Diagnosis

The diagnosis of VZV is generally not difficult if the characteristic dermatomal rash and pain are present. Diagnosis is most difficult during the prodromal phase, when patients have pain but no visible lesions.

In patients who have the characteristic rash, a Tzanck preparation shows presence of multinucleated giant cells and thus provides strong supportive evidence of zoster infection. The Tzanck preparation and immunofluorescence have proved superior to viral isolation for diagnosing early lesions. Samples obtained from patients during the acute stage of

FIGURE 12 Photograph shows patient with varicella zoster virus of the thoracic dermatome and concomitant right facial palsy.

disease show a fourfold higher level of VZV antibody titer compared with serum samples obtained from convalescent patients, but this observation comes too late to have value for determining treatment (23).

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