Herpes Zoster (Shingles) Overview of Herpes Zoster / Shingles
Herpes Zoster or Shingles is a viral infection that causes painful rash caused by the varicella-zoster virus, the same virus associated as the causal virus for chickenpox. Any individual who had an episode of chicken pox or recovered from chickenpox can develop shingles in their lifetime. However it is not possible to have shingles if one had not been exposed to chicken pox in their lifetime. The virus can lay dormant for years in the body after exposure however most people with the virus do not have an episode of shingles and some may be reactive to the virus on May occasions.
Herpes Zoster virus affects the nerve (the dorsal root ganglia) where it remain latent for years until an episode occur due to low immunity or other causal factors. Shingles can be painful however it is not a life threatening infection. It can occur anywhere in the body, however vaccination can help reduce the risk of contacting or coming down with herpes zoster while it also reduces the chances of complications. Herpes zoster frequently occurs in elderly, HIV-infected individuals and immunocompromised patients because cell-mediated immunity in these patients is decreased due to their conditions.
Transmission of Herpes Zoster
Shingles caused by the varicella zoster virus can spread and transmitted through
Direct contact with herpes zoster lesions
Airborne route over distances of greater than 3 feet.
Risk factor of Herpes Zoster or Shingles
1. HIV/AIDS Patients
2. In the elderly
3. Immunocompromised or immunosuppressed patients
Clinical Signs and symptoms of Herpes Zoster / Shingles
The clinical manifestations of shingles can be divided into three phases:
1. Preeruptive phase (preherpetic neuralgia)
2. Acute eruptive phase
3. Chronic phase (PHN)
The preeruptive phase :
Sensory occurrence along the skin dermatomes this can last for about 1-10 days, this comes with pain and itching that causes headache, itching or paresthesias. Pain may simulate headache, pleurisy, brachial neuritis, cardiac pain, malaise, myalgia, headache, photophobia and fever
The acute eruptive phase :
This phase comes with a Patchy erythema and regional lymphadenopathy and at this stage Scarring can occur if there are infection or other complications. Symptoms tend to resolve in 10-15 days and complete healing of lesions or scars take up to a month
Chronic phrase PHN :
This phase comes with persistent and recurring pain lasting a month or more after the lesions have crusted in about 45% of all cases with pain usually felt in the area of origin of the dematones, the pain can be severe, serious and incapacitating and can persist for months and in some cases years.
Signs and Symptoms
Headache
Fever
Malaise
Burning pain,
itching,
hyperesthesia (oversensitivity), or
Paresthesia (niddle-like pain, tingling, pricking, or numbness).
Pain
Rash
Severe Blistering
Scarring
Discolored Skin
Other forms of Herpes Zoster include the following:
HerpesZoster ophthalmicus with manifestation includes conjunctivitis, scleritis, episcleritis.
Herpes zoster of maxillary branch of cranial nerve (CN) V
Herpes zoster of mandibular branch of CN V
Herpes zoster oticus (Ramsay Hunt syndrome)
Glossopharyngeal and vagal herpes zoster
Herpes occipitocollaris (vertebral nerves C2 and C3 involvement)
Herpes zoster encephalomyelitis
Disseminated herpes zoster
Unilateral herpes zoster involving multiple dermatomes
Recurrent herpes zoster
Herpes zoster involving urinary bladder, bronchi, pleural spaces, or gastrointestinal tract
Herpes zoster with motor complications
Diagnosis of Herpes Zoster / Shingles
Shingles diagnosis is based on the history and physical finding
laboratory testing.
Laboratory studies for VZV include the following:
Direct fluorescent antibody (DFA) testing of vesicular fluid or a corneal lesion
Polymerase chain reaction (PCR) testing of vesicular fluid, a corneal lesion, or blood
Tzanck smear of vesicular fluid (lower sensitivity and specificity than DFA or PCR)
Differential diagnosis
Shingles can be confused with herpes simplex , dermatitis herpetiformis and
impetigo, and skin reactions caused by contact dermatitis, candidiasis, certain drugs and insect bites.
Treatment and Management of Herpes Zoster / Shingles
Herpes Zoster can sometimes be healed without medical interventions and are mild in children than in adult.
Treatment includes the following:
Nonsteroidal anti-inflammatory drugs (NSAIDs) administration to manage pains
Wet dressings with 5% aluminum acetate (Burrow solution), applied for 30-60 minutes 4-6 times daily
Lotions (eg, calamine)
Primary medications for acute Herpes zoster associated with pain include:
Narcotic and nonnarcotic analgesics (
Neuroactive agents (eg, tricyclic antidepressants)
Anticonvulsant agents
Oral treatment with the following has been found beneficial:
Acyclovir
Famciclovir
Valacyclovir
Prevention of Herpes Zoster
There are several shingles vaccines that reduce the risk of developing shingles or developing severe shingles if the disease occurs.
A live attenuated virus vaccine, Zostavax ,
An adjuvanted subunit vaccine, Shingrix .
They can prevent for u to 3 years and its about fifty percent reduction in risk of co ming down with the virus and also reduces the persistent severe pain if there are occurrence
In the U.S. the CDC recommends that healthy adults 50 years and older receive two doses of Shingrix, 2 to 6 months apart.
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