Clinical Diagnosis of Herpes Zoster in Family Practice
- 1 July 2007
- journal article
- research article
- Published by Annals of Family Medicine in Annals of Family Medicine
- Vol. 5 (4), 305-309
- https://doi.org/10.1370/afm.707
Abstract
Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice. Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confirmation of herpes zoster. Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confirmed serologically (positive predictive value of clinical judgment 90.8%; 95% confidence interval, 87.3%-94.3%). Independent clinical variables for serologically confirmed herpes zoster were severity and duration of rash at first examination. Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster.Keywords
This publication has 21 references indexed in Scilit:
- Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniquesPain, 2004
- What does epidemiology tell us about risk factors for herpes zoster?The Lancet Infectious Diseases, 2004
- Characteristics of Patients with Herpes Zoster on Presentation to Practitioners in FranceClinical Infectious Diseases, 2001
- Combination of Reverse Transcriptase PCR Analysis and Immunoglobulin M Detection on Filter Paper Blood Samples Allows Diagnostic and Epidemiological Studies of MeaslesJournal of Clinical Microbiology, 2001
- Epstein-Barr Virus Antibodies in Whole Blood Spots: A Minimally Invasive Method for Assessing an Aspect of Cell-Mediated ImmunityPsychosomatic Medicine, 2000
- Laboratory diagnosis of herpes zosterJournal of Clinical Virology, 1999
- Herpes Zoster: Risk Categories for Persistent PainThe Journal of Infectious Diseases, 1999
- The incidence of herpes zoster.1995
- Antibody-capture enzyme-linked immunosorbent assays that use enzyme-labelled antigen for detection of virus-specific immunoglobulin M, A and G in patients with varicella or herpes zosterEpidemiology and Infection, 1992
- Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adultsAmerican Journal Of Medicine, 1986