Herpes Zoster Infection: Description, Causes and Risk Factors:Abbreviation: HZ.It is also called as shingles.ICD-9: 53.00.The incubation period is 7 - 23 days.Herpes zoster is a viral infection, an infection caused by a varicella-zoster virus, characterized by an eruption of groups of vesicles on one side of the body following the course of a nerve due to inflammation of ganglia and dorsal nerve roots resulting from activation of the virus, which in many instances has remained latent for years following a primary chickenpox infection.Herpes zoster is caused by the same virus that causes chickenpox. After an episode of chickenpox, the virus becomes dormant in the body. Herpes zoster occurs as a result of the virus re-emerging after many years. Herpes zoster may affect any age group, but it is much more common in adults over 60 years old, in children who had chickenpox before the age of one year, and in individuals whose immune system is weakened.A person who never had chickenpox earlier can get infected by HZ by direct contact and people who has low immunity level can also get this infection. People who are suffering from leukemia, other cancers, atopic dermatitis, Hodgkin's disease, HIV, are also risk of this infection. People who are taking drugs for suppressing immune systems are also at risk.Symptoms:Symptoms include:General feeling of malaise.
In children, the illness begins with the characteristic rash. The rash is characteristically centripedal in distribution and is seen mainly in areas not exposed to pressure, such as the flank, shoulder blades, and in the axillae. The skin lesions progress rapidly through the stages of macules to papules to vesicles which rapidly break down with crust formation. The lesions appear in a series of crops so that all stages in their genesis can be seen at any one time. In adults, a prodrome resembling an influenza-like illness commonly presents a few days earlier.Complication includes secondary bacterial infection, hemorrhagic chickenpox, viral pneumonia, encephalitis, neuralgia, and ocular zoster.Diagnosis:To diagnose herpes zoster, a dermatologist looks at the appearance of the skin and asks if the patient has experienced pain before the rash developed. To confirm the diagnosis, a dermatologist may scrape skin cells from a blister onto a glass slide for examination under a microscope and this will be sent for laboratory diagnosis.Laboratory Tests Include:Cytology - smears of scrapings of the base of the lesions will reveal characteristic multinucleate giant cells, also known as Tzanck cells. However this technique will not distinguish between HSV (herpes simplex virus) and VZV (varicella zoster virus) infection.Electron microscopy - herpesvirus particles can be seen in fluid taken from the early vesicles of either varicella or zoster. This technique cannot distinguish between HSV and VZV.Immunofluorescence cytology - smears of the base of lesions can be examined by immunofluorescence cytology, as in the case for HSV. This technique is more sensitive than EM (electron microscopy) but is more labour intensive and requires greater technical expertise.Molecular Methods - PCR assays for VZV are available and have been reported to be of use in the diagnosis of VZV meningoencephalitis from CSF (cerebrospinal fluid) specimens.Treatment:HZ usually clears on its own in a few weeks and seldom recurs. While zoster is clearing, pain relievers can help ease the discomfort, and cool compresses may provide soothing relief. The primary goal of supportive treatment is to relieve itching and neuralgic pain with calamine lotion.Since HZ is a viral disease, antiviral drugs such as acyclovir can be used to shorten the duration of a flare. This means that soon after the signs of shingles appear (redness and blisters, pain and numbness, fatigue, headache, and fever) the drug can be administered.OTC (over-the-counter) pain relief medications and prescription analgesics are prescribed to deal with the pain. Acetaminophen, aspirin, ibuprofen, and naproxen are just some of the pain relief medications recommended.Additional Treatment Include:Proteolytic Enzymes (supplements derived from papaya, pineapple). Side effects of proteolytic enzymes may include digestive upset and allergic reactions. People with allergies to pineapple or papaya should avoid supplements derived from those fruit. Proteolytic enzymes, particularly bromelain and papain, should not be taken with warfarin (Coumadin), aspirin, or other "blood-thinning" medications as it may increase the effect of the drug. The proteolytic enzyme pancreatin may interfere with the absorption of the vitamin folate.There is preliminary evidence suggesting that tai chi may improve immune function and health in older adults at risk for shingles.If bacteria have infected ruptured vesicles, treatment usually includes an appropriate systemic antibiotic. Trigeminal zoster with corneal involvement calls for instillation of idoxuridine ointment or another antiviral agent.Corticosteroids, such as prednisone, may occasionally be used to reduce inflammation and risk of post-herpetic neuralgia. They have been shown to be most effective in the elderly population. Corticosteroids have certain risks that should be considered before using them.Disclaimer: The following tests, drugs and medications, surgical procedures are in some way related to, or used in the treatment. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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