Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting

Objective: This research aims to compare (1) the sensitivity and specificity of Tzanck smear and indirect immunofluorescence assay (IFA) which detect viral antigen for the diagnosis of cutaneous herpes simplex virus (HSV) and varicella zoster virus (VZV) infections; and (2) the detection rates of th...

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Main Authors: Chayada Chaiyabutr, Nuttagarn Jantanapornchai, Chalermkwan Apinuntham, Charussri Leeyaphan, Sukhum Jiamton
Other Authors: Siriraj Hospital
Format: Article
Published: 2022
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/78688
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spelling th-mahidol.786882022-08-04T18:08:09Z Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting Chayada Chaiyabutr Nuttagarn Jantanapornchai Chalermkwan Apinuntham Charussri Leeyaphan Sukhum Jiamton Siriraj Hospital Medicine Objective: This research aims to compare (1) the sensitivity and specificity of Tzanck smear and indirect immunofluorescence assay (IFA) which detect viral antigen for the diagnosis of cutaneous herpes simplex virus (HSV) and varicella zoster virus (VZV) infections; and (2) the detection rates of the tests among various patient groups and lesion morphologies. Materials and Methods: This retrospective study reviewed 440 and 172 samples from patients with clinically suspicious cutaneous HSV and VZV infections, who underwent both Tzanck smear and IFA, respectively. The gold standard of the study was defined by showing agreement of diagnostic codes between initial and subsequent visits. Results: For HSV infections, the respective sensitivity and specificity of Tzanck smear were 32.8% and 96.6% whereas those of IFA were 60.7% and 100%. As to VZV infections, the sensitivity and specificity of Tzanck smear were 54.3% and 97.8%, respectively, while the corresponding values of IFA were 71.7% and 100%. According to disease characteristics and lesion morphologies, IFA provided substantially higher ability to detect HSV than the Tzanck smear, especially in patients with immunosuppressed conditions. Tzanck smear and IFA demonstrated no statistically significant difference for early-onset VZV infections (≤ 3 days). Conclusion: The Tzanck smear and IFA had higher sensitivities for detecting VZV than HSV infections. IFA testing is recommended in patients with immunosuppressed conditions who present with suspected cutaneous HSV infection. Despite the overall sensitivity and specificity of IFA being greater than those of Tzanck smear especially in HSV infections, the latter test is comparable option for early-onset VZV infections. 2022-08-04T11:08:09Z 2022-08-04T11:08:09Z 2021-01-01 Article Siriraj Medical Journal. Vol.73, No.5 (2021), 305-311 10.33192/Smj.2021.40 22288082 2-s2.0-85109910940 https://repository.li.mahidol.ac.th/handle/123456789/78688 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85109910940&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Chayada Chaiyabutr
Nuttagarn Jantanapornchai
Chalermkwan Apinuntham
Charussri Leeyaphan
Sukhum Jiamton
Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
description Objective: This research aims to compare (1) the sensitivity and specificity of Tzanck smear and indirect immunofluorescence assay (IFA) which detect viral antigen for the diagnosis of cutaneous herpes simplex virus (HSV) and varicella zoster virus (VZV) infections; and (2) the detection rates of the tests among various patient groups and lesion morphologies. Materials and Methods: This retrospective study reviewed 440 and 172 samples from patients with clinically suspicious cutaneous HSV and VZV infections, who underwent both Tzanck smear and IFA, respectively. The gold standard of the study was defined by showing agreement of diagnostic codes between initial and subsequent visits. Results: For HSV infections, the respective sensitivity and specificity of Tzanck smear were 32.8% and 96.6% whereas those of IFA were 60.7% and 100%. As to VZV infections, the sensitivity and specificity of Tzanck smear were 54.3% and 97.8%, respectively, while the corresponding values of IFA were 71.7% and 100%. According to disease characteristics and lesion morphologies, IFA provided substantially higher ability to detect HSV than the Tzanck smear, especially in patients with immunosuppressed conditions. Tzanck smear and IFA demonstrated no statistically significant difference for early-onset VZV infections (≤ 3 days). Conclusion: The Tzanck smear and IFA had higher sensitivities for detecting VZV than HSV infections. IFA testing is recommended in patients with immunosuppressed conditions who present with suspected cutaneous HSV infection. Despite the overall sensitivity and specificity of IFA being greater than those of Tzanck smear especially in HSV infections, the latter test is comparable option for early-onset VZV infections.
author2 Siriraj Hospital
author_facet Siriraj Hospital
Chayada Chaiyabutr
Nuttagarn Jantanapornchai
Chalermkwan Apinuntham
Charussri Leeyaphan
Sukhum Jiamton
format Article
author Chayada Chaiyabutr
Nuttagarn Jantanapornchai
Chalermkwan Apinuntham
Charussri Leeyaphan
Sukhum Jiamton
author_sort Chayada Chaiyabutr
title Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
title_short Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
title_full Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
title_fullStr Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
title_full_unstemmed Comparison of the Sensitivity and Specificity of Tzanck Smear and Immunofluorescence Assay for the Diagnosis of Cutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections in a Real-life Clinical Setting
title_sort comparison of the sensitivity and specificity of tzanck smear and immunofluorescence assay for the diagnosis of cutaneous herpes simplex virus and varicella zoster virus infections in a real-life clinical setting
publishDate 2022
url https://repository.li.mahidol.ac.th/handle/123456789/78688
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