Herpes Zoster

Synonym: Shingles

Varicella-zoster virus (VZV) is the causative organism an the site of its pathology is the posterior root ganglion; the skin is only secondarily affected. One or several posterior root ganglia may be involved. The inflammation, sometimes, though rarely, spreads to the posterior horn and then to the anterior horn and even the meninges. Physical injuries, mental trauma, febrile illnesses and drugs are also known to act as triggers as well as predisposing factors.

What is Shingles or Herpes Zoster?

Shingles may occur at any age, though of course, adults are more often affected. Occasionally, herpes zoster may take an epidemic form.

Herpes zoster is also known as zoster and more commonly known as shingles. It is a viral disease in which the patient has painful skin rash with blisters spread in some specific area on one side of body often in limited regions. The initial infection with varicella zoster virus (VZV) first causes chickenpox and once it is resolved another illness called shingles can occur often years later.

Some of the other names are zona and zoster. The culprit is the varicella-zoster virus.

Statistics related to Herpes Zoster

1. About 95% of adults in US have antibodies to the varicella-zoster virus
2. All these people are vulnerable to reactivation of infection.
3. A person of any age with any type of varicella infection history is vulnerable to zoster
4. Advancing age increases the chances of zoster further due to declining immunity.
5. According to an estimate, 4% of patients who suffered from zoster will develop it again in later part of life.

Symptoms of Herpes Zoster

The earliest symptoms of herpes zoster includes headache, fever, and malaise. More intense symptoms include burning pain, itching, hyperesthesia or paresthesia. The pain may be mild to extreme. It is often painless in children. Herpes zoster is most common on the trunk and buttocks. Blisters on the tip of the is the indicative of possible eye involvement.

Pain duration in Zoster is variable but generally it is less than 1 month. When the pain lasts longer than a month it is now referred to as postherpetic neuralgia. According to the statistics, about 10-15% of people suffering will have pain for more than 1 month.

Drugs and cure of Herpes Zoster

Corticosteroids are often used for treatment of the herpes zoster infection. The medications can be started within 24 hours of pain or burning. It should preferably happen before the blisters appear. The drugs are usually administered in pill form. The doses are more than that recommended for herpes simplexherpes simplex or genital herpes.

A herpes zoster vaccine is quite popular. It is not same as the chickenpox vaccine. Adults who have reached certain age and receive the herpes zoster vaccine does not recieve complications from shingles. People elder than 60 should get the booster for herpes zoster as a routine medical care.

What complications can occur in Herpes Zoster?

Some of the complications that can occur due to Zoster are as follows:

• Yet another attack of shingles
• Blindness if the eys are affected
• Deafness
• Infection, such as encephalitis or sepsissepsis
• Other b acterial skin infections
• Ramsay Hunt syndrome
  

Is Herpes Zoster contagious?

The simple answer to this question is Yes. Shingles or Zoster is contagious. Shingles can be go from one person to another who have not had chickenpox.

During the sleeping phase, the zoster virus may resides in the dorsal root spinal ganglion. On reactivation, the virus spreads from the ganglia through the sensory nerves to other sensitive nerves and then finally to the sensory dermatomes.

Conditions prevailing indicative of Herpes Zoster

An attack starts with neuralgic pain, local increased sensitivity of the skin (hyperesthesia) and fever with a range of 102° to 103° F. Cutaneous lesions develop three days after the onset of the attack. Sometimes, the rash may develop suddenly without any premonitory symptom.

The rash develops in the segmental distribution of the affected nerve roots, and consists of typical herpetic lesions e.g., groups of vesicles on inflammatory/base in several patches with intervening areas of normal skin. The contents of the vesicles soon turn opaque. The vesicles may become confluent to form flat bullae.

Prognosis of Herpes Zoster

It is good as far as the cutaneous lesions are concerned. An individual attack subsides nicely, leaving faint scars. The troublesome sequelae may be the annoying post-herpetic neuralgia and muscular paralysis due to extension of inflammation to anterior horn of the spinal cord. Viremia and meningo-encephalitis may rarely occur in susceptible patients or in patients under immuno-suppressive drugs.

Diagnosis of Herpes Zoster

It is based upon the sudden onset of a unilateral, herpetic eruption along the distribution of one or more nerve roots accompanied by pain and hyperaesthesia. In the initial stage of sudden pain, before the rash develops, confusion may occur with other local causes of pain like mastoiditis, pleurisy, appendicitis, cholecystitis, pyelitis etc.