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1、《GENERALVIROLOGY》《普通病毒學(xué)》18.DIAGNOSTICVIOLOGY第18章診斷病毒學(xué)Page：514-526RapidDiagnosis快速診斷RapiddiagnosisofbothHSVandVZVinfectionscanbeaccomplishedbyFAstaining.Forthistechnique,cellsfromthebaseofalesionareobtainedbyscrapingthebasewithascalpelbladeorrubbingvigoro
2、uslywithaDacronorrayonswab,andplacingthematerialobtainedononeormoremicroscopeslides.Thismaterialisairdried,fixedwithacetone,andthenstainedwithfluorescent-labeledmonoclonalantibodiestoHSVandVZV.ThistechniqueisparticularlyadvantageousforVZVbecauseofthediff
3、icultyofculturingthatvirus.FAstainingispreferabletoaTzancksmearbecauseitallowsspecificviralidentificationandismoresensitive.PCRcanbeusedtodetectHSVorVZVDNAincutaneouslesionswithgreatersensitivitythancellculture.通過(guò)FA染色可以實(shí)現(xiàn)對(duì)HSV和VZV感染的快速診斷。這種方法，用手術(shù)刀片刮或用滌綸、人
4、造絲拭子用力摩擦來(lái)制造病變，并從病變基處來(lái)獲得細(xì)胞。放置在一個(gè)或幾個(gè)載玻片上，材料干燥后,用丙酮固定,然后以熒光標(biāo)記的HSV和VZV的單克隆抗體染色。這種方法對(duì)較難培養(yǎng)的VZV更為有利。FA染色是一種較好的Tzanck涂片方法，因?yàn)樗軌驅(qū)μ囟ǖ牟《具M(jìn)行檢測(cè)并且敏感性較高。PCR的方法用來(lái)檢測(cè)病變皮膚中的HSV或VZVDNA比細(xì)胞培養(yǎng)的方法更敏感。Serology血清學(xué)SerologyhaslittleroleinthediagnosisofacuteHSVinfectionbecauseviralcu
5、ltureorantigendetectionisusuallysuccessful,becauseserologyrequiresacuteandconvalescentphasespecimens,andbecauseofdifficultiesininterpretationrelatedtocross-reactionsaswellasasymptomaticreactivations.VZVserologyisoccasionallyusefulfordiagnosisofacuteVZVif
6、appropriatespecimenswerenotobtainedforcultureandantigendetectionorifthosetestswerenegativedespiteaclinicalimpressionthatVZVwasthetruediagnosis.Detectionofseroconversionisthestrongestserologicevidenceofinfection,althoughdetectionofVZV-specificIgMantibodie
7、salsosupportsthediagnosisofrecentinfection.Virus-specificIgMantibodiescanbepresentwithreactivation(zoster)aswellaswithprimaryinfection.血清學(xué)檢測(cè)對(duì)急性HSV感染的診斷意義較小。因?yàn)檠鍖W(xué)檢測(cè)需要有急性期的和恢復(fù)期的標(biāo)本，而且難以解釋交叉反應(yīng)和陰性感染。通過(guò)病毒培養(yǎng)或抗原檢測(cè)則往往更易成功。對(duì)于那些雖有VZV的臨床表現(xiàn)但沒(méi)有得到相應(yīng)的標(biāo)本來(lái)培養(yǎng)第17頁(yè)共17頁(yè)病毒或抗原檢
8、測(cè)為隱性，VZV血清學(xué)檢測(cè)通常是有用的。血清轉(zhuǎn)化實(shí)驗(yàn)是感染的最好的血清學(xué)證據(jù)，雖然VZV-特異IgM抗體的檢出也是近期感染的證據(jù)。繼發(fā)感染和原發(fā)感染可能會(huì)共同出現(xiàn)病毒特異的IgM抗體。Serologyiswidelyusedfordeterminationofimmunestatus,especiallytoVZV.Thereferencetestforthispurposeisthefluorescentantibodytomembran
