Comparison ofTechniques andEvaluation ofThreeCommercial Monoclonal Antibodies forLaboratory Diagnosis of Varicella-Zoster Virus inMucocutaneous Specimens

Acomparison ofdirect antigen detection incell scrapings withculture techniques (tube culture andshell vial method) fordiagnosis ofvaricella-zoster virus(VZV) mucocutaneous infections wasdoneinparallel intwo groups ofspecimens. A total of100specimens werefrompatients withclinical diagnosis ofVZV infection (group 1),and69werefrompatients withnosuspicion ofVZVinfection (group 2)butmainly withherpes simplex virus infections. Inaddition, three commercially available monoclonal antibodies (Whittaker, Biosoft Clone2013, andOrtho3B3)directed against VZVantigens wereevaluated inparallel inthelast 87group1 specimens. Overall, 80%ofthegroup1specimens wereconfirmed positive bydirect detection, incomparison with56%positive bytubeculture and/or shell vial. Noneofthegroup2specimens werepositive forVZVbyany ofthemethods, andnoneofthemonoclonal antibodies assayed reacted withanyherpes simplex virus stock strains. Antiviral therapy andthelength ofevolution timeoflesions affected negatively theperformance ofall laboratory methods, buttoa lesser extent indirect detection techniques thaninculture techniques. The Whittaker andBiosoft reagents (indirect immunofluorescence assay) showedstatistically significant differencesinsensitivity withrespect totheOrthoantibody (P= 0.002andP = 0.039, respectively; two-tailed binomial test). Direct antigen detection isa rapid, easy-to-perform, sensitive, andspecific technique and appears tobethemethodofchoice forlaboratory confirmation ofVZVmucocutaneous infections.