Shingles Flashcards
Pathogen - VZV - what does it stand for?
Pathophysiology
Where does it lie dormant?
Varicella Zoster Virus
Infection in childhood causes chickenpox
VZV reactivates travelling from dorsal root ganglia along sensory nerve fibres to skin and causing a rash.
Type of rash
Where?
How long does it last?
What may the patient experience before the onset of the rash?
What could the patient experience after the disappearance of the rash?
Vesicular
Single dermatome
3-5 days
Pain 1-3 days before rash
Post-herpetic neuralgia
What is herpes zoster ophthalmicus?
Where
Complications
VZV reactivation in the trigeminal nerve of CN5 causing lesions in or around the eye.
Lesions or around the eye
Conjunctivitis Scleritis Retinitis Oculomotor palsy Optic atrophy
What is herpes zoster oticus?
VZV reactivation in the geniculate ganglion of the facial nerve causing CN7 palsy and rash of the ear canal, auricle, anterior tongue and/or soft palate.
How can be be prevented?
Diagnosis?
Shingles vaccine if > 70 yrs old
Clinical
Swab of lesions for PCR
Management:
Anti-virals - 3 names
How long?
Route?
Indications
Aciclovir
Famciclovir
Valaciclovir
7-10 days
PO
Patient presenting within 72 hours of onset
>50 yrs old
Immunosuppressed
Herpes zoster ophthalmicus
How can post-herpetic neuralgia be managed?
Neuropathic analgesia such as amitriptyline or gabapentin
When is an ophthalmology referral needed?
Herpes zoster ophthalmicus with red eye
Visual impairment
Hutchinson’s sign
