Chickenpox Workup

Updated: Jun 04, 2018
  • Author: Anthony J Papadopoulos, MD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Approach Considerations

The workup for chickenpox includes a Tzanck smear, vesicular fluid culture, serologic testing, chest radiography, and histologic examination.

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Tzanck Smear

A Tzanck smear of vesicular fluid, which can be prepared in an office setting, demonstrates multinucleated giant cells and epithelial cells with eosinophilic intranuclear inclusion bodies. [15]

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Culture

Isolation of the varicella-zoster virus (VZV) through culture of vesicular fluid provides a definitive diagnosis; however, culturing for VZV is technically difficult, and cultures are positive less than 40% of the time. Direct immunofluorescence study offers excellent sensitivity and is more rapid than tissue culture. Polymerase chain reaction-based techniques are highly sensitive in identifying VZV, but they are not readily available. [16]

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Serology

Serologic evidence of immunity (native immunoglobulin G formation) to VZV can be achieved through a number of different assays, including the following:

  • Enzyme immunoassay

  • Indirect fluorescent antibody

  • Complement fixation

  • Fluorescent antibody to membrane assay

  • Latex agglutination test

Enzyme immunoassay, fluorescent antibody to membrane assay, and indirect fluorescence are not widely available, and complement fixation is not highly sensitive for VZV. The latex agglutination test is the most popular serologic assay for determining exposure and immunity to VZV.

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Chest Radiography

Chest radiography is indicated for adults who are experiencing pulmonary symptoms of chicken pox.

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Histologic Findings

Histologic examination of skin lesions does not differentiate VZV from herpes simplex virus (HSV) infection. Intranuclear eosinophilic inclusion bodies are seen in epithelial cells in both infections. Leukocytoclastic vasculitis and hemorrhage are more common in VZV lesions than HSV, however, and both immunohistochemistry and direct fluorescent antibody testing can be used to differentiate between the infections. [17]

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