Diagnostic Value of Laboratory Parameters for Distinguishing Between Herpes Zoster and Bacterial Superficial Skin and Soft Tissue Infections
Christian Drerup, Maria Eveslage, Cord Sunderkötter, Jan Ehrchen
Clinical differentiation between herpes zoster and bacterial superficial skin and soft tissue infections of the face can be difficult. In addition, diagnosis can be complicated by bacterial superinfection of lesional herpes zoster. The aim of this study was to determine whether inflammatory parameters, such as C-reactive protein (CRP) and blood counts, might be reliable biomarkers to distinguish between skin and soft tissue infections and herpes zoster when the face is infected. The study data (multivariate analysis and area under the curve) identified CRP (0.880) and leukocytes (0.730) together as the parameters that best discriminate between skin and soft tissue infections and herpes zoster. A CRP threshold ≥ 2.05 mg/dl indicated a diagnosis of skin and soft tissue infection with a sensitivity of 80% and specificity of 83.8%. For leukocytes ≥ 7.3×109/l, diagnosis of skin and soft tissue infection had a sensitivity of 75% and specificity of 67.6%. Thus, when differential diagnosis is difficult, CRP and leukocytes should be determined, while parameters such as neutrophils or immature granulocytes do not add diagnostic value.
Clinical differentiation between superficial skin and soft tissue infections (SSTI, including cellulitis and erysipelas) and herpes zoster of the face can be difficult. Moreover, bacterial superinfection can develop in patients with herpes zoster. This may lead to delayed treatment or unnecessary use of antibiotics, which could lead to further microbial resistance or higher costs of treatment. This analysis of diagnostic parameters is often determined as standard of care in hospitalized patients and can help clinicians to guide their treatment decisions.