Rapid diagnosis of smallpox infection and differentiation from its mimics.

TitleRapid diagnosis of smallpox infection and differentiation from its mimics.
Publication TypeJournal Article
Year of Publication2003
AuthorsNuovo GJ, Plaza JAntonio, Magro C
JournalDiagn Mol Pathol
Volume12
Issue2
Pagination103-7
Date Published2003 Jun
ISSN1052-9551
KeywordsBioterrorism, Chickenpox, Diagnosis, Differential, DNA Viruses, Herpes Simplex, Herpes Zoster, Humans, In Situ Hybridization, Smallpox
Abstract

The potential for a bioterrorism-induced smallpox outbreak has been much discussed of late. The literature of the late 1960s stressed that the distinction between smallpox and the other viral-induced vesicle-forming diseases, namely varicella zoster and disseminated herpes simplex, was difficult to make. Given that the cutaneous manifestations of smallpox would be among the initial symptoms, we reviewed 2 cases of smallpox diagnosed in South America in the 1970s in conjunction with 9 cases of multiple skin vesicles diagnosed as either disseminated herpes simplex or varicella-zoster. These were examined by routine hematoxylin and eosin stain (H&E) as well as by in situ hybridization. A blind review of the cases demonstrated that each showed striking intraepithelial vesicles containing multinucleated squamous cells exhibiting a ground glass appearance of the nuclear chromatin. Thus, as expected, routine H&E examination could not differentiate the 2 smallpox cases from the other 9 samples. In situ hybridization easily distinguished the 2 cases of smallpox from the other 9 samples, 5 of which contained varicella-zoster (two had been misdiagnosed as herpes) and the other 4 were disseminated herpes simplex. The in situ test, readily accomplished in any histology-based molecular laboratory in 4 hours, allows for the rapid and specific identification of smallpox infection and, importantly, its distinction from its mimics. Formalin fixation, which is optimal for in situ hybridization, guarantees the inactivation of the smallpox virus.

DOI10.1097/00019606-200306000-00006
Alternate JournalDiagn Mol Pathol
PubMed ID12766615
Grant ListR01 HL-00-012 / HL / NHLBI NIH HHS / United States
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Cynthia M. Magro, M.D.

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