Varicella Zoster Virus

Question 1

What is VZV?

Answer 1

Primary infection = varicella (chickenpox). Reactivation of the dormant virus (in dorsal root ganglia), causes zoster (shingles).

Question 2

Explain the aetiology of varicella zoster

Answer 2

VZV is a herpes ds-DNA virus
Highly contagious
Transmission by aerosol inhalation or direct contact with vesicular secretions

Question 3

Summarise the epidemiology of varicella zoster

Answer 3

Chickenpox: 4-10 yrs
Shingles: > 50 yrs
90% of adults are VZV IgG positive

Question 4

Give 3 features of Chickenpox on presentation

Answer 4

Prodromal malaise
Sudden appearance of intensely itchy spreading rash mainly affecting face + trunk
Vesicles weep, crust over + new vesicles appear

Question 5

Describe the presentation of shingles

Answer 5

May occur after a period of stress
Tingling/ hyperaesthesia in a dermatomal distribution
Painful skin lesions

Question 6

List 4 signs of chickenpox

Answer 6

Maculopapular rash
Areas of weeping + crusting
Skin excoriation (from scratching)
Mild pyrexia

Question 7

List 3 signs of shingles

Answer 7

Vesicular maculopapular rash
Dermatomal distribution
Skin excoriation

Question 8

What are the appropriate investigations for varicella zoster?

Answer 8

CLINICAL dx
Vesicle fluid: electron microscopy, viral PCR (RARELY necessary)
HIV testing in adult Chickenpox with previous hx of varicella infection

Question 9

Describe the management of chickenpox in children and adults

Answer 9

Children: treat symptoms: Calamine lotion, analgesia, antihistamines
Adults: consider aciclovir if < 24 hours of onset

Question 10

Describe the management of shingles

Answer 10

Aciclovir, valaciclovir, famciclovir if < 72 hours of onset

Simple analgesia e.g. paracetamol

Question 11

List 5 complications of chickenpox

Answer 11

Secondary infection  
Scarring  
Pneumonia  
Encephalitis  
Congenital varicella syndrome

Question 12

List 5complications of shingles

Answer 12

Postherpetic neuralgia  
Zoster ophthalmicus (rash in the ophthalmic division of the trigeminal nerve) 
Ramsay-Hunt syndrome  
Sacral zoster: urinary retention
Motor zoster: muscle weakness of myotome

Question 13

What is the prognosis for VZV?

Answer 13

Depends on complications

Worse in pregnancy, elderly + immunocompromised

Question 14

How long does it take to recover from shingles?

Answer 14

10-14 days

Question 15

What is used in prevention of shingles? Which patients may be considered for this?

Answer 15

Varicella Zoster Ig (VZIG)

Immunosuppressed + pregnant exposed to VZV

Question 16

What is Ramsay Hunt syndrome?

Answer 16

Reactivation of VZV in the geniculate ganglion causing zoster of the ear + facial nerve palsy.
Vesicles behind pinna of ear or in ear canal

Question 17

What is VZV also known as?

Answer 17

HHV3

Herpes zoster