HERPES ZOSTER

HERPES ZOSTER

1. Definition

   • Also know as shingles was an acute viral infection,characterized by inflammation of dorsal root ganglia/extra medullary cranial nerve ganglia.

2. Type of organisms

   • Varicella- zoster virus, - varicella (chicken pox) - zoster (shingles)

3. Pathophysiology

   • 1. VZV enters through respiratory tracts
   • 2. viral reaplication in regional lymphs nodes
   • 3.primary verimia in blood stream
   • 4. further viral reaplication in liver & spleen
   • 5. secondary viremia
   • 6. enter into nerve& transport to dorsal root ganglia, be dormant in there
   • 7. reactivation in dorsal root ganglia
   • 8.infection of nerve & dermatone
   • 9. Herpes zoster

4. Mood of transmission

   • direct contact with open sores of shingles rash
   • indirect through formities contaminated with discharge from lesion,skin or respiratory tract

5. Incubation period

   • 10 - 21 days

6. Reservoir

   • man

7. Etiology

   • 1. Age , in people older than 50 y/o
   • 2. Disease that weaken the immune system
   • 3. immunosuppressant drug - prolonged use of steroid

8. Clinical features

   • 1. prodome phase
     • Zoster Sine Herpete (dermatomal pain without rash
     • active ganglionitis: neuronal necrosis, severe neuralgia
     • virus travel to nerves may cause aching, burning, stabbing
     • pain, malaise, headache
   • 2. Acute phase
     • involved skin develop cluster of vesicle on erythematous base
     • vesicle becomes pustular & ulcerate with crusts developing
     • oral lesions
     • James Ramsay Hunt's Syndrome
   • 3. chronic phase
     • post herpetic neuralgia

9. Diagnosis

   • Full Blood Count
   • Tzanck Smear
   • polymerase chain reaction
   • direct fluorescent antibody

10. Treatment & management

    • oral antiviral agent,
      • Acyclovir
      • Valacyclovir
    • corticosteroids
      • prednisone
    • Analgesics
      • Ibuprofen
      • Naproxen
    • Tryclyclic antidepressant
      • Amitriptyline
    • Anticonvulsant
      • Gabapentin

11. Complication

    • 1.Neurologic
      • post herpetic neuralgia
      • cranial & neuron motor pulses, Ramsey Hunt's Syndrome
    • 2. ophthalmic shingles
    • 3. cutaneous
    • 4. visceral

12. Prevention

    • 1. notification
    • 2. personal hygiene
    • 3. Immunization
    • 4. isolation
    • 5. health education