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Herpes zoster
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- 2. Herpes Zoster Alsoknown as Shingles An acute viral infection of the nerve cells and surrounding skin. Characterized by a rash of blisters, can be very painful but is not life- threatening. Caused by the varicella zoster virus that also causes chickenpox.
- 3. • Shingles usuallyappears, band of blisters on one side of the chest or back, but it can occur anywhere on the body, including on the face and near the eyes.
- 4. Varicella-zoster virus Varicella-zostervirus (VZV) infection causes two clinically distinct forms of disease: Varicella (chickenpox) Herpes zoster (shingles)
- 5. Herpes virus (DNA) Primaryinfection results in varicella (chickenpox) Recurrent infection results in herpes zoster (shingles)
- 6. Shingles Epidemiology Transmission • Directcontact with open sores of shingles rash • Can pass to someone who has never had the chickenpox High incidence groups • Anyone who had chickenpox • People over the age of 50 Incubation period • 10–21 days
- 7. Pathophysiology Herpes zoster Infection ofnerves and dermatome Reactivation in dorsal root ganglia Enter into nerve endings and transport to dorsal root ganglia (DRG) where it lies DORMANT in sensory nerve ganglia, dorsal root. Secondary viremia Further viral replication in liver and spleen Primary viremia in bloodstream Viral replication in regional lymph nodes VZV enters through the respiratory tract
- 11. Causes & Riskfactors Age common in people older than 50. Diseases that weaken the immune system, such as HIV/AIDS and cancer. Cancer treatments Undergoing radiation or chemotherapy can lower the resistance to diseases and may trigger shingles. Immunosuppres sant Drugs prolonged use of steroids, such as prednisone.
- 12. Clinical Symptoms Initial prodromalstage The first signs of shingles may include Headache Feeling generally unwell Myalgia Fever
- 13. Acute stage Arash will begin to develop, often causing a pain. Itching or tingling sensation in the area of the affected nerve. A fluid filled painful rash then develops a few days after and commonly occurs either on one side of the face or body. Fluid-filled blisters that break open and crust over in 7-10 days and this clears within 2-4 weeks.
- 15. Complications 1. Post herpeticneuralgia (PHN) Post herpetic neuralgia can cause severe nerve pain that persists after the rash. PHN occurs most often in elderly people and in people whose immune systems have been compromised. 2. Ophthalmic shingles Shingles in or around an eye can cause painful eye infections that
- 16. Ramsay Huntsyndrome Otherwise known as herpes zoster oticus, inflammation of several of the nerves that come out of the brain. The symptoms of Ramsay Hunt syndrome are facial ear pain. Encephalitis Hearing problems Bacterial infections on the
- 17. Cranial Nerve Involvement Iophthalmic II maxillary III mandibular
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- 19. Shingles Diagnosis Skin sample Infectedwith varicella-zoster virus Blood test Increase in white blood cells
- 20. Management of acuteherpes zoster Antiviral medication to reduce pain and complications. Should be started within 24 hours of first symptom .These medications include: Acyclovir (Zovirax) Valacyclovir (Valtrex) Famciclovir (Famvir)
- 21. Management of Postherpetic Neuralgia Tricyclic antidepressants, such as amitriptyline. Opioids, such as methadone, morphine. Lidocaine patch. Anticonvulsants, such as gabapentin. Capsaicin cream. Topical anesthetics, including benzocaine.
- 22. Non-pharmacologic treatment Apply coolwater compresses to the skin or soak in a bathtub filled with cool water Add finely ground oatmeal to the bathtub. Apply calamine lotion to the affected areas. Trim your fingernails to avoid infection. Wear loose-fitting clothing.
- 23. Prevention o Shingles vaccine(Zostavax) It is given to people 60 years of age and older who have already had the chickenpox. The shingles vaccine is a live vaccine given as a single injection, usually in the upper arm. The most common side effects of the shingles vaccine are redness, pain, tenderness and swelling at the injection site, and headaches.
- 24. Prognosis • Many casesof shingles go away by themselves, with or without treatment • The rash and pain should be gone in two to three weeks • However, shingles may last longer and be more likely to recur if the person is older, especially older than 50 years of age, or if they have a serious medical problem