Varicella‐Zoster Virus in the Saliva of Patients with Herpes Zoster

Mehta, Satish K.; Tyring, Stephen K.; Gilden, Donald H.; Cohrs, Randall J.; Leal, M; Castro, Victoria; Feiveson, Alan H.; Ott, C. Mark; Pierson, Duane L.

doi:10.1086/527420

Cited by 82 publications

(78 citation statements)

References 13 publications

(14 reference statements)

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“…16 Varicella zoster virus DNA may be detected in saliva very early after infection or even before the development of symptomatic illness. 17 Disseminated varicella in immunocompromised patients should be initially treated with parenteral acyclovir until new lesions stop and systemic symptoms improve, followed by a course of oral valacyclovir.…”

Section: Discussionmentioning

confidence: 99%

Clinical Pearls in Infectious Diseases

Edson

Bundrick

Litin

2011

Mayo Clinic Proceedings

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Section: Discussionmentioning

confidence: 99%

Clinical Pearls in Infectious Diseases

Edson

Bundrick

Litin

2011

Mayo Clinic Proceedings

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“…BAL is important [159] as pneumonia is found in 5%-20% of pregnant women with varicella [54,121,158,163] , although it can also be caused by bacterial superinfection. Saliva can be useful for diagnosing neurological diseases without rash [473] , and CSF for diagnosing encephalitis [429] . The materials of choice in the case of varicella are the vesicles and scabs [23,449,450,[474][475][476] and so, once the lesions have resolved, the probability of finding viral DNA by means of PCR is virtually zero [30] .…”

Section: Direct Fluorescent Antibody Assaymentioning

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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“…For laboratory diagnosis of VZV infection, the following approaches are currently most useful: PCR on material from skin vesicles (submitted as swabs, fluid or scabs [102][103][104] ), saliva 90,102,103,[105][106][107] and cerebrospinal fluid if neurological symptoms or signs are present 91,92,108,109 . Detection of VZV antigens by direct immunofluorescence from vesicles is also rapid and specific, although less sensitive than PCR 110 .…”

Section: Diagnosis Screening and Prevention Diagnosismentioning

confidence: 99%

“…Detection of VZV antigens by direct immunofluorescence from vesicles is also rapid and specific, although less sensitive than PCR 110 . During varicella and zoster, viral DNA can be detected in saliva, and this method is diagnostically useful and specific in symptomatic patients with or without rash 102,104,106 . PCR along with restriction enzyme digest and sequencing of specific segments of the viral genome can be used to determine whether VZV is resistant to acyclovir 111 .…”

Section: Diagnosis Screening and Prevention Diagnosismentioning

confidence: 99%