LABORATORY TESTS AVAILABLE

FOR QUICK DIAGNOSIS

The physician should make use of the following
laboratory tests immediately or within 8 hours:
1. Direct smear from the base of a vesicle. This
procedure, known as the Tzanck test, is described
in the "Introduction of the book."
Smears are examined for acantholytic cells,
giant acanthocytes, and/or multinucleated
giant cells.
2. Viral culture, negati~ stain {electron
microscopy), polymerase chain reaction for
infections with herpes viruses, and direct
fluorescence (DIF) technique.
3. Gram stain of aspirates or scraping of pustules.
Organisms can be seen in the lesions of acute
meningococcemia, rarely in the skin lesions
of gonococcemia and ecthyma gangrenosum.
4. Touch preparation. Helpful in deep fungal
infections and leishmaniasis. The
dermal part of a skin biopsy specimen is
touched repeatedly to a glass slide, which is
immediately fixed in 95% ethyl alcohol Special
stains will reveal organisms.
5. Biopsy of the skin lesion. All purpuric lesions,
inflammatory dermal nodules, and most
ulcers should be biopsied (at the base and
margin) and a portion of tissue minced and
cultured for bacteria and fungi. In gangrenous
cellulitis (see Section 25), frozen sections
of a deep biopsy will verify the diagnosis
in minutes.
6. Blood and urine examinations. Blood culture,
rapid serologic tests for syphilis, and
serology for lupus erythematosus. Examination
of urine sediment may reveal red
cell casts in renal involvement in allergic
vasculitis.
7. Dark-field examination. In the skin lesions
of secondary syphilis, repeated examinations
of papules show Treponema pallidum. Not
reliable in the mouth because of resident
nonpathogenic organisms but a lymph node
aspirate can be subjected to a dark-field
examination.