Infectious Disease Book

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Herpes ZosterAka: Shingles

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  1. See Also
    1. Postherpetic Neuralgia
  2. Pathophysiology
    1. Reactivation of latent virus from dorsal root ganglion
    2. Inflammation to acute viral ID in segmental nerve
    3. Contagious to non-immune persons
      1. Avoid contact until rash heals
  3. Symptoms
    1. Pain within dermatome occurs first
    2. Rash develops after 48-72 hours
      1. Starts as erythematous rash
      2. Clear Vesicles then develop
    3. Prodrome may be present
      1. Fever
      2. Chills
      3. Malaise
  4. Signs
    1. Rash
      1. Erythematous base
      2. Clear Vesicles
    2. Tender regional lymph nodes
    3. Images
      1. DermHerpesZosterEarly.jpg
      2. DermHerpesZosterLate.jpg
  5. Labs
    1. Tzanck Smear of lesion base
      1. Multinucleated giant cells
    2. Viral antigen detection
    3. Serologic titers to Herpes Zoster
  6. Complications
    1. Postherpetic Neuralgia
    2. Meningitis
    3. Encephalitis
    4. Granulomatous Angiitis with contralateral Hemiplegia
    5. Cutaneous dissemination in Lymphoma (40%)
  7. Management: General
    1. Relative indications for antivirals (maximal benefit)
      1. Onset within 72 hours of starting treatment
      2. Age 50 years and older
      3. More than 50 lesions
    2. Oral antiviral agents
      1. Acyclovir 800 mg PO 5x/day for 7 days
        1. Reduces healing time, pain, and rash dissemination
        2. Valacyclovir appeared more effective in over age 50
          1. (1999) Med Lett Drugs Ther 41:113
      2. Valacyclovir 1 g PO tid for 7 days
        1. Equivalent efficacy to Famciclovir
          1. Tyring (2000) Arch Fam Med 9:863
      3. Famciclovir 500 mg PO tid for 7 days
        1. Lesions healed faster, more brief virus shedding
        2. Reduces Postherpetic Neuralgia duration by 2 months
        3. Reference
          1. Tyring (1995) Ann Intern Med 123:89
    3. Systemic Corticosteroids
      1. Use is controversial
      2. May be associated with increased complications
      3. May reduce acute pain, inflammation and speed up healing
      4. Does not reduce risk of Postherpetic Neuralgia
        1. Wood (1994) N Engl J Med 330:896
  8. Management: Special Circumstances
    1. Zoster Ophthalmicus
      1. Atropine
      2. Topical Antiviral (IUDR, ara-A, Acyclovir)
      3. Analgesic
    2. Immunocompromised Patient
      1. Acyclovir 10 mg/kg IV q8h 10 days
  9. Prophylaxis: Varicella Immune Globulin (VZIG) Indications
    1. Immunodeficient under age 15 years
      1. Give within 72-96 hours exposure
    2. Newborn of infected mother
      1. Exposure 5 days before delivery or 2 days after
  10. Prevention
    1. Avoid contact with active shingles or Chicken Pox
    2. Consider prophylaxis if exposure in high-risk groups
    3. Varicella Vaccine
      1. May reduce risk of developing shingles
      2. Now part of routine Primary Series
      3. Booster Varivax for age >55 years may be considered
  11. References
    1. Berger in Goldman (2000) Cecil Medicine, p. 2130-1
    2. Habif (1996) Dermatology, p. 351-9
    3. Gnann (2002) N Engl J Med 347:340

Herpes zoster disease (C0019360)

Definition (MSH)An acute infectious, usually self-limited, disease believed to represent activation of latent varicella-zoster virus (HERPESVIRUS 3, HUMAN) in those who have been rendered partially immune after a previous attack of CHICKENPOX. It involves the SENSORY GANGLIA and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area. (From Dorland, 27th ed)
Definition (CSP)acute infectious, usually self-limited, disease believed to represent activation of latent varicella zoster virus in those who have been rendered partially immune after a previous attack of chickenpox; it involves the sensory ganglia and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area.
ConceptsDisease or Syndrome (T047)
ICD9053, 053.9
MSHD006562
BasqueZOSTER HERPESA
DanishHerpes Zoster
DutchHerpes zoster
Englishherpes zona, Herpes Zoster, Herpes zoster disease, Herpes zoster infection, Shingles, Zona, Zoster
FinnishVYORUUSU
FrenchHerpes zoster
GermanHerpes Zoster
Hebrewshalbeket xogeret
Hungarianherpes zooster
ItalianHerpes zoster
NorwegianHERPES ZOSTER
PortugueseHerpes zoster
Spanishculebrilla, herpes zoster, zona, zona ignea, zona serpiginoso
SwedishHERPES ZOSTER/BALTROS
Parent ConceptsHerpesviridae Infections (C0019372), Virus Diseases (C0042769), Infection (C0021311), Vesiculo-bullous (C0549582), SKIN INFECTION/INFLAMMATION (C0549663), Viral diseases with exanthemata NOS (C0153062), Diagnosis/Diseases Component (C0497531), Skin (C1123023), Herpes zoster disease (C0019360), Varicella-zoster virus infection (C0586989), Inflammatory disorder (C1290884), Duplicate concept (C1274013)
SourcesAOD, CCS, COSTAR, CSP, CST, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, MEDLINEPLUS, MSH, MTH, MTHICD9, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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