Re: Tzanck Smears

From:Ford Royer

The Following is reprinted from the National Network of STD/HIV Prevention Training
Centers (Attached to the CDC I believe), "Core Training Programs: Satellite
Broadcasts" - "STD Grand Rounds: Genital Dermatology" - Question and Answer Summary
You can check out their web site for more information:


Question 11: Is there a collection procedure available that could be shared with
health departments to assure optimal samples are collected for Tzanck smears?

Answer: Your state or local Health Department could provide you with a copy of their
protocol. I have included our Standard Operating Procedure for acquisition of Tzanck
smear utilized by the STD Center for Excellence at Montefiore Medical Center, (I am
sure they are very similar).


Tzanck smears stained by Volu-sol Giemsa (Dif-Quick) or Wright stain demonstrating
multinucleated giant cells due to Herpes virus.


"Stat Stain" -- Distilled/De-ionized Water -- Sodium Hypochlorite Solution -- Glass
slides --Scalpel blades -- Gauze pads


(1) Label the slides with the patient's initials
(2) Select the lesion site
(3) Using gloves, cleanse the site with gauze or swab soaked in water
(4) Incise the top of a vesicle with a sterile scalpel and lightly apply the
specimen to the middle of a glass slide
(5) Lightly scrape the base of the vesicle and apply the lesion material to the
middle of another glass slide.  Smear an area about the size of a U.S. dime, i.e.,
just enough to be covered by a No. 1 (22 X 22mm) cover slip
(6) Prepare two or more smears if necessary.


a) Crusted Lesions: Remove the crust and prepare smear of the basal scrapings

b) Erosive Lesions: Lightly scrape and prepare smear


(1) Wearing gloves, carefully add sodium hypochlorite solution (diluted 1:10) into
the disinfectant vessel until it is one-fourth full
(2) Place the labeled (smeared) slides on the disinfectant vessel
(3) Air dry the slides for no less than five minutes (4) Using the dropper bottle
add 2 or 3 drops of stat stain on the smear (or just enough to cover the smear) and
let stand for exactly 20 seconds
(6) Add an equal number of drops of distilled or de-ionized water to the staining
smears (i.e., dilute 1:1) and let stand for an additional 10 seconds
(7) Pour off stain/water mixture into the disinfectant and
(8) Quickly wash slides (over the disinfectant) by gently squirting distilled water
(or de-ionized water) via wash "squeeze bottle"
(9) Wipe the underside of each slide with an isopropyl alcohol pad or tissue
moistened with 70% isopropyl alcohol
(10) DRAIN DRY over an absorbent surface (DO NOT BLOT).

Question 12: How often does a positive Tzanck smear turn out to be something other
than HSV?
Answer: A positive Tzanck smear almost always indicates a diagnosis of herpes
simplex virus. However, it is important to remember that other members of the herpes
family can also result in a positive smear, including: herpes zoster and
cytomegalovirus. The clinical manifestation should help with the diagnosis as will a
culture for confirmation of HSV.

Question 13: Should follow-up cultures be done on negative Tzanck smear samples if
Answer: Tzanck smears have a sensitivity of only 50%, and that is highly dependent
upon the age of the lesion, therefore, cultures would be very helpful in this
clinical setting.

Question 14: Assuming that Tzanck smears are relatively insensitive and that your
clinic has a positivity rate of 10-15%, what could you assume your true positivity
rate to be?
Answer: It would be important to compare them to your herpes culture positivity

Hope this helps.

~ Ford
Ford Royer, MT(ASCP)
Analytical Instruments, Inc.
(Refurbished Lab Equipment)
Minneapolis, MN
(800) 565-1895, Ext. 17

Toy Bridgman wrote:

> Has anyone heard of Tzanck Smears?  Does it have another name?  Does anyone have
> a  protocol for this stain?  Any help is much appreciated.  Thanks
> Toy Bridgman

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