Shingles Flashcards
What is Shingles?
- A vesicular rash that occurs due to the reactivation of the VZV
What are the risk factors for Shingles?
- Age
- Immunosuppression
- Transplant recipients
- Autoimmune diseases
- HIV
What is the Pathophysiology of Shingles?
- VZV lies dormant within the dorsal root ganglia
- This is seen within a dermatomal distribution with a vesicular rash
What are the clinical features of Shingles?
- Unilateral, erythematous, vesicular rash in a dermatomal distribution
- Prodromal period - burning pain over affected dermatome for 2/3 days, pain so severe interferes with sleep
- Pain (throbbing, burning, stabbing)
- Rash: vesicular rash - 3/4 days become pustular and burst, 7/10 days lesions crust over
- Scarring - hypopigmented/ hyperpigmented areas
- Systemic features: headache, fever, malaise, fatigue
- Hutchinson’s signs
What is Herpes Zoster Ophthalmicus?
- This refers to the reactivation of Herpes Zoster within the distribution of the trigeminal nerve
- Can be sight-threatening due to corneal involvement
What is Hutchinson’s Sign?
- This is the presence of vesicular lesions on the side or tip of the nose that represents the dermatome of the nasociliary nerve
- Ophthalmic division of the trigeminal nerve
- This correlates with eye involvement
What is Ramsay Hunt Syndrome?
- Reactivation of Herpes Zoster in the geniculate ganglion of the facial nerve
- Facial Nerve Palsy with a vesicular rash affecting the ipsilateral ear, hard palate and 2/3 of the tongue
What is the diagnosis and investigations?
- Clinical diagnosis based on appearance
- PCR testing
- Testing for immunosuppression
What is the Management for Shingles?
- Consider Admission for severe shingles, complications or significant immunosuppression
- oral Anti-virals for within 72 hours of rash onset
- Analgesia - mild pain (paracetamol), moderate pain (paracetamol + amitriptyline and gabapentin)
- oral corticosteroids may be considered in first 2 weeks in immunocompetent adults with localised shingles
When should you consider hospital admission?
- Severe complications (meningitis, encephalitis)
- Herpes Zoster Ophthalmicus
- Severely immunocompromised
- Severe infection
- Immunocompromised child
Who do you consider giving anti-viral therapy to?
- Immuncompromised
- Non-truncal involvement
- Moderate to severe pain or rash
- Patients >50 years old
- Pregnancy
Which groups of people is it important to avoid?
- People who have not had chickenpox
- Immunocompromised individuals
- Babies <1 month
What is post-exposure prophylaxis?
- Offered to VZV antibody negative pregnant women who have had a significant exposure to chickenpox or shingles
What is the Vaccination process of Shingles?
- A shingles vaccination may be offered to patients 70 or older if no contraindications
- Zostavax
What are the complications of Shingles?
Scarring: hypo- or hyperpigmented areas
Post-herpetic neuralgia (see below)
Secondary bacterial infection
Ramsay hunt syndrome
Herpes zoster ophthalmicus
Motor neuropathy
CNS involvement: encephalitis, meningitis, myelitis
Disseminated infection
