Tzanck cytology smear in diagnosis of cutaneous talaromycosis (penicilliosis)

Talaromyces marneffei infection is an AIDS-defining illness in South and Southeast Asia. Travel-related talaromycosis is being increasingly recognized in non-endemic areas too. It is a potentially fatal infection with rapid deterioration, if left untreated. Usage of Tzanck cytology smear for rapid diagnosis of T. marneffei is rarely described. In this case study, we report a man who presented with altered behaviour, headache, fever and cutaneous lesions. Tzanck smear test, skin biopsy and blood culture showed presence of T. marneffei. The cytomorphology findings of T. marneffei in Tzanck cytology smear were described. In conclusion, Tzanck smear is a simple and inexpensive test in establishing a rapid clinical diagnosis of talaromycosis before the culture is reported

A study on the effectiveness of Tzanck smear to diagnose the vesiculobullous lesions in comparison with histopathology

Background: Tzanck smear named after Arnault Tzanck (1886-1954), to evaluate Cytopathology as a quick less invasive method for early diagnosis of bullous lesions. Aim: To determine the diagnostic value of Tzanck smear in vesiculobullous skin lesions, to evaluate the vesiculobullous lesions and correlating the diagnosis with Tzanck smears and histopathological findings and when required with Immmunoflourescence. Materials and methods: 565 patients clinically diagnosed as vesico-bullous skin lesions were included in the present study from July 2011 to July 2018 for a period of 7 years. Tzanck smear preparation and biopsy as well as immunoflouresence tests were done in all 565 patients. Results: Out of the 565 patients with vesiculo bullous lesions, 297 were males, and 268 were females. The concordant results between cytology and histopathology was observed in majority (92.7%) direct immunoflouresence test was done in some which also confirmed the diagnosis. Conclusion: The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for vesiculo-bullous lesions of skin diseases and can be recommended as a bedside first line investigation.

Revaluing the Tzanck Test: A Comparative Study with Direct Immunofluorescence for Herpes Virus.

Introduction: Tzanck Test (TT) is a sensitive method applicable to mucocutaneous lesions. Direct immunofluorescence (DIF) for Simplex Herpes Virus (HSV) is now a simple, no routine clinical laboratory practice, allows to differentiate the types of virus. Objectives: To evaluate the diagnostic sensitivity of Tzanck test vs DIF for herpetic lesions, and to know its usefulness as a complementary diagnostic tool to clinical skin lesions in patients with erosive, vesicular, bullous and pustular lesions. Materials and Methods: The TT was carried out in 157 lesion patient’s samples admitted to the Laboratory of Cytology of our Hospital from 1 January 2010 until 30 December 2014. Smears were stained with Giemsa and in parallel we performed DIF for HSV-1, HSV-2 and Varicella Zoster over 112 samples. Results: Of the total samples, 40 (25%) were unsatisfactory for cytodiagnosis. The TT was positive in 60 samples (38%), of which 55 (35%) showed cytopathic effect for Herpes virus, 2 (1.6%) samples showed characteristic inclusion bodies of Molluscum contagiosum infection (Henderson-Paterson bodies), 1 (0.6%) sample showed acantholytic cells typical of Pemphigus Vulgaris, 1 (0.6%) showed morphological characteristics of Incontinentia Pigmenti and 1 (0.6%) presented immature cells of lymphoid appearance. 64 samples were positive by DIF and 58 by TT for HSV. Specificity and sensitivity for TT were 100% and 88% respectively. Conclusion: The TT should be appreciated as a useful tool in the diagnosis of skin lesions by the rapid implementation and their ease interpretation, as well as being affordable and accessible for most cytology laboratories.

Oral Pemphigus Vulgaris: A Case Report.

Pemphigus vulgaris is an autoimmune mucocutaneous disorder that affects the skin and other mucous membranes of which the intra-oral lesions are first to appear. The occurrence of this disease is very few in the general population. Nevertheless, pemphigus vulgaris is a critical condition because if untreated, it often results in patient’s death. This disease is characterized by the production of autoantibodies against intercellular bridges. Most of the patients are misdiagnosed. Hence, it is necessary for the dental professionals to be aware with the clinical manifestations of this disease to ensure early diagnosis and treatment. Here, we present a case of 57-year-old female patient, which was diagnosed as pemphigus vulgaris.

Acute Generalized Exanthematous Pustulosis with Hemodynamic Instability Induced by Ingestion of Lacquer Chicken / 대한피부과학회지

No abstract available.

Comparison of Tzanck Test and Polymerase Chain Reaction in the Diagnosis of Herpes Simplex Virus and Varicella Zoster Virus infections / 대한피부과학회지

BACKGROUND: Herpes simplex virus (HSV) and varicella zoster virus (VZV) are two of the most common causes of mucocutaneous vesicular eruptions. Their diagnoses are usually made clinically, but the clinical distinction between HSV and VZV is sometimes difficult. OBJECTIVE: We investigated the usefulness of polymerase chain reaction (PCR) and Tzanck test in patients with HSV and VZV infections. METHODS: From June 2008 through June 2010, a total of 396 patients (53 patients with HSV and 343 patients with VZV) were included in this study. Wright-stained smears of scrapings from the base of skin lesions and viral DNA amplification by PCR were examined in all patients. We compared the positivity rates of Tzanck test and PCR according to virus type and duration of skin lesions. RESULTS: The overall positivity rates of Tzanck test and PCR were 56.6% and 86.9%, respectively, and the difference between the positivity rates of the two tests was statistically significant (p<0.0001). The Tzanck test was positive in 41.5% and 58.9% of the HSV and VZV cases, respectively, and the difference was statistically significant (p=0.0259). For PCR, there were no significant differences between the HSV and VZV cases. The positivity rate of the Tzanck test decreased in the old skin lesions over 7 days; however, PCR method showed no significant differences in positivity rates according to duration of the skin lesions. CONCLUSION: PCR is a more sensitive method for the diagnoses of HSV and VZV infections, and it can be utilized for diagnosis even of old skin lesions.

El test de Tzanck en pacientes inmunocomprometidos: una metodología emergente y reemergente / The Tzanck test in immunocompromised patients: an emerging and re-emerging methodology

El test de Tzanck es un método útil para verificar la infección por Herpesvirus desmostrando la presencia de células gigantes multinucleadas (80% muestras de vesículas y 20% en úlceras). Sin embargo, esto puede cambiar en los inmunocomprometidos de manera dramática, donde las lesiones ulcerosas predominan. Conocer la eficacia del test de Tzanck como herramienta diagnóstica en pacientes inmunocomprometidos con lesiones dermatológicas úlcerosas y vesiculares, intentando rescatar esta técnica como un apoyo en la esfera diagnóstica. Estudio retrospectivo y comparativo basado en informes d laboratorio de la Unidad de Microbiología Médica del Centro Ortopédico Podológico, años 2005-2009 de pacientes a quienes se les practicó el test en muestra de secreción de úlceras y decapitación de vesículas, con algún tipo de diagnóstico de inmunocompromiso. Estudiamos 40 vesículas y 94 úlceras de 134 pacientes con diagnóstico de infección VIH/SIDA (34), neoplasias sólidas (60), diabetes mellitus (22) patologías autoinmunes (12) y probables leucemias (6). Predominaron las lesiones ulcerosas genitales seguidas por cavidad oral. El test de Tzanck fue positivo en 90/134 pacientes (67,16%), con diferencia estadísticamente significativas según el tipo de muestra (úlceras 76/94 vs. vesículas 14/40) (X² P< 0,001). No se demostraron diferencias estadísticamente significativas en el análisis de los subgrupos según tipo de inmunocompromiso. El test de Tzanck sigue siendo un método diagnóstico en lesiones ulcerosas de etiología viral en pacientes inmunocomprometidos y en lesiones vesiculares; además es una técnica diagnóstica fácil, económica y rápida.

Taznck`s test is a quick diagnostic method to corroborate Herpesvirus infection following demostration of multinucleate giant cells. Positivy is near 80% in vesicle samples, but as low as 20% in ulcer samples. To know Tzanck`s test ultility as a diagnostic method in immunocompromised patients with dermatological injuries as vesicles or ulcers, in order to rescue it as an emergence & re-emergence diagnostic technique. We studied the records of the Medical Microbiology Unit of the Centro Ortopédico Podológico between 2005-2009, selecting all immunocompromised patients in who Tzanck`s test was performed. 134 patients with 94 ulcers and 40 vesicles; with immunocompromise diagnosis as HIV/AIDS (34), solid tumors (60), diabetes mellitus (22), autoimmune diseases (12) and hematologic tumors (6). Genital lesions were positive in 90/134 patients (67,16%), with extremely statistical significance diference according to type of sample (76/94 ulcers vs. 14/40 vesicles) (X² P> 0,001). No statistical significance was observed when immnocompremised subgroup was analyzed. In immunocompromised patients, Tzanck`s test is an important method for differential diagnosis in suspected viral ulcers, and confirm diagnosis; it is cheap, fast & easy to perform.

Generalized granuloma annulare in a patient with myelocytic leukemia and chronic hepatitis B virus infection.

Granuloma annulare is a granulomatous disorder of the dermis and subcutaneous tissue, with different clinical types. Generalized granuloma annulare is a rarely encountered clinical entity. We describe a 60-year-old woman with a 4-month history of generalized annular lesions. She had a history of myelocytic leukemia and chronic hepatitis B virus infection. To date, both acute myelocytic leukemia and hepatitis B virus infection have been described independently in association with generalized granuloma annulare but have never been described together in association with generalized granuloma annulare. Probable etiological causes of granuloma annulare are discussed in our patient.

A Study on the Tzanck Test of Vesicobullous Skin Diseases / 대한피부과학회지

For the more practical and convenient application of the Tzanck test, we evaluated several staining methods and cytological findings 98 cases of vesicobullous skin diseases. Fixation by air-drying of specimen aad modified Giemsa staining method were thought to be the most appropriate procedure in clinical use. The disease studied were chickenpox, herpes zoster & simplex, contact dermatitis, Id reaction, tinea pedis, urticaria pigmentosa, incontinentia pigmenti, farnilial benign pemphigus, hand-foot-mouth disease, erytherna multiforme, toxic epiderrzal necrolysis, fixed drug eruption, and septic vesicle. Among these, herpes and chickenpox vesicles shawed the most characteristic and specific findings. And degenerating giant cell could be added as an useful diagnostic marker for these diseases in relatively old lesions. In the other diseases, cytological findings were neither charcteristic nor specific. But these findings suggested the possibility of picking up useful findings by more elaborated study including more large number of cases.