Warthin-Starry stain
Summary
The Warthin-Starry stain is a silver impregnation technique that renders thin, poorly staining bacteria black against a golden background. It is used to demonstrate spirochaetes, Bartonella henselae, Helicobacter pylori, and the agent of Whipple disease.
Detail
Silver stains work by depositing metallic silver on the bacterial surface, greatly increasing apparent thickness so that organisms invisible on Gram stain become detectable by light microscopy. Warthin-Starry is the classic stain for Treponema pallidum in tissue sections of chancre, secondary syphilis lesions, or placenta, and for Borrelia and Leptospira. It also demonstrates Bartonella henselae in cat-scratch disease lymph nodes and in bacillary angiomatosis, the vascular proliferative lesion of advanced HIV that mimics Kaposi sarcoma but responds to erythromycin or doxycycline. It shows Helicobacter pylori on gastric biopsy, though immunohistochemistry and rapid urease testing are now more usual, and it can highlight Tropheryma whipplei, although PAS staining with foamy macrophages containing PAS-positive granules in the lamina propria is the classic finding in Whipple disease. Related silver methods include Gomori methenamine silver for fungi and Pneumocystis jirovecii, and Dieterle for Legionella.
Sources
- Robbins Basic Pathology
- Levinson Medical Microbiology and Immunology
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