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Varicella Zoster Virus by PCR

Herpes Zoster PCR, Chickenpox PCR, VZ PCR, VZV PCR, Varicella Zoster Virus (VZV) by PCR, VZV Detection by PCR

Test Codes

EPIC: LAB6408, Beaker: IVZVG

Department

Molecular Pathology

Specimen Collection Criteria

Collect: ONE of the following specimen types:

• Amniotic Fluid: 1.0 mL fluid in a sterile collection container or syringe with the needle removed. (Minimum: 0.5 mL) 
• Cerebrospinal Fluid (CSF): 1.0 mL CSF in a sterile collection container. (Minimum: 0.5 mL)
• Skin/Mucous Membranes: Swab the lesion and place in viral transport medium.
• Ocular (Aqueous or Vitreous) Fluids: Submit 1.0 mL vitreous fluid (not the dilute fluid in the cassette) in a sterile collection container. (Minimum: 0.2 mL)
• Vesicles: Puncture the vesicle and collect the vesicle fluid with a swab. Place the swab in viral transport medium.
• Serum*: Submit a Gold-top SST tube (Minimum: 1.0 mL); Pediatric: submit 2 Microtainers^®
• Plasma*: Submit a Lavender-top EDTA tube (Minimum: 1.0 mL) ; Pediatric: submit 2 Microtainers^®
• Bronchoalveolar Lavage (BAL): Submit in a sterile collection container. (Minimum: 0.5 mL)
• Sputum (Expectorated, Tracheal, Trans-Tracheal, Nasotracheal, Endotracheal): Submit in a sterile collection container. (Minimum: 0.5 mL)

*Blood, serum or plasma will only be helpful in the detection of disseminated VZV infection.

Other specimen types require approval of the Medical Director of Molecular Pathology or Microbiology.

Physician Office/Draw Specimen Preparation

Maintain all specimen types refrigerated (2-8°C or 36-46°F) prior to transport.

Preparation for Courier Transport

Transport: All specimen types, at room temperature (20-25°C or 68-77°F) or refrigerated (2-8°C or 36-46°F).

Rejection Criteria

• Heparinized specimens.
• Specimens with gross bacterial contamination. 

In-Lab Processing

Refrigerate (2-8°C or 36-46°F) specimens if testing will not be performed within 48 hours of the time of collection.

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): 48 hours
Refrigerated (2-8°C or 36-46°F): 30 days
Frozen (-20°C/-4°F or below): 30 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days

Laboratory

Royal Oak Molecular Pathology Laboratory.

Performed

Sunday – Saturday.
Results available within 24 hours for CSF, ocular, or pediatric specimens. Results for all other specimen types available in 2-3 days.

Reference Range

Negative.

Test Methodology

Real-Time Polymerase Chain Reaction PCR.

Interpretation

A negative result does not rule out VZV infection.

Clinical Utility

This assay provides a highly sensitive and specific test for the diagnosis of VZV infection, VZV encephalitis, and intraocular infections. This method can also be used to detect VZV in fetal tissue and amniotic cells.

Clinical Disease

• Varicella-zoster virus causes two distinct diseases- varicella (chickenpox) and herpes zoster (shingles).
  
• Chickenpox is a seasonal childhood disease characterized by low grade fever, malaise, and a generalized vesicular rash. Chickenpox may occur after exposure to either chickenpox or shingles and is a manifestation of primary VZV infection. VZV infection during pregnancy causes birth defects in rare cases. When infection occurs at term, life threatening infections can occur in the neonate.
  
• Shingles exhibits no seasonality and it usually occurs in immunocompromised patients and in older adults. Evidence suggests that shingles results from a reactivation of virus that remains latent in the sensory spinal ganglia after the primary infection rather than a reintroduction of the virus into the host. It is characterized by painful vesicular eruptions of the skin along the distribution of the involved nerves.

Epidemiology

Most varicella cases occur in winter and early spring with peak incidence in March and April. Epidemics occur at irregular 5 year intervals.

Incubation Period

11-21 days with a mean of 13-17 days.

Transmission

VZV is highly contagious, and transmission is via direct contact and through droplets. Patients are infectious 1-2 days before the rash appears and for 3-5 days thereafter.

CPT Codes

87798

Contacts

Last Updated

10/22/2023