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Year : 1992  |  Volume : 58  |  Issue : 5  |  Page : 336-338

Atypical lymphocyte : A marker of dissemination in herpes zoster?

Correspondence Address:
S Ganesh Pai

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Atypical lymphocytes were noted in the peripheral blood smear of 19 patients of zoster. Sixty eight percent of them had aberrant lesions. The positive correlation between the atypical lymphocytes and aberrant lesions is described and its usefulness in predicting the possible dissemination is discussed.

Keywords: Herpes zoster

How to cite this article:
Pai S G, Nayak S, Kot. Atypical lymphocyte : A marker of dissemination in herpes zoster?. Indian J Dermatol Venereol Leprol 1992;58:336-8

How to cite this URL:
Pai S G, Nayak S, Kot. Atypical lymphocyte : A marker of dissemination in herpes zoster?. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Aug 9];58:336-8. Available from:

  Introduction Top

Viral multiplication in the zoster affected ganglion may also result in haematogenous dissemination to cause disseminated varicelliform lesions. [1],[2] The present study explores the relationship between the presence of aberrant lesions of zoster and the presence of atypical lymphocytes in the peripheral blood smears of the patients.

  Material and Methods Top

Clinical data of 100 zoster patients were recorded. Aberrant lesions, if any, and their number were noted. Routine urine and blood investigations and peripheral blood smears were performed. The findings of the smear, including the differential count of atypical lymphocytes when present, were noted. The statistical relationship between the two was calculated. [3]

  Results Top

[Table - 1] shows the number of aberrant lesions and the differential count of atypical lymphocytes in each patient. The graph reveals the trend of relationship between the two. Correlation coefficient [3] (r) for the correlation between the number of aberrant lesions and differential count of atypical lymphocytes was 0.289. Since 0 < r < + 1, it indicates a partial positive correlation between the number of atypical lymphocytes and the number of aberrant lesions. The correlation was statistically significant [3] as the 'P' value was less than 0.05.

  Comments Top

Atypical lymphocytes in peripheral blood smear occur in many viral infections. They vary greatly in size and shape and possess oval, kidney shaped, or slightly lobulated nucleus. Their nuclear chromatin forms a coarse network of strands and masses. The cytoplasm may be vacuolated or foamy and may be indented by adjacent erythrocytes. It is not fully established whether atypical lymphocytes develop only due to reactive proliferation or due to active viral replication within the lymphocyte. [2]

Patterson et al [2] had reported atypical lymphocytes in lymphnodes of a patient with atypical generalised zoster. Ultrastructural study of these lymphocytes had revealed active viral replication, virions in all stages and viable complete virions in them. The fact that viremias in patients with disseminated zoster is leucocyte associated is well documented [4][5],[6] Nineteen of our patients had 1-15% (mean 4%) atypical lymphocytes in their peripheral smear. Thirteen (68%) of the 19 also had aberrant varicelliform lesions, though it was significant (>- 20 disseminated lesions) in only 2. It is therefore possible that viable multiplying virions are dispersed haematogenously through infected lymphocytes [4],[5],[6] which may appear as atypical lymphocytes. [2] Atypical lymphocytes however may not be detectable in all patients, as occurred in 59% of our patients with aberrant lesions. Further, the significant partial position correlation between the differential count of atypical lymphocytes and the number of aberrant lesions indicate that the chance of detecting atypical lymphocytes increases with the number of aberrant lesions present or the vice versa.

Thus the detection of atypical lymphocytes early in the disease could be a pointer to the increased risk of developing disseminated lesions in patients of zoster. This will be of great importance to patients with immunosuppression as the expensive antiviral (acyclovir) therapy may be promptly instituted.

  References Top

1.Oxman MN. Varicella and herpes zoster. In: Dermatology in general medicine (Fitzpatrick TB, Eisen AZ, Walff K, et al eds) 3rd edn, New York, Mc Graw-Hill Book Company, 1987; 2314-40.  Back to cited text no. 1    
2.Patterson SD, Larson E B, Corey L. Atypical generalised zoster with lymphadenitis mimicking lymphoma. N Eng J Med 1980; 320: 848- 51.  Back to cited text no. 2    
3.Mahajan BK. Methods in biostatistics for medical students and research workers, 5th edition. New Delhi: Jaypee brothers, 1989; 183-99.  Back to cited text no. 3    
4.Feldman S, Epp E. Isolation of Varicella zoster virus from blood. J Pediatrics 1976; 88: 265 -7.  Back to cited text no. 4  [PUBMED]  
5.Feldman S, Chaudary S, Ossi M, Epp E. A viremic phase for herpes zoster in children with cancer. J Pediatrics 1977; 91:597 -600.  Back to cited text no. 5  [PUBMED]  
6.Weller TH. Varicella and Herpes zoster: Changing concepts of the natural history, control and importance of a not so benign virus. N Eng J Med 1983; 309: 1368 -74.  Back to cited text no. 6  [PUBMED]  


[Figure - 1]


[Table - 1]


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