Clinical Information

Varicella-zoster virus (VZV), a herpes virus, causes 2 distinct exanthematous (rash-associated) diseases: chickenpox (varicella) and herpes zoster (shingles). Chickenpox is a highly contagious, though typically benign, disease, usually contracted during childhood. Chickenpox is characterized by a dermal vesiculopustular rash that develops in successive crops approximately 10 to 21 days following exposure.(1) Although primary infection with VZV results in immunity and protection from subsequent infection, VZV remains latent within sensory dorsal root ganglia and upon reactivation, manifests as herpes zoster or shingles. During reactivation, the virus migrates along neural pathways to the skin, producing a unilateral rash, usually limited to a single dermatome. Shingles is an extremely painful condition typically occurring in older nonimmune adults or those with waning immunity to VZV and in patients with impaired cellular immunity.(2)

Several populations are at risk of suffering unusually severe reactions to VZV infections. The infection in pregnant women may spread through the placenta to the fetus causing congenital disease in the infant. Immunocompromised patients in hospitals may contract severe nosocomial infections from others who have active VZV infections and are at risk for developing severe VZV-related complications, which include cutaneous disseminated disease and visceral organ involvement.(2,3) Therefore, serologic screening of direct healthcare providers (physicians, allied healthcare personnel) and individuals in high-risk groups is necessary to avoid uncontrolled spread of infection.

While the clinical presentation of VZV infection is generally characteristic, serologic evaluation of patients with atypical and systemic infections is often required. For example, it is extremely important to serologically evaluate patients for the early detection of VZV infections in hospital settings. Nosocomial spread of VZV infection can be life-threatening to immunocompromised patients susceptible to infection.