Dermatology Book

Viral Infection

  • Tzanck Smear

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Tzanck SmearAka: Tzanck Preparation

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  1. Indication
    1. Confirms viral infection (does not identify virus type)
      1. Herpes Simplex Virus (HSV)
      2. Varicella Zoster Virus (VZV)
  2. Obtaining specimen
    1. Gently rupture fresh Vesicle with #15 scalpel blade
    2. Gently scrape mushy debris from Vesicle base
      1. Use curved belly of blade
      2. Do NOT use cotton swab
    3. Smear debris onto microscope slide
    4. Sample 3-4 Vesicles if possible
  3. Preparing Specimen
    1. Gently heat slide over match
      1. Heat for 10 seconds until warm
      2. Fixes tissue to slide
    2. Place drops of stain
      1. Giemsa stain
      2. Pap stain
      3. Wright's stain
    3. Allow stain to sit on slide for over 1 minute
    4. Rinse off stain under gently Running water
    5. Put on a drop of immersion oil or Mineral Oil
    6. Apply cover slip
  4. Examination of specimen
    1. Examine under 10x power
      1. Scan for smear bands
      2. Background of lightly stained debris
      3. Look for darkly stained cells
    2. Examine cells under 43x power
      1. Positive Test: Multinucleated Giant Cells
        1. Herpes Simplex Virus (HSV)
        2. Varicella Zoster Virus (VZV)

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