Herpes Zoster

 

Herpes zoster

• Herpes zoster, or shingles results from reactivation of latent varicella–zoster virus (VZV)

• The same virus that causes chickenpox

• The virus remains dormant (latent) in the dorsal root ganglia. It can reactivate later in a person’s life.

• It causes intense inflammation and necrosis of the neurons, often go along with pain.

• It is a localized, usually painful, maculopapular rash.



What are clinical symptoms?

Prodromal pain:

• Prodromal pain that generally starts 4 to 6 days before rash onset.

• The dermatomal pain is frequently accompanied by burning, numbness or tingling sensations.

• Patients may have fever, malaise, headache and myalgia

Acute pain:

• Rash appears on the trunk along dermatome.

• The rash does not usually present across the body’s midline.

• The pain can be intermittent or constant and is often described as burning, shooting, throbbing, or itching.

• The rash changes into clusters of vesicles

• There may be lasting pigmentation changes and scarring on the skin

• The rash usually lasts 7 to 10 days and heals fully within 2 to 4 weeks

Subacute herpetic neuralgia

• Pain that persists beyond the acute phase of herpes zoster, up to 3 months after rash onset.

• After this time, persistent pain is inferred as postherpetic neuralgia (PHN).

What are the complications of singles?

• Postherpetic neuralgia (PHN):

• Is persistent pain for at least 90 days following the herpes zoster rash.

• Is the most common complication.

• occurs in 8%–27% of herpes zoster cases.

• The risk for developing postherpetic neuralgia also increases with age.

• Pain beyond 30 days: 30% in people younger than 40 and up to 74% in those 60 years and older.

• Pain beyond 90 days: 6% in people younger than 40 and 12% in those 60 years and older.

• Shingles may also cause serious complications involving eyes. Very seldom, shingles can also lead to pneumonia,

Who are at risk of singles?

The incidence and severity of herpes zoster increase with advancing age; more than half of all persons in whom herpes zoster develops are older than 60 years. Complications occur in almost 50 percent of older persons with herpes zoster.

Other key risk factors were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), chronic obstructive pulmonary disease (COPD), asthma, chronic kidney disease (CKD), depression and diabetes. And immunocompromised patients also have high risk of herpes zoster.

Prevalence of Herpes zoster

Herpes zoster is common: approximately 1 million cases were reported each year in the United States. The incidence rises with age, from 5 cases per 1,000 populations in adults aged 50–59 years to 11 cases per 1,000 populations in persons aged ≥80 years.

Transmission:

• The virus is spread through direct contact with fluid from the rash blisters caused by shingles.

• A person with active shingles can spread the virus when the rash is in the blister-phase.

• Once the rash has developed crusts, the person is no longer infectious.

If you have shingles, you should:

• Cover the rash.

• Avoid touching or scratching the rash.

• Wash your hands often to prevent the spread of varicella zoster virus.

• Avoid contact with the people below until your rash has developed crusts

• Pregnant women who have never had chickenpox or the chickenpox vaccine;

• Premature or low birth weight infants; and

• People with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

Treatment

• Herpes zoster (HZ) is often treated with antiviral therapy, analgesics, and supportive care. And talking to your doctor.