Summary about Disease
A Tzanck smear is a diagnostic test used to examine cells from skin lesions, particularly blisters or ulcers, for certain viral infections. A positive Tzanck smear indicates the presence of multinucleated giant cells, which are characteristic of infections caused by herpes viruses. The most common diseases identified by a positive Tzanck smear are herpes simplex virus (HSV-1 and HSV-2) infections (causing oral and genital herpes, respectively) and varicella-zoster virus (VZV) infections (causing chickenpox and shingles). The test itself is not specific; it simply indicates herpes virus infection and does not differentiate between HSV and VZV. Further testing may be required to identify the specific virus.
Symptoms
Symptoms vary based on the specific disease:
Herpes Simplex (HSV-1 & HSV-2):
Painful blisters or ulcers, typically around the mouth (cold sores) or genitals.
Itching, tingling, or burning sensation before blisters appear.
Swollen lymph nodes.
Fever, headache, and body aches (especially during the first outbreak).
Varicella-Zoster (VZV):
Chickenpox: Itchy rash with small, fluid-filled blisters that eventually scab over, fever, fatigue, loss of appetite.
Shingles: Painful rash with blisters that typically appear in a band on one side of the body, usually on the torso. Pain can persist after the rash heals (postherpetic neuralgia).
Causes
The causes are viral infections:
Herpes Simplex: Caused by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV-1 typically causes oral herpes, while HSV-2 usually causes genital herpes.
Varicella-Zoster: Caused by the varicella-zoster virus (VZV). Primary infection causes chickenpox. After chickenpox resolves, the virus remains dormant in nerve cells and can reactivate later in life to cause shingles.
Medicine Used
Antiviral medications are the primary treatment:
Herpes Simplex (HSV-1 & HSV-2):
Acyclovir (oral, topical, IV)
Valacyclovir (oral)
Famciclovir (oral)
Topical creams (e.g., docosanol) can help with symptoms.
Varicella-Zoster (VZV):
Acyclovir (oral, IV)
Valacyclovir (oral)
Famciclovir (oral)
Pain medication for shingles (e.g., NSAIDs, opioids, nerve pain medications like gabapentin or pregabalin).
Calamine lotion or oatmeal baths for chickenpox itching.
Is Communicable
Yes, these diseases are communicable:
Herpes Simplex: Highly contagious through direct contact with sores or bodily fluids (e.g., saliva, genital secretions). Transmission can occur even when there are no visible sores (asymptomatic shedding).
Varicella-Zoster:
Chickenpox: Highly contagious through airborne droplets or direct contact with blisters.
Shingles: Contagious through direct contact with blisters. A person exposed to shingles virus can develop chickenpox if they have not been previously infected or vaccinated.
Precautions
Avoid direct contact with sores or blisters.
Wash hands frequently with soap and water.
Do not share personal items (e.g., towels, razors, lip balm).
Avoid sexual contact during outbreaks of genital herpes. Use condoms during periods of remission, but be aware that they do not eliminate the risk of transmission.
Cover shingles blisters to prevent spread of the virus.
Vaccination:
Varicella vaccine for chickenpox prevention.
Shingles vaccine (Shingrix) for adults to prevent shingles and postherpetic neuralgia.
Pregnant women who have not had chickenpox should avoid exposure to VZV, as it can be dangerous to the fetus.
How long does an outbreak last?
The duration of an outbreak varies:
Herpes Simplex:
Initial outbreak: 2-4 weeks.
Recurrent outbreaks: 7-10 days.
Varicella-Zoster:
Chickenpox: About 5-10 days from the start of the rash until all blisters have crusted over.
Shingles: The rash typically lasts 2-4 weeks. Pain (postherpetic neuralgia) can persist for months or even years after the rash has healed.
How is it diagnosed?
Tzanck Smear: A sample is taken from a blister or ulcer, stained, and examined under a microscope for multinucleated giant cells.
Viral Culture: A sample is taken from a lesion and cultured to identify the specific virus (HSV-1, HSV-2, or VZV).
Polymerase Chain Reaction (PCR): A highly sensitive test that detects the virus's DNA or RNA in a sample from a lesion or bodily fluid. PCR is more accurate than viral culture.
Antibody Testing: Blood tests can detect antibodies to HSV or VZV. These tests can determine if a person has been previously infected with the virus but cannot diagnose an active outbreak.
Timeline of Symptoms
Herpes Simplex (Initial Outbreak):
Prodrome (1-2 days): Tingling, itching, or burning sensation at the site where blisters will appear.
Blisters (2-4 days): Small, painful blisters develop.
Ulcers (2-5 days): Blisters rupture and form ulcers.
Crusting (5-10 days): Ulcers begin to heal and form crusts.
Healing (1-2 weeks): Crusts fall off, and the skin heals.
Herpes Simplex (Recurrent Outbreak): The timeline is similar to the initial outbreak but typically shorter and less severe.
Chickenpox:
Incubation Period (10-21 days): No symptoms.
Prodrome (1-2 days): Fever, headache, fatigue, loss of appetite.
Rash (5-10 days): Starts as small, red spots that develop into itchy blisters, which eventually scab over. New crops of blisters appear over several days.
Shingles:
Prodrome (1-5 days): Pain, itching, or tingling in the area where the rash will appear.
Rash (2-10 days): Painful rash with blisters that typically appear in a band on one side of the body.
Healing (2-4 weeks): Blisters scab over and the rash heals.
Postherpetic Neuralgia (Variable): Pain can persist for months or years after the rash has healed.
Important Considerations
A positive Tzanck smear only indicates a herpes virus infection; it does not specify which virus (HSV or VZV). Further testing is needed for definitive diagnosis.
Antiviral medications can shorten the duration and severity of outbreaks but do not cure the infection. The virus remains dormant in the body.
Recurrent outbreaks of herpes simplex are common. Frequency varies among individuals.
Shingles vaccination is highly effective in preventing shingles and postherpetic neuralgia.
Complications can occur, such as secondary bacterial infections of the sores, eye involvement (herpes keratitis or shingles involving the ophthalmic nerve), and, rarely, encephalitis or meningitis.
Pregnant women with herpes simplex or varicella-zoster should consult with their doctor about management to minimize the risk of transmission to the newborn.