recent methodological advances have rendered PCR more applicable to routine practice. Aim: To compare automated PCR with viral culture for diagnosis of genital herpes. METHODS: We studied 236 patients presenting with clinical features suggestive of genital herpes at an inner city genitourinary medicine clinic. Two swabs were taken from each patient. Cell culture and typing were performed by standard methods. Automated PCR was performed using the LightCycler instrument and the infecting viral type was determined by restriction endonuclease digestion of amplicons. RESULTS: 109 patients (46%) had a positive test for herpes simplex virus (HSV). In 88, both PCR and culture were positive; in 21 PCR only was positive. With both detection methods, lesion duration and morphology were associated with HSV detection. Compared with culture alone, use of PCR increased sensitivity by 13.3% in specimens from vesicular lesions, by 27.4% from ulcerative lesions, and by 20.0% from crusting lesions. CONCLUSIONS: We advocate adoption of automated PCR as an efficient HSV detection and typing method for diagnosis of genital herpes in routine clinical practice. PCR allowed rapid laboratory confirmation of the diagnosis and increased the overall HSV detection rate by 24%.     

Recurrent cutaneous herpes simplex: comments on diagnosis in an unusual case

A patient with undiagnosed recurrent cutaneous herpes of twenty-four years' duration is described. The probable reason for the failure to recognize this disease on numerous occasions was the rapid progression of the lesions to the pustular stage within one day.     

The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection

OBJECTIVES: To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on psychosocial functioning among people with no known history of genital herpes. METHODS: Individuals (age 14-30 years) without a history of genital herpes were recruited from an urban university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics. Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment, and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and 60 HSV-2 negative people demographically matched from the same source of recruitment were re-evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality of life (GHQOL) measure. RESULTS: Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated there were no significant differences over time on any of the measures. None the less, many HSV-2 positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal sensitivity (r = -0.44, p<0.05), lower social support (r = 0.40, p<0.05), and quality of sex (r = 0.62, p<0.01) at baseline. CONCLUSIONS: A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be important to include as part of pretest and post-test counselling.     

The difficulty in diagnosis of cutaneous herpes simplex virus infection in patients with AIDS

Three patients with AIDS are described with atypical manifestations of cutaneous herpes simplex virus infection. This infection should be considered in the immuno-suppressed patient with persistent or bizarre cutaneous ulceration despite negative virological cultures, and in the acutely ill patient with a generalized rash.