Antibody-capture enzyme-linked immunosorbent assays that use enzyme-labelled antigen for detection of virus-specific immunoglobulin M, A and G in patients with varicella or herpes zoster

Loon, Anton M. van; Logt, J. T. M. Van Der; Heessen, F. W. A.; Heeren, Meike; Zoll, Jan

doi:10.1017/s095026880004961x

Cited by 30 publications

(17 citation statements)

References 24 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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“…It is not rare for samples to be negative for VZV reactivation at the first examination, and significant changes (greater than 2-fold) in IgG antibody values in paired sera are considered to indicate a recent VZV infection [7]. VZV IgM has been reported to be found in the acute phase in only 11% of patients with herpes zoster [8]. From a significant elevation in VZV IgG observed in the paired sera, the cause of associated laryngeal paralysis was thought to be reactivation of VZV.…”

Section: Discussionmentioning

confidence: 99%

Varicella Zoster Virus Infection of the Pharynx and Larynx without Vocal Cord Palsy

Kim¹,

Shim²

2018

Korean J Otorhinolaryngol-Head Neck Surg

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We report a patient with significant weakness of the left soft palate, paralysis of the left vocal cord, and left facial nerve palsy. Although the patient showed no herpetic eruption in the pharyngolaryngeal mucosa and auricle skin, reactivation of varicella zoster virus (VZV) was confirmed by serological examination. She was diagnosed with zoster sine herpete. After treatment with antiviral drugs and corticosteroids, her neurological disorder improved completely. When we encounter a patient with associated laryngeal paralysis, we should consider the possibility of reactivation of VZV even when no typical herpetic eruption is observed.

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“…Finally, in addition to antibody-dependent cellular cytotoxicity, natural killer cell cytotoxicity is also important [70] . Humoral immunity is expressed as the production of antibodies against components of the capsomere and surface glycoproteins [71][72][73][74][75][76][77][78] . The antibodies against the surface glycoprotein components (anti-gE, anti-gB, antigI and anti-gH) are particularly neutralising [79][80][81] .…”

Section: Natural Immunitymentioning

confidence: 99%

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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Antibody-capture enzyme-linked immunosorbent assays that use enzyme-labelled antigen for detection of virus-specific immunoglobulin M, A and G in patients with varicella or herpes zoster

Cited by 30 publications

References 24 publications

Clinical Diagnosis of Herpes Zoster in Family Practice

Clinical Diagnosis of Herpes Zoster in Family Practice

Varicella Zoster Virus Infection of the Pharynx and Larynx without Vocal Cord Palsy

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

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