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The Integumentary (Dermatologic) System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Laboratory procedures include examination for bacteria in crusts and biopsy specimens, examination for mycelia (the growth threads of fungi), and the Tzanck test (a microscopic examination of cells from the base of vesicles to detect the presence of herpes simplex/zoster and varicella). Dark-field examination of serum from ulcers and erosions on the genitalia is used to detect Treponema pallidum. Biopsies of skin tissue are frequently utilized in diagnosis since these are easy to obtain.
Herpes Simplex
Published in Nilton Di Chiacchio, Antonella Tosti, Therapies for Nail Disorders, 2020
The most common disorders from which HSV should be differentiated is acute bacterial paronychia. This last one gives usually a purulent discharge not present in HSV infections. A diagnostic test is, however, always advisable to make a prompt and correct diagnosis. If there is no possibility of doing the test and when there is no response to topical/systemic antibiotics, an HSV infection should always be suspected. Contrary to HSV, herpes zoster virus infections are very rare around the nail unit and Coxsackievirus infections are responsible for more disseminated vesicles even if they may lead to a misdiagnosis due to a very frequent concomitant gingivostomatitis. Many other dermatological disorders can present with pustular lesions around the nail unit, such as pustular psoriasis, parakeratosis pustulosa, blistering distal dactylitis, dyshidrotic eczema, pemphigus, and pemphigoid. When the clinical picture is doubtful, a Tzanck test or polymerase chain reaction (PCR) needs to be performed.
Varicella-Zoster Virus Pneumonitis *
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Sandor Feldman, Dennis C. Stokes
The diagnosis of VZV pneumonitis is based upon typical radiographic findings of bilateral, ill-defined nodular infiltrates in the presence of the cutaneous rash. Herpes virus particles, apparent from electron microscopic examination of negatively stained vesicle fluid or multinucleated giant cells with intranuclear inclusions evident from a Tzanck test of a fresh vesicle, provide support for a VZV origin of the cutaneous lesions. Confirmation can be obtained by isolation of VZV in tissue culture from samples of vesicle fluid and (or) leukocyte-rich plasma.
Cutaneous manifestations of COVID-19 in skin of color: a firsthand perspective of three cases in a tertiary care center in India
Published in Postgraduate Medicine, 2021
Shivam Goyal, Smitha Prabhu, Shashikiran U, Sathish B. Pai, Afsal Mohammed
The third case was a man in his 60s who presented with erythematous vesicular lesions on the left side of his trunk for 10 days. Two days after the onset of skin lesions, he developed fever, myalgia, anosmia, and weakness. He was subsequently tested COVID-19 positive by RT-PCR and admitted to an isolation facility. On examination, the patient had multiple tender grouped hemorrhagic crusted vesicles on an erythematous base in a dermatomal distribution (T6) over the left side of the trunk (Figure 3). Systemic examination and other baseline investigations were otherwise normal. Tzanck test could not be done as the vesicles had crusted. The patient was diagnosed with HZ clinically and treated with oral Acyclovir 800 mg five times a day for 7 days and topical fusidic acid cream.
Severe oral stomatitis due to reactivation of herpes simplex virus type 1 in a methotrexate-treated patient with dermatomyositis
Published in Immunological Medicine, 2021
Takahiko Akagi, Tomoyuki Mukai, Shunichi Fujita, Takenobu Yamamoto, Mikiko Fukuda, Yoshitaka Morita
MTX is one of the most widely used immunosuppressive drugs for treating autoimmune diseases and is known to induce oral mucositis due to its mucosal toxicity [10,11]. Therefore, MTX toxicity was first suspected as the cause of stomatitis in our case when the patient developed stomatitis during MTX treatment. Our case illustrates the importance of a differential diagnosis for stomatitis. Stomatitis is caused by several other etiologies, such as infection (with bacteria, viruses, and fungi), trauma, systemic lupus erythematosus, immunobullous diseases, and recurrent aphthous stomatitis [1,2]. Thus, detailed medical history taking, blood examination, and microbial culture tests are required for the differential diagnosis. Since there are no obvious differences in the findings of visual examination between MTX-induced and HSV-1 reactivation–induced stomatitis, it is also important to carefully monitor the clinical course of patients with oral stomatitis. HSV-1 reactivation should be strongly suspected, for instance, when stomatitis progresses even after the discontinuation of MTX and supplementation with folinic acid, or when stomatitis rapidly deteriorates with stomatalgia. Furthermore, to appropriately diagnose and treat stomatitis, consultation with dermatologists and otorhinolaryngologists is needed. Other than the PCR test, the Tzanck test or immunochromatographic test can be used as quicker and easier diagnostic methods for the HSV infection in clinical practice.
Primary varicella infection in children with systemic juvenile idiopathic arthritis under tocilizumab therapy
Published in Modern Rheumatology, 2019
Tomo Nozawa, Kenichi Nishimura, Asami Ohara, Ryoki Hara, Shuichi Ito
Although two patients had each previously received one dose of VZV vaccine, all six patients were negative for anti-VZV IgG antibody, both six months before and at the time of their primary varicella infection. However, all but one patient (patient 3) achieved seroconversion to varicella after infection (Table 4). On admission, anti-VZV immunoglobulin M (IgM) antibody was detected (>0.8) in three patients (patients 1, 4, and 5), and VZV DNA was detected by real time polymerase chain reaction method in five patients (all except patient 3). However, although patient 3 lacked detectable levels of VZV DNA or anti-VZV IgM, she was diagnosed with varicella because her father had initially suffered a VZV infection and she presented with typical varicella skin lesions on her face and trunk shortly afterward. Additionally, the results of her Tzanck test were positive. We did not evaluate her cellular immunity, such as the number of CD4-positive lymphocytes, CD4/CD8 ratio, and phytohemagglutinin stimulation of lymphocytes. However, this patient had never suffered any severe infections besides the varicella infection and had never experienced severe adverse effects to a live vaccine, including the measles-rubella vaccine and the Bacille Calmette-Guérin vaccine.