Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

Presentation

VZV: Diagnosis & Basic Treatment

Description

The presentation discusses the diagnosis and treatment of varicella zoster virus (VZV), primarily from the perspective of a dermatologist and dermatopathologist. It highlights the decreased incidence of chickenpox due to vaccination but acknowledges potential outbreaks due to declining vaccination rates. Diagnoses can be established through various methods, including biopsy, direct fluorescent antibody tests, and PCR, which is gaining popularity. Key histopathological findings include multinucleated keratinocytes and Cowdry bodies. A practical case was presented involving a 24-year-old patient with breakthrough varicella despite vaccination, illustrating the importance of thorough diagnostics, including immunohistochemical stains and PCR, to confirm the diagnosis quickly. Treatment options for uncomplicated varicella and postherpetic neuralgia are briefly mentioned, with references to gabapentin and prednisone, although specifics for immunocompromised patients will be covered in subsequent discussions. The speaker emphasized the utility of different diagnostic tests and the need for clinical vigilance, especially in vaccinated individuals presenting with atypical symptoms.

View more

Conclusions

Primary varicella infection leads to chickenpox, while reactivation of the varicella-zoster virus results in shingles.
A decrease in chickenpox cases is noted due to vaccination, but outbreaks occur due to declined vaccination rates.
Diagnosis of VZV can be complex, often requiring biopsies and various diagnostic techniques such as PCR, DFA, and serology.
Immunohistochemical stains significantly aid in differentiating between VZV and HSV infections.
Breakthrough varicella can occur in vaccinated individuals, often presenting as milder disease yet still capable of transmission.
PCR has emerged as the most sensitive and rapid diagnostic method for detecting varicella-zoster virus.
Treatment options for varicella include antiviral medications like acyclovir and valacyclovir, tailored based on age and clinical presentation.
Pain management may require adjunct therapies like gabapentin or corticosteroids for zoster, particularly in older patients.

Mayo Clinic. (2007). Rapid PCR - The New Gold Standard for Dermal and Genital Testing for HSV and VZV. Mayo Medical Laboratories.