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Year 3 > Varicella zoster (I) > Flashcards

Varicella zoster (I) Flashcards

1
Q

What is VZV also known as?

A

Human Alpha Herpes Virus

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2
Q

What disease does VZV primarily cause?

A

Chickenpox (varicella)

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3
Q

What infection does primary vs secondary infection by VZV cause?

A
  • primary infection (acute) –> chickenpox
  • secondary infection –> shingles
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4
Q

When does primary acute VZV (chickenpox) normally present?

A

Chickenpox normally presents in childhood and is usually self-limiting

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5
Q

Who does VZV infect?

A

Exclusively human virus - over 80% of people have been infected by the age of 10 years

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6
Q

Which groups are at high risk of VZV complications? (4)

A
  • adults
  • pregnant women
  • immunocompromised patients
  • neonates
  • (including pneumonia, neurological sequelae, hepatitis, secondary bacterial infection and death)
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7
Q

How is VZV transmitted?

A

Direct contact with lesions (vesicular secretions) or through airborne spread from respiratory droplets

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8
Q

What is the incubation period for VZV?

A

14 days (9 to 21 days)

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9
Q

What happens after primary infection with VZV?

A
  • can become latent in dorsal root ganglia and trigeminal ganglia
  • later in life: in 1/3 of cases it may reactivate –> shingles
  • increased risk if HIV or immunocompromised (e.g. steroid use or chemotherapy)
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10
Q

What is Ramsay-Hunt Syndrome (VZV)?

A
  • LMN facial nerve palsy due to reactivation of VZV in geniculate ganglion of facial nerve
  • Sx - first auricular pain –> then unilateral facial nerve palsy and vesicular rash around ear +/- blisters on anterior 2/3 of tongue
  • Rx - oral acyclovir and corticosteroids (prednisolone)
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11
Q

What is Herpes Zoster Ophthalmicus (VZV)?

A
  • reactivation of VZV in area supplied by ophthalmic division of trigeminal nerve
  • Sx - vesicular rash around eye + Hutchinson’s sign (rash on tip/side of nose) indicates likely ocular involvement e.g. anterior uveitis
  • Rx - urgent ophthalmology review + oral antivirals 7-10d
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12
Q

What are the clinical features of chickenpox - VZV? (7)

A
  • fever
  • vesicular rash - appears centrally first then spreads to extremities
  • vesicles on mucous membranes e.g. nasopharynx
  • pruritus
  • headache
  • fatigue/malaise (prodromal)
  • sore throat
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13
Q

Describe the rash in chickenpox (VZV).

A
  • macular papular rash evolving into vesicles with areas of weeping (exudate) and crusting
  • as vesicles sweep and crust over new ones appear
  • scabs fall off without leaving a scar
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14
Q

How does the rash spread in chickenpox (VZV)?

A

Starts centrally (face and trunk) then spreads to extremities (and oropharynx, conjunctivae, GU tract)

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15
Q

What are the clinical features of shingles - VZV?

A
  • acute, unilateral, painful, blistering rash - erythematous, macular, vesicular rash
  • prodromal period of burning/tingling pain over affected dermatome for 2-3 days
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16
Q

Describe the rash in shingles (VZV).

A

Acute, unilateral, painful, blistering

Erythematous, macular, vesicular

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17
Q

When are patients with shingles infectious until (VZV)?

A

Until vesicles have crusted over - usually 5-7 days from onset

18
Q

What is the treatment for shingles (VZV)? (3)

A
  • paracetamol
  • NSAIDs
  • can give antivirals within 72h
19
Q

Which groups should those with shingles avoid?

A

Pregnant women and immunocompromised whilst infectious

20
Q

What are the clinical features of Ramsay-Hunt Syndrome in order (VZV)?

A
  • first auricular pain
  • then unilateral facial nerve palsy and vesicular rash around ear +/- blisters on anterior 2/3 of tongue
21
Q

What are the clinical features of Herpes Zoster Ophthalmicus (VZV)?

A
  • vesicular rash around eye
  • Hutchinson’s sign (rash on tip/side of nose) –> indicates likely ocular involvement e.g. anterior uveitis
22
Q

What are the risk factors for chickenpox - VZV? (5)

A
  • exposure to VZV
  • age 1-9y
  • unimmunised status
  • occupational exposure
  • immunocompromised
23
Q

What are the risk factors for shingles - VZV? (4)

A
  • primary VZV Hx
  • adults >50y
  • immunocompromised
  • stress –> reactivation
24
Q

How is VZV usually diagnosed?

A

Clinical diagnosis

25
Q

What are the first-line investigations for VZV?

A
  • PCR - positive for VZV DNA
  • ultrasound in pregnant women - screen for foetal consequences of VZV
  • vesical fluid - electron microscopy, direct immunofluorescence (DFA), cell culture, viral PCR
26
Q

What is the main investigation done for VZV?

A

PCR - positive for viral DNA

27
Q

What investigation do we do in pregnant women with VZV?

A

US - screen for foetal consequences of VZV infection

28
Q

What investigation would we consider in VZV chickenpox in adults?

A

HIV testing

29
Q

What are some differential diagnoses for VZV? (4)

A
  • smallpox - fever, centrifugal distribution (face and extremities)
  • HSV infection - mucous membranes of oral / genital region
  • SJS-TEN - targetoid lesions that become flaccid blisters, erythema, positive Nikolsky’s sign
  • monkeypox - travel to Africa, exotic pets, palms/soles, lymphadenopathy
30
Q

What kind of disorder is chickenpox usually?

A

Self-limiting

31
Q

How is chickenpox in children usually managed (VZV - low risk of severe disease)?

A

Supportive care - paracetamol, skin emollients, antihistamines (diphenhydramine), hydration, calamine lotion (itching)

32
Q

What do we give for VZV - risk of moderate/severe disease?

A

Oral acyclovir

33
Q

What do we give for VZV - high risk of severe disease?

A

IV antiviral therapy (acyclovir)

(Underlying pulmonary disease, long-term salicylates, short-course/intermittent oral corticosteroids)

34
Q

How do we manage VZV (chickenpox and shingles) in adults?

A

Acyclovir if elderly, immunocompromised or ophthalmic involvement + simple analgesia

35
Q

Which groups of patients should take post-exposure prophylaxis for VZV? (3)

A
  • significant exposure to chickenpox or VZV
  • immunosuppressed, neonate, pregnant
  • no antibodies to VZV
36
Q

What is VZV prophylaxis?

A

Varicella zoster immunoglobulin (VZIG) –> immunosuppressed and pregnant women exposed to VZV

Chickenpox vaccine - live attenuated VZV vaccine

37
Q

What do we give for a common complication of shingles?

A

Antivirals to reduce chances of post-hepatic neuralgia, especially in elderly

38
Q

How do we manage Ramsay-Hunt Syndrome - VZV? (2)

A

Oral acyclovir + corticosteroids (prednisolone)

39
Q

How do we manage Herpes Zoster Ophthalmicus - VZV? (2)

A
  • urgent ophthalmology review
  • oral antivirals for 7-10d
40
Q

What are some complications of VZV? (5)

A
  • Varicella pneumonia
  • encephalitis
  • meningitis
  • hepatitis
  • severe infection in newborn
41
Q

Describe the prognosis of VZV.

A

Typically self-limiting disease

In up to 1/3, VZV reactivates later as shingles or Herpes Zoster

Year 3 (208 decks)

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