Herpetic Whitlow Workup

  • Author: Michael S Omori, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 23, 2012
 

Laboratory Studies

  • Diagnosis of herpetic whitlow usually is clinical, based on presentation of the affected digit with characteristic lesions and a typical history.
  • In children, observation of concurrent gingivostomatitis is almost pathognomonic.
  • In adults, the presence of occupational risk factors or finding of concurrent oral or genital herpes lesions should strongly suggest the diagnosis.
  • Definitive diagnostic testing includes the Tzanck test, viral cultures, serum antibody titers, fluorescent antibody testing, or DNA hybridization.
    • In the Tzanck test, smears are obtained by scraping the base of an unroofed vesicle. Smears are Giemsa stained, and a positive test is indicated by light microscopy findings of multinucleated giant cells, often with visible viral inclusions.
    • Viral culture of the aspirated vesicle fluid is the most sensitive assay, but this test is usually more costly and time consuming, requiring 24-48 hours.
    • Serum antibody titers are usually cost prohibitive, as are fluorescent antibody testing and DNA hybridization, which are not commonly available.
  • Recurrent infections, atypical presentations, or unusual locations should suggest an immunodeficient state. HIV testing should be considered in patients with such presentations.[3, 4]
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Contributor Information and Disclosures
Author

Michael S Omori, MD  Attending Staff, Emergency Medicine Residency, St Vincent Mercy Medical Center; Acting Director, Pediatric Emergency Center, Mercy Children's Hospital; Clinical Assistant Professor, Department of Surgery, University of Toledo Medical Center, The University of Toledo College of Medicine

Michael S Omori, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Weiss, MD, DTM&H  Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Progressor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Wu IB, Schwartz RA. Herpetic whitlow. Cutis. Mar 2007;79(3):193-6. [Medline].

  2. Klotz RW. Herpetic whitlow: an occupational hazard. AANA J. Feb 1990;58(1):8-13. [Medline].

  3. Robayna MG, Herranz P, Rubio FA, Pena P, Pena JM, Gonzalez J, et al. Destructive herpetic whitlow in AIDS: report of three cases. Br J Dermatol. Nov 1997;137(5):812-5. [Medline].

  4. El Hachem M, Bernardi S, Giraldi L, Diociaiuti A, Palma P, Castelli-Gattinara G. Herpetic whitlow as a harbinger of pediatric HIV-1 infection. Pediatr Dermatol. Mar-Apr 2005;22(2):119-21. [Medline].

  5. Nikkels AF, Pierard GE. Treatment of mucocutaneous presentations of herpes simplex virus infections. Am J Clin Dermatol. 2002;3(7):475-87. [Medline].

  6. Cunha BA, ed. Antibiotic Essentials. 7th ed. Sudbury, Mass: Physician's Press; 2008:109.

  7. Weisman E, Troncale JA. Herpetic whitlow: a case report. J Fam Pract. Nov 1991;33(5):516, 520. [Medline].

 
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