Name
HERPES ZOSTER
DESCRIPTION
DETAIL
D.D. : - HERPES SIMPLEX INFECTION - PUSTULAR ERRUPTIONS - COXSACHIEVIRUS INFECTIONOTHER TESTS : * DIRECT IMMUNOFLUORESCENT STAINING OF CELL FROM THE LESION BASE * DETECTION OF VIRAL ANTIGENS BY IMMUNOPEROXIDASE ASSAY * IMMUNOFLUORESCENT DETECTION OF ANTIBODIES TO VZV MEMBRANE ANTIGENS * FLUORESCENT ANTIBODY TO MEMBRANE ANTIGEN ( FAMA ) TEST * IMMUNE ADHERENCE HEMAGGLUTINATION TEST * ENZYME LINKED IMMUNOSORBENT ASSAY ( ELISA ) * STAINING OF SCRAPINGS FROM THE BASE OF LESIONS TO DEMONSTRATE CHARACTERISTIC GIANT CELLS OR INTRANUCLEAR INCLUSION BODIES BY TZANCK SMEAR.
TYPENOTES
APPROPRIATE HEALTH CARE Outpatient unless disseminated or occurring as complication of serious underlying disease requiring hospitalization GENERAL MEASURES β’ Wet dressings with tap water or 5% aluminum acetate (Burowβs) applied 30 to 60 minutes 4-6 times per day β’ Lotions such as calamine DRUG(S) OF CHOICE . Acute eruption treatment . Antiviral agents initiated within 72 hours of rash may relieve symptoms, speed resolution of rash and perhaps modify postherpetic neuralgia. These agents are indicated for immunocompromised patients, ophthalmic zoster and disseminating zoster. - Valacyclovir 1000 mg tid for 7 days - Famciclovir 500 mg tid for 7 days - Acyclovir 800 mg every 4 hours (5 doses daily) for 7 days . Analgesics (acetaminophen, codeine, NSAIDs) prn . Corticosteroids may help acute symptoms, but theoretically increase risk of dissemination . Postherpetic neuralgia and zoster-associated pain . Tricyclic antidepressants (amitriptyline 25 mg qhs and other low dose TCAs) relieve pain acutely and may reduce pain duration . Lidocaine (Lidoderm) patch 5% applied after skin rash closure over painful areas (limit 3 patches simultaneously or trim single patch) for up to 12 hours is reported effective in one limited trial . Gabapentin 100-600 mg tid for pain and other quality of life indicators, but is limited by adverse effects . Opioids and other analgesics may be useful adjuncts . Pregabalin 50-100 mg tid reduces pain, but usefulness limited by side effects . Capsaicin (Zostrix) cream, percutaneous nerve stimulation, and over 40 other medications and treatments have been advocated in the literature without good quality evidence . Prevention of postherpetic neuralgia and zoster-associated pain (these treatments should be limited to patients over age 50 years) . Antiviral therapy with valacyclovir, famciclovir or acyclovir given during acute skin eruption may be effective in limiting duration of pain . Low dose amitriptyline (in the same dosage as for treatment of postherpetic neuralgia) but started within 72 hours of rash onset and continued for 90 days may reduce postherpetic neuralgia incidence or duration . Corticosteroids do not reduce incidence, severity or duration of postherpetic neuralgia . Treatment of complications . Secondary bacterial skin infections - Silver sulfadiazine topically and/or systemic antibiotics PREVENTION/AVOIDANCE β’ Varicella vaccines currently available will theoretically reduce zoster incidence in the future β’ Vaccines are being tested for prevention of herpes zoster in individuals previously infected with wild VZ virus β’ Zoster patients may transmit virus causing varicella (chickenpox) to susceptible persons POSSIBLE COMPLICATIONS β’ Postherpetic neuralgia β’ Ocular involvement with facial zoster. Corneal ulceration (classically a dendritic ulcer). β’ Superinfection of skin lesions β’ Meningoencephalitis β’ Cutaneous dissemination β’ Hepatitis β’ Pneumonitis β’ Peripheral motor weakness β’ Segmental myelitis β’ Cranial nerve syndromes especially ophthalmic and facial (Ramsay Hunt syndrome) β’ Guillain-BarrΓ© syndrome β’ Arteritis, large vessel β’ Encephalitis, small vessel EXPECTED COURSE/PROGNOSIS β’ Resolution of acute rash within 14 to 21 days β’ Postherpetic neuralgia may occur in patients over age 50
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PCR, ELISA TEST
SHINGLES
[HERPES ZOSTER]