How is Tzanck preparation performed for the diagnosis of herpes simplex virus (HSV) infection?

Updated: Mar 01, 2018
  • Author: Folusakin O Ayoade, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Tzanck preparation is a time-honored procedure for assisting in the diagnosis of cutaneous herpesvirus infections. However, it does not easily distinguish HSV-1, HSV-2, and varicella-zoster virus.

Typically, an intact vesicle is used from which the vesicular fluid is aspirated by puncture with a sterile tuberculin syringe. This fluid can be used for viral culture or PCR.

Aspiration should facilitate complete collapse of the vesicle because it is not multiloculated as cutaneous poxvirus infections can be.

After aspiration, the vesicle should be unroofed aseptically.

Using a sterile instrument, the floor of the newly produced ulcer can then be scraped. The obtained material can be spread on a glass microscope slide and then dried and fixed for staining.

Staining can be performed with a Papanicolaou smear stain or, alternatively, whatever is available will suffice (eg, Gram, Giemsa, or Wright stain).

A positive result is the finding of multinucleate giant cells.

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