Miyachi Motoko, Ihara Honoka, Imafuku Shinichi
Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
J Dermatol. 2017 Jun;44(6):656-659. doi: 10.1111/1346-8138.13733. Epub 2016 Dec 24.
Herpes zoster is an internal reactivation of varicella zoster virus following establishment of latent infection in the dorsal root ganglia during primary infection, which presents as chickenpox. Therefore, serologically, herpes zoster patients already have anti-varicella zoster virus immunoglobulin G at the onset of disease. Hence, positive serum antibody does not confirm the diagnosis of herpes zoster. We retrospectively investigated the incidence of varicella zoster virus-specific complement fixation in 865 zoster patients at initial presentation to a dermatology clinic. As a result, 66% of patients showed negative complement fixation, with patient numbers decreasing as titer increased. Paired complement fixation tests conducted within a short period showed a marked elevation in titer, and complement fixation titer gradually decreased after a year. Furthermore, incidence showed no correlation with patient age. These observations indicate that the complement fixation titer at first visit is mainly influenced by the duration from onset to presentation at clinic. Our findings indicate that a positive complement fixation result by single-point testing confirms at least recent onset of herpes zoster, while paired tests can confirm disease when primary tests are negative.
带状疱疹是初次感染水痘-带状疱疹病毒在背根神经节建立潜伏感染后病毒的再次激活，初次感染时表现为水痘。因此，从血清学角度来看，带状疱疹患者在疾病发作时已经具有抗水痘-带状疱疹病毒免疫球蛋白G。所以，血清抗体呈阳性并不能确诊带状疱疹。我们回顾性调查了865例初次到皮肤科门诊就诊的带状疱疹患者水痘-带状疱疹病毒特异性补体结合试验的发生率。结果显示，66%的患者补体结合试验呈阴性，随着滴度升高，患者数量减少。短期内进行的配对补体结合试验显示滴度显著升高，且一年后补体结合滴度逐渐下降。此外，发病率与患者年龄无关。这些观察结果表明，初诊时的补体结合滴度主要受发病至就诊时间的影响。我们的研究结果表明，单点检测补体结合试验呈阳性至少可确诊近期发生的带状疱疹，而配对试验在初次检测为阴性时可确诊疾病。
