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Chapter 99 : Varicella-Zoster Virus

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Varicella-Zoster Virus, Page 1 of 2

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Abstract:

Varicella-zoster virus (VZV) is a human herpesvirus and the cause of varicella (chicken pox). After primary infection, the virus remains latent in the human host and may later reactivate and cause herpes zoster (shingles). Although the diagnosis of uncomplicated VZV infection is often based on the typical clinical picture, application of laboratory diagnostic methods is of major importance in specific clinical situations, as for the diagnosis of neurological complications of VZV during infection and reactivation, especially in cases of zoster “sine herpete,” for diagnosis in the immunocompromised host or for the identification of the VZV serostatus, which may be especially important in pregnancy or prior to transplantation. In this chapter, various approaches to identify and quantify the virus directly in the human host are presented, as well as current methods to detect the antibody response against VZV. In addition, other special aspects of VZV diagnostics, such as the detection of cellular immune response against VZV, the detection of antibody avidity, and the characterization of VZV strains and discrimination between vaccination and wild-type strains, are described. The rational application of these methods and the correct interpretation of the test results in specific clinical situations are of high importance and are also discussed, as this has major implications for the clinical management of the patients.

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Image of FIGURE 1
FIGURE 1

Electron micrograph of VZV in skin vesicle fluid from a patient with varicella; magnification, ×100,000. (Reprinted from .) doi:10.1128/9781555817381.ch99.f1

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Image of FIGURE 2
FIGURE 2

Schematic of the VZV linear double-stranded DNA genome. UL, unique long segment (100 kbp); US, unique short segment (5.4 kbp); TRs and TRL, terminal repeats; IRs and IRL, internal repeats. The arrows indicate the direction of the transcription of the viral genes indicated. RR, ribonucleotide reductase; DBP, DNA binding protein. (Reprinted from .) doi:10.1128/9781555817381.ch99.f2

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Image of FIGURE 3
FIGURE 3

Giemsa-stained preparation of material from the base of a vesicular lesion. Magnification, ×102. The arrow indicates a giant cell with a folded nucleus characteristic of VZV or HSV. doi:10.1128/9781555817381.ch99.f3

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Image of FIGURE 4
FIGURE 4

Comparison of the amount of VZV DNA in CSF according to the neurological diagnosis (A), the severity of disease (B), and the presence of acute peripheral facial palsy with meningeal signs (C). The geometric mean value is shown by a horizontal line. The value was calculated using the Mann-Whitney test. (Modified from , with permission.) doi:10.1128/9781555817381.ch99.f4

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Image of FIGURE 5
FIGURE 5

Immunofluorescence assay for the detection of VZV-positive cells from a patient with zoster. A smear of a skin vesicle was fixed and stained with monoclonal antibody to VZV gE. Magnification, ×200. doi:10.1128/9781555817381.ch99.f5

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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Tables

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TABLE 1

Diagnostic tests for VZV-induced disease

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99
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TABLE 2

Quantitative VZV DNA results with different clinical materials from patients with different VZV-associated diseases

Citation: Puchhammer-StÖckl E, Aberle S. 2015. Varicella-Zoster Virus, p 1704-1717. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch99

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