Chickenpox laboratory findings: Difference between revisions

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==Overview==
==Overview==
The laboratory findings of chicken pox include: Blood tests can be done to identify the response to acute infection (IgM) or previous infection and subsequent immunity (IgE). Prenatal diagnosis of fetal varicella infection can be performed using ultrasound at 5 weeks following primary maternal infection. A PCR (DNA) test of the mother's amniotic fluid can also be performed, though the risk of spontaneous abortion due to the amniocentesis procedure is higher than the risk of the baby developing fetal varicella syndrome.
The laboratory findings of [[chickenpox]] include [[blood]] tests that can be done to identify the response to acute [[infection]] ([[IgM]]) or previous [[infection]] and subsequent [[Immunity (medical)|immunity]] ([[IgG]]). [[Prenatal]] diagnosis of [[Fetus|fetal]] [[Chickenpox|varicella infection]] can be performed using [[ultrasound]] at 5 weeks following primary [[maternal]] [[infection]]. A [[PCR]] test of the mother's [[amniotic fluid]] can also be performed, though the risk of [[spontaneous abortion]] due to the [[amniocentesis]] procedure is higher than the risk of the baby developing fetal [[Chickenpox|varicella syndrome]].


==Laboratory Findings==
==Laboratory Findings==


* Laboratory tests useful for the diagnosis of chicken pox include:
Laboratory tests that are shown to be useful for the diagnosis of [[chickenpox]] include:
** Antibody Testing
* [[Polymerase chain reaction|PCR]] is done by collecting [[skin]] [[Vesicle|vesicles]] [[fluid]], [[Scab|scabs]], [[saliva]] and [[cerebrospinal fluid]] if neurological symptoms or signs are present.<ref name="pmid27188665">{{cite journal| author=Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D et al.| title=Varicella zoster virus infection. | journal=Nat Rev Dis Primers | year= 2015 | volume= 1 | issue=  | pages= 15016 | pmid=27188665 | doi=10.1038/nrdp.2015.16 | pmc=5381807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188665  }} </ref>
** Viral detection
*[[Polymerase chain reaction|PCR]] done with a [[restriction enzyme]] can be used to [[hydrolyze]] and sequence specific segments of the [[Virus|viral]] [[genome]]. This can be used to determine whether [[Varicella zoster virus|VZV]] is resistant to [[acyclovir]].<ref name="pmid27188665">{{cite journal| author=Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D et al.| title=Varicella zoster virus infection. | journal=Nat Rev Dis Primers | year= 2015 | volume= 1 | issue=  | pages= 15016 | pmid=27188665 | doi=10.1038/nrdp.2015.16 | pmc=5381807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188665  }} </ref>
** VZV DNA testing
* [[Antibody]] Testing
** Direct Fluorescent Antibody (DFA)
* [[Virus|Viral]] detection
** VZV culture
* [[Varicella zoster virus|VZV]] [[DNA]] testing
* Direct [[Fluorescent]] Antibody ([[Direct fluorescent antibody|DFA]])
* [[Varicella zoster virus|VZV]] culture


===Antibody Testing===
===Antibody Testing===
*Laboratory tests detect and measure the level of VZV antibodies, presence of IgM antibodies indicates acute infection.
*Laboratory tests detect and measure the level of [[Varicella zoster virus|VZV]] [[antibodies]]. The presence of [[IgM]] antibodies indicates acute [[infection]].


====IgM====
====IgM====
*It can be detected within a week or two post exposure.
*It can be detected within 1-2 weeks post exposure.
*The levels of [[IgM]] antibodies rises for a short period of time and then falls below detectable levels.
*The levels of [[Immunoglobulin M|IgM antibodies]] rise for a short period of time and then fall below detectable levels.
*Post-Infection, the IgM levels rise only when the latent VZV is reactivated.
*Post-Infection, the [[IgM]] levels rise only when the latent [[VZV]] is reactivated.
====IgG====
====IgG====
*IgG antibodies are produced several weeks after the initial exposure.
*[[Immunoglobulin G|IgG antibodies]] are produced several weeks after the initial exposure.
*[[IgG]] levels rise during active infection and then the levels become stable as the VZV infection gets resolves and as the virus gets inactivated.
*[[IgG]] levels rise during active [[infection]] and then the levels become stable as the [[Varicella zoster virus|VZV]] infection gets resolves and as the [[virus]] gets inactivated.


===Viral detection===
===Viral detection===
* Viral detection is done by finding VZV in a blood, vesicle fluid, or tissue sample. Detection done by culturing the virus or by detecting it's genetic material (VZV DNA).
* [[Virus|Viral]] detection is done by finding [[Varicella zoster virus|VZV]] in a [[blood]], [[vesicle]] [[fluid]], or [[tissue]] sample. Detection is done by culturing the [[virus]] or by detecting its [[genetic material]] ([[Varicella zoster virus|VZV]] [[DNA]]).


===VZV DNA testing===
===VZV DNA testing===


* VZV DNA testing is sensitive and measures viral load.
* [[Varicella zoster virus|VZV]] [[DNA]] testing is [[Sensitivity (tests)|sensitive]] and measures [[viral load]].


===Direct Fluorescent Antibody (DFA)===
===Direct Fluorescent Antibody (DFA)===


* DFA test visualizes the presence of VZV in the cells taken from an individuals's skin lesion using a special microscope and labeled antibody. Advantages of DFA test are that it is rapid, but less specific and sensitive than DNA testing.
* [[Direct fluorescent antibody|DFA]] test detects the presence of [[Varicella zoster virus|VZV]] in the cells in the [[skin]] lesion using a labeled [[antibody]]. It is rapid but less [[Specificity (tests)|specific]] and [[Sensitivity (tests)|sensitive]] than [[DNA]] testing.


===VZV culture===
===VZV culture===


* Culture is not very reliable for VZV and can lead to false-negative results.
* [[Culture medium|Culture]] is not very reliable for [[Varicella zoster virus|VZV]] and can lead to [[false-negative]] results.
The choice of tests and samples collected depends on the person, their symptoms, and on the healthcare practitioner's clinical findings.


===Microscopic Findings===
===Microscopic Findings===
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==References==
==References==
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Latest revision as of 20:53, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

The laboratory findings of chickenpox include blood tests that can be done to identify the response to acute infection (IgM) or previous infection and subsequent immunity (IgG). Prenatal diagnosis of fetal varicella infection can be performed using ultrasound at 5 weeks following primary maternal infection. A PCR test of the mother's amniotic fluid can also be performed, though the risk of spontaneous abortion due to the amniocentesis procedure is higher than the risk of the baby developing fetal varicella syndrome.

Laboratory Findings

Laboratory tests that are shown to be useful for the diagnosis of chickenpox include:

Antibody Testing

IgM

  • It can be detected within 1-2 weeks post exposure.
  • The levels of IgM antibodies rise for a short period of time and then fall below detectable levels.
  • Post-Infection, the IgM levels rise only when the latent VZV is reactivated.

IgG

  • IgG antibodies are produced several weeks after the initial exposure.
  • IgG levels rise during active infection and then the levels become stable as the VZV infection gets resolves and as the virus gets inactivated.

Viral detection

VZV DNA testing

Direct Fluorescent Antibody (DFA)

VZV culture

Microscopic Findings

References

  1. 1.0 1.1 Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D; et al. (2015). "Varicella zoster virus infection". Nat Rev Dis Primers. 1: 15016. doi:10.1038/nrdp.2015.16. PMC 5381807. PMID 27188665.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "Public Health Image Library (PHIL)".

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