Herpes zoster

Varicella zoster virus (VZV) causes clinically 2 different diseases:


 * 1) Chickenpox (Varicella)
 * 2) Shingles

VZV causes common encephalitis, rarely acute disseminated encephalitis.

Patogenesis
The virus survives in the latent form in the sensitive ganglia of the posterior spinal roots: ganglion Gasseri (nervus trigeminus) and ganglion geniculi. The infection ignites when the body is weakened (surgery, general illness, etc.). The infection usually spreads to the periphery in the respective skin dermatome.

Clinical findings
During the dermatome, pain appears, sometimes preceded by itching. In a few days, a serous (even partially hemorrhagic) rash of various magnitudes appears, and the regional lymph nodes are painful and swollen. The blisters dry out after 2 weeks, leaving depigmentation or hyperpigmentation, the pain gradually disappears. In some patients, severe neuralgic pain persists in the respective dermatome even after the crust separates. Paresis are present in 20% of the cases, encephalitis is rare. When the ganglion geniculi is affected. The blisters appear in the ear canal and around the ear itself. Hunt's syndrome - hearing impairment, dizziness, paresis of the facial nerve (n. VII).
 * Herpes zoster oticus

Gasseri ganglion lesion. Sowing of blisters in the first branch of the trigeminal nerve (ophthalmic nerve). It causes conjunctivitis and the risk of keratitis. 50-70% of patients have eye complications. It occurs predominantly at an older age (in the 5th-8th decade). We find an increase of lymphocytes in the cerebrospinal fluid.
 * Herpes zoster ophthalmicus

Treatment
The drug of choice is aciclovir. Descending treatment of prednisone. Also liquid powder for the treatment of the blisters, ATB against superinfection and for neuralgia carbamazepine or tricyclic antidepressants.

Vaccination
Zostavax live vaccine is indicated for people over 50 years of age. After undergoing shingles, an interval of 6 months is recommended. Contraindicated in pregnant, immunosuppressed, active untreated TB, hypersensitivity to vaccine components. Available in the Czech Republic since 2014, it is not covered by health insurance.

Source

 * ws:Herpes zoster