7) Tzanck Preparation

Definition
Tzanck preparation is a rapid test done to diagnose infections caused by
herpesviruses. Cells are examined under a microscope for signs of infection.
Purpose
Herpesviruses are responsible for several superficial infections. Varicella zoster virus
causes chickenpox and shingles, herpes simplex type 1 causes the common cold
sore or fever blister, and herpes simplex type 2 causes the sexually transmitted
disease genital herpes. They are all characterized by blisters and ulcers.
Physicians usually can diagnose herpes infections simply by looking at the type of
blisters and ulcers, and their distribution on the person's body. Sometimes
laboratory evidence of herpes is needed to confirm the diagnosis. For example,
herpes can be devastating to a newborn baby or a person with a weakened immune
system. Treatment can begin once herpes is confirmed in a laboring mother's
genital ulcers or in the skin blisters of an immunocompromised person. A lab tries to
grow (culture) the virus that may be present in the blister. This lab test takes
several days to complete, but the Tzanck preparation takes minutes.
Description
The Tzanck preparation is done by smearing cells taken from a fresh blister or ulcer
onto a microscope slide. The cells are stained with a special stain, such as Wright's
stain, and then examined under a microscope for characteristic changes caused by
a herpesvirus. Herpes causes giant cells with multiple nuclei. The shape of each
nucleus appears molded to fit together with those adjacent. The background of the
cell looks like ground glass and contains small dark spots called inclusion bodies.
Tzanck preparation is also called a Tzanck smear, herpes stain for inclusion bodies,
or inclusion bodies stain. Results are available the same or following day, often
within minutes.
Preparation
A fresh blister is opened with a scalpel or sterile needle. The physician scrapes the
base of the blister with the scalpel, gathers as much cellular material as possible,
and gently spreads it on a microscope slide.
Normal results
A normal smear shows no evidence of a herpes infection. This test may also have
false negatives. Studies have shown that the Tzanck preparation shows signs of
infection in only 50-79% of people with a herpes infection. A negative Tzanck
preparation may have to be confirmed by a herpes culture.

Abnormal results
A smear that shows evidence of herpes infection does not distinguish between the
various infections caused by herpes virus. The physician uses the person's
symptoms and other clinical findings to distinguish between these infections. In
certain cases, the physician will follow a positive Tzanck smear with a culture for
confirmation.
Key terms
Herpes A family of viruses including herpes simplex types 1 and 2, and herpes
zoster (also called varicella zoster). Herpes viruses cause several infections, all
characterized by blisters and ulcers, including chickenpox, shingles, genital herpes,
and cold sores or fever blisters.
Resources
Henry, John B., editor. Clinical Diagnosis and Management by Laboratory Methods.
19th ed. Philadelphia: W. B. Saunders Co., 1996.