Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology.

BACKGROUND: Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM: To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION: We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.

El citodiagnóstico en dermatología: alcances y limitaciones / Cytodiagnosis in dermatology: its reaches and limitations

El citodiagnóstico, ampliamente difundido, virtualmente carece de aplicación práctica en dermatología. En parte, por las características inherentes al método y además por la particular histoarquitectura de la piel y membranas mucosas sanas y enfermas. Sin embargo, su técnica sencilla puede constituirse en un auxiliar valioso en ciertas dermatosis, en particular vesicoampollares y tumorales. Se revisa éste método diagnóstico y sus limitaciones y se rescatan aquellos casos en los que puede ofrecer utilidad (AU)

Disseminated Herpesvirus hominis (herpes simplex) infection: retrospective diagnosis by light and electron microscopy of paraffin wax-embedded tissues.

Disseminated Herpesvirus hominis infection had previously been reported from other parts of the world, but the disease was initially recognized at necropsy in Cape Town in 1957 (McKenzie, Hansen, and Becker, 1959).The present retrospective study established that the disease had been occurring before 1957 but that its aetiology had not been recognized. An awareness of the disease, together with an adequate knowledge of the clinical history, the morbid anatomy, and histology of the lesions, usually allows a confident diagnosis to be made.