RAPID DETECTION AND DISTINCTION OF CUTANEOUS HERPESVIRUS INFECTIONS BY DIRECT IMMUNOFLUORESCENCE

Background: Optimal management of cutaneous herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections requires rapid, accurate distinction between these pathogens. Objective: In a mixed-case series of suspected cutaneous herpesvirus infections, we compared the diagno stic utility of viral culture and direct immunofluorescence (DIF) usin g a panel of fluoresceinated monoclonal antibodies against HSV and VZV . Methods: Epifluorescence microscopy of smears and viral culture were performed in parallel on 58 lesions. Results: DIF and culture were eq ually sensitive (88%) in HSV infections, whereas DIF was four times as sensitive as culture (100% vs 18%) in VZV. DIF either refuted an inco rrect clinical diagnosis or permitted definitive laboratory diagnosis of a clinically indeterminate lesion in 7 (12%) of 58 lesions rested. Conclusion: DIF is a rapid simple, sensitive, specific, cost-effective , and clinically useful technique for detecting and distinguishing cut aneous HSV and VZV infections.