Nahass G T, Goldstein B A, Zhu W Y, Serfling U, Penneys N S, Leonardi C L
Department of Internal Medicine, St Louis University School of Medicine, MO 63104.
JAMA. 1992 Nov 11;268(18):2541-4.
To compare Tzanck smears, viral cultures, and DNA diagnostic methods using the polymerase chain reaction (PCR) in detection of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infection in clinically suspected cases.
A 12-month trial comparing PCR with viral cultures and Tzanck smears in patients with clinically suspected HSV or VZV infection.
Both ambulatory and hospitalized patients were recruited from a tertiary referral center and the Miami (Fla) Veterans Affairs Medical Center.
Convenience samples of patients clinically suspected to have HSV (n = 48) or VZV (n = 35). To be included in the final analysis patients needed to have a positive Tzanck smear, viral culture, or PCR result. Patients who were clinically suspected to have HSV but had VZV by viral culture or PCR were analyzed in the VZV group. Similarly, patients who were clinically suspected to have VZV, but had HSV by viral culture or PCR were analyzed in the HSV group. Seventy-seven patients were available for final analysis: HSV (n = 30), VZV (n = 32), and 15 control cases who did not have evidence of viral infection.
For HSV, PCR detected HSV DNA sequences in 73% of stained smears and 83% of unstained smears. For VZV infection, VZV DNA sequences were detected in 88% of stained smears and 97% of unstained smears. Viral DNA sequences were not detected in the 15 control cases. Viral cultures were positive in 83% and 44% of HSV and VZV cases, respectively. The Tzanck smear was positive in 60% and 75% of HSV and VZV cases, respectively.
PCR is a reliable method for detecting HSV and VZV DNA sequences from single stained and unstained Tzanck smears. It is clearly superior to viral culture in identifying VZV infection and is equivalent to conventional culture techniques in identifying cases of HSV.
比较Tzanck涂片、病毒培养以及采用聚合酶链反应（PCR）的DNA诊断方法在临床疑似病例中检测单纯疱疹病毒（HSV）或水痘带状疱疹病毒（VZV）感染的效果。
一项为期12个月的试验，比较PCR与病毒培养及Tzanck涂片在临床疑似HSV或VZV感染患者中的应用。
从一家三级转诊中心和迈阿密（佛罗里达州）退伍军人事务医疗中心招募门诊和住院患者。
临床疑似患有HSV（n = 48）或VZV（n = 35）的便利样本患者。纳入最终分析的患者需Tzanck涂片、病毒培养或PCR结果为阳性。临床疑似患有HSV但病毒培养或PCR检测为VZV的患者在VZV组进行分析。同样，临床疑似患有VZV但病毒培养或PCR检测为HSV的患者在HSV组进行分析。77例患者可进行最终分析：HSV组（n = 30）、VZV组（n = 32）以及15例无病毒感染证据的对照病例。
对于HSV，PCR在73%的染色涂片和83%的未染色涂片中检测到HSV DNA序列。对于VZV感染，在88%的染色涂片和97%的未染色涂片中检测到VZV DNA序列。15例对照病例中未检测到病毒DNA序列。病毒培养在HSV和VZV病例中的阳性率分别为83%和44%。Tzanck涂片在HSV和VZV病例中的阳性率分别为60%和75%。
PCR是从单张染色和未染色的Tzanck涂片中检测HSV和VZV DNA序列的可靠方法。在识别VZV感染方面明显优于病毒培养，在识别HSV病例方面与传统培养技术相当。
