varicella zoster Flashcards
definition
Shingles (herpes zoster infection) is an acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus (VZV).
RF’s
increasing age
HIV: strong risk factor, 15 times more common
other immunosuppressive conditions (e.g. steroids, chemotherapy)
most commonly affected dermatomes
T1-L2.
features
prodromal period
burning pain over affected dermatome
severe pain
systemic features can exist
rash - macular that becomes vesicular
management
may need to avoid pregnant women and the immunosuppressed
should be advised that they are infectious until the vesicles have crusted over, usually 5-7 days following onset
paracetamol and nsaids followed by neuropathic agents
oral corticosteroids in first 2 weeks in immunocompromised
oral acyclovir unless patient < 50 and mild rash
main complication of shingles
post herpetic neurangia
Herpes zoster opthalmicus (HZO)
reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
herpes zoster virus features
vesicular rash around the eye, which may or may not involve the actual eye itself
Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
management of herpes zoster opthalmicus
oral antivirals for 7-10 days to be started in 72 hours
topical steroids may be used to treat any secondary inflammation
ramsay hunt syndrome
caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
features of ramsay hunt
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus
management of Ramsey hunt syndrome
oral acyclovir and corticosteroids
