Herpes Zoster

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Herpes zoster

Content:

• What is herpes zoster?
• Herpes zoster symptoms
• Herpes zoster causes
• Consequences and complications
• Is herpes zoster contagious?
• Treatment for herpes zoster
• Collection of medicinal plants

What is herpes zoster?

Herpes zoster is a sporadic illness caused by the reactivation of the herpes zoster virus type III (Varicella Zoster virus). The disease is characterized by a predominant lesion of the skin and the nervous system with severe complications.

Lifelong latent carriage of varicella zoster is established in about 20% of the inhabitants of our country who have had chickenpox in childhood. Asymptomatic carriage of the dormant virus can be lifelong. The main refuge for him are the nerve cells of the body. Under the influence of internal and / or external agents, the virus is activated.

The risk group includes all people with a latent form of Varicella Zoster virus, but to a greater extent have:

• Age of fifty and older;
• Chronic diseases;
• Violations of the cellular link of the immune system;
• Women with complicated pregnancy;
• Children who have had chickenpox;
• Young and middle-aged people with HIV.

The frequency of detection of herpes zoster is 5-12 cases per 100 thousand citizens. Approximately 80% of cases are people over fifty years old. Elderly women get sick twice as often as men. There are no gender differences in young and middle age. The disease ends in severe, in 1-5% of extremely severe complications.

Herpes zoster is characterized by a low mortality rate of no more than 2%. The majority of deaths occur in patients over 75 years of age or young people with severe forms of AIDS.

Herpes zoster HIV infected

In people aged 20 to 40 years, OH can serve as a marker of HIV infection, it is detected in about 10-25% of HIV carriers, while:

• The average age of the sick is 32 ± 4 years versus 65 ± 5 years in persons not infected with HIV;
• The tendency to relapse - 60% versus 1.3% in persons not infected with HIV;
• Deep skin lesions - 30% versus 5% in persons not infected with HIV.

Herpes zoster in cancer patients and organ transplant patients

The frequency of cases of herpes zoster in patients undergoing chemotherapy or drug prevention of transplanted organ rejection ranges from 25 to 50%, mortality - up to 5-7%.

Herpes zoster in pregnant women

Detection rate: 7 cases per 100 thousand women. The clinical course of the disease in the first trimester of pregnancy is one of the reasons for its interruption due to placental insufficiency, intrauterine hypoxia and fetal growth retardation.

Herpes zoster in children

In essence, this means a re-illness of a child who previously had chickenpox during the first year of life, or contracted in utero from a mother who first contracted chickenpox during pregnancy. There is no evidence of the severity of herpes zoster in children, with the rare exception of a child's immunodeficiency.

Herpes zoster symptoms

OH is characterized by a variety of symptoms that depend on the stage of pathogenesis. There are four main periods:

• Prodromal - from zero to third, maximum of the tenth day;
• Sharp - from the tenth to the twentieth day;
• Reconvalescence - from three weeks to three months;
• Long-term consequences - from three months to three years.

Symptoms of the prodromal stage consist of three components: general clinical, neurological disorders and skin rashes.

The combination of two of the four following signs is a reason to go to the clinic

• Febrile temperature from 38 to 39 ^o C, sometimes subfebrile from 37-37.5 ^o C. The increased temperature lasts no more than five to ten days. Prolonged hyperthermia is characteristic of herpes zoster complicated by meningitis or encephalitis. General symptoms are observed in about 20% of patients.
• An increase in regional lymph nodes, mainly on one side (on the neck, in the armpit, under the collarbone, in the groin) in places of itching, pain and rashes.
• Soreness at the sites of rashes (constant, paroxysmal, from touch, it feels like burning, stabbing), which often persists for several months after recovery - `` post-zoster neuralgia ''.
• A blistering rash on one side of the body - on the chest, abdomen, or face in the form of a tape or patch that encircles the entire area In 70% of patients, the rash appears within the first three days of the onset of the fever.

Localization of rashes

The most characteristic places of localization of rashes with herpes zoster are the chest, head, neck and lower back. The approximate ratio of rashes on different parts of the body:

• Chest - 55%;
• Head - 23%;
• Neck - 12%;
• Loin - 10%.

The rash is localized in the area of dermatomes - areas of the skin innervated from the root of the nerve affected by the virus. Knowing the topography of the dermatomes (here) and the localization of the rash on the patient's body, it is possible to determine which branch of the nerve is involved in the pathogenesis. The encircling projection of the thoracic dermatomes on the body explains the name of the disease.

Pathogenesis of rashes on the dermatome

Step-by-step pathogenesis of dermatome rashes:

• Erythema (redness);
• Papules - one to two days;
• Vesicles merging into groups of vesicles - five to seven days;
• Crusts in place of vesicles, the process ends by the 30th day of the disease.

The erythema stage is very short or absent, the pathogenesis begins with papular eruptions. If you do not carry out treatment, then the stage of the rash lasts about a month. A longer stage of the rash (up to two to four months) is evidence of the patient's immunodeficiency states. The intensity of the rash is different: from single to confluent forms of the rash. Sometimes the rash doesn't develop at all. This form is called "zoster sine herpete".

There is also shingles on the mucous membranes. Instead of a rash, shallow red erosion is formed.

In patients without a history of immunodeficiency, the rash is localized in one, rarely in several dermatomes. It has been noticed that a rash, localized, for example, in the left dermatome, rarely occurs in a similar right one, and vice versa. In immunodeficient conditions of the patient, localization of the rash in the dermatome and throughout the body is found - this is a generalized form of herpes zoster. With HIV infection in a patient, the localization of a rash that is scattered throughout the body is called a disseminated form of herpes zoster.

Herpes zoster pain

Pain can be:

• Only at the beginning of the disease;
• Throughout the illness (about a month);
• Long time after the disappearance of the symptoms of the disease.

Postzosteric pain is a pain syndrome lasting more than four months (120 days) from the onset of the disease.

Characterization of post-zoster pain

There are three types of unpleasant sensations described by patients with post-zoster pain syndrome:

• Constant, including burning, dull, deep, pressing;
• Spontaneous, including stabbing, twitching, shooting;
• Provoked (up to 90% of all patients are isolated) - appears from touching the body, when dressing, covering with a blanket.

In the acute period, the pain does not necessarily correspond to the intensity of the rash. It almost always increases at night under the influence of external stimuli, exposure to cold, heat, or touch. Tight underwear can also provoke pain. Phenomena of a paradoxical simultaneous combination of decreased and increased sensitivity of different parts of the body are often observed.

Herpes zoster is accompanied by inflammation of the nerve node - ganglionitis. One or more nodes may be involved in pathogenesis. Nerve damage can be complicated by a rapid loss of hearing or vision.

Variants of the development of pathogenesis in individual nerve nodes:

1. Lesion of the V-pair of facial nerves and the trigeminal nerve. Localization of the rash is on the head, in the hairy or hairless area corresponding to one of the three branches of the nerve. Inflammation is accompanied by excruciating pain in the area of the rash, hyperthermia, edema of the subcutaneous tissue of the affected side of the head. A detailed examination reveals points of increased pain along the trigeminal nerve.
2. Defeat of the VII pair of facial nerves, his geniculate node (Hunt syndrome). It manifests itself as rashes in the ear canal, on the mucous membrane of the tongue and palate. It is accompanied by dizziness, pain on the side of the head radiating to the face, neck or back of the head. It ends with complications in the form of facial muscle paralysis, one-sided hearing loss, tinnitus.
3. Damage to the cervical node. This node is formed by the branches of the four cervical spinal nerves C1-C4. The disease is manifested by rashes in the neck and chest. It is accompanied by burning pains, sometimes pains on palpation on one side in the head, face and neck. It ends with violations of the sensitivity of the skin, prolonged pains of body parts innervated by the roots of the node.
4. Lesion of the cervicothoracic stellate node. Causes chest pain that resembles an angina attack. It ends with complications in the form of dysfunctions of the innervated areas of the skin and internal organs. The skin may change pigmentation, impaired sweating, decreased tone.
5. The defeat of the nerve nodes of the coccygeal zone. It is manifested by rashes in the anus and severe pain. Possible complications: violation (delay) of urination, genital lesions.

Ophthalmic herpes

The defeat of the roots of the facial nerves that innervate the eye area is called ophthalmic herpes. The disease manifests itself as keratitis, lesions of the sclera, the iris of the eyes and the optic nerve in the form of its atrophy. Rashes, when involved in the pathogenesis of the optic nerve roots, are localized on one side of the head from eye level to the crown. In this case, the most dangerous are rashes on the wings and tip of the nose (Hutchinson's symptom). The combination of two herpes viruses, Varicella zoster virus and Herpes simplex, is the most common cause of facial nerve palsy (Bell's palsy).

The presence of blister rashes on the face is a reason to consult an ophthalmologist for advice and antiviral therapy, which reduces the likelihood of complications of herpes in the eyes by about 50%.

The variety of pathogenesis underlies the clinical classification of herpes zoster.

Classification by localization of the pathogenesis of herpes zoster

Mandatory participation in the pathogenesis of symptoms of damage to the nervous system and skin rashes underlies the classification of herpes zoster.

Herpes zoster can manifest itself:

• Meningitis, encephalitis, meningoencephalitis (inflammation of the brain and its membranes, their combinations);
• Lesions of other organs of the nervous system (ganglionitis);
• Eye lesions (inflammation of the conjunctiva, eyelids, iris, eyeball and cornea);
• Rashes scattered (disseminated) throughout the body;
• Complications spreading to other organs and systems;
• Latent flow without eruptions;
• Atypical symptoms.

Diagnosis and differential diagnosis of herpes zoster

Definition and differentiation of the disease is carried out on the basis of a clinical survey, external examination and palpation of damaged areas.

The following similar pathologies are excluded:

• Zosteriform lichen due to herpes simplex;
• Contact dermatitis and insect bites;
• Bullous pemphigoid.

Laboratory methods - PCR diagnostics, detection of a specific virus. A sample is taken from the vesicle.

Herpes zoster causes

It has been noticed that herpes zoster develops in people with impaired homeostasis due to aging of the body and / or damage to protective specific immunity. Other reasons for the development of pathology are known (see the beginning of the article).

Triggers remain unclear until the end - factors pushing the body on the path of development of the pathogenesis of herpes zoster. Many people who have all the prerequisites for the development of this disease (the presence of a latent virus, deep damage to the immune system) never get sick with herpes zoster.

The insidious mechanism of the development of the disease, the variety of symptoms and the relatively easy re-illness are factors that distract from the threat of serious consequences of OG for human health.

Consequences and complications of herpes zoster

Herpes zoster is rarely fatal. However, numerous cases of uncomfortable conditions of people have been noticed after a re-illness. It is possible to develop damage to the cortex and the substance of the brain, as well as the spinal cord, its membranes and roots.

After the completion of the pathogenesis, only 28% of patients declare that they have no complications.

Some patients complain about:

• Local pain within six months after recovery - 25%;
• The presence of painful reactions for more than six months - 16%;
• Headaches and dizziness - 3%;
• Movement disorders - 4.5%;
• Acquired hearing loss - 2.7%;
• Visual impairment - 1.8%.

Approximately 0.2% of patients develop cardiovascular failure, resulting in coronary artery disease and ischemic stroke, and sometimes the progression of cancer. Retinal necrosis with a 70-80% probability ends in the development of complete blindness.

Is herpes zoster contagious?

The first contact with the virus occurs during childhood, then the virus causes chickenpox. The disease proceeds according to a benign scenario. Repeatedly do not get sick with smallpox. Herpes zoster mainly develops after the reactivation of the herpes zoster virus.

The probability of transmission of Varicella Zoster virus from a sick person to a healthy person is quite high, but this does not matter much in the epidemic process, since herpes zoster is characterized by a sporadic course (isolated cases of the disease).

Meanwhile, adherence to normal protective measures is a prerequisite for communicating with a patient with herpes zoster.

Treatment for herpes zoster

Antiviral therapy includes a set of measures, including the use of antiviral, analgesic and anti-inflammatory drugs in the form of tablets and ointments. Immunocorrection, vitamin therapy and other methods are justified in cases agreed with the attending physician.

RELATED: List of Best Home Remedies for Herpes

The maximum effect of specific therapy can be expected if treatment is started no later than 72 hours after the detection of the first clinical signs of herpes zoster. Timely started therapy significantly increases the likelihood of a quick completion of the pathogenesis and easy recovery without complications.

I. The most effective specific antiviral drugs (for adults):

• Valacyclovir - tab. 1.0 g three times a day, seven days;
• Famciclovir - tab. 0.5 g three times a day, seven days.
• Acyclovir - tab. 0.8 g five times a day, seven to ten days;
• Zovirax - 2.0 gr. 7-10 days in a row per day.

There are contraindications and restrictions, for example, during pregnancy and lactation. The indicated dosage must be checked with the doctor. Antiviral drug prescribed for herpes zoster for children - Acyclovir in table. 0.02 g / kg, four or five times a day.

II. Drugs that relieve pain in the early stages of the disease:

• Aspirin, Paracetamol, Ibuprfen, Diclofenac;
• Alfentanil, Anileridin, Remifentanil, Sufentanil;

III. Antidepressants are prescribed for lingering forms of pain syndrome:

• Amitriptyline, Clomipramine, Imipramine, Trimipramine, Doxepin, Dotiepine;
• Maprotiline, Pirlindol, Mirtazapine, Mianserin;
• Fluoxetine, Citalopram, Escitalopram, Sertraline, Fluvoxamine;
• Venlafaxine, Duloxetine, Milnacipran.

IV. Corticosteroids:

• Diprosan;
• Prednisolone;
• Dexamethasone

V. Novocaine blockade. The combination of novocaine and corticosteroid in the form of sympathetic and epidural blockades is justified only in case of severe pain syndrome.

Vi. Treatment of ophthalmic herpes. At the heart of the same principles of treating herpes zoster, add local therapy with eye ointments, drops, liniment. Application is agreed with the doctor, depending on the localization of eye lesions.

Vii. The use of infrared and visible radiation spectrum reduces pain and reduces the duration of the period of rashes.

GlaxoSmithKline's varicella vaccine is registered in Russia, but there is no specific vaccine for herpes zoster.

Treatment with folk remedies

The use of medicinal pharmacopoeial herbs is justified in case of mild pathogenesis of herpes zoster.

Collection of medicinal plants to reduce nervous excitability

All of the following recipes for collecting plants (optional) are prepared as follows: insist one tablespoon of herbs in a glass of boiling water for 20-30 minutes, cool and use 1 / 2-1 / 3 cup 2-3 times a day to relieve mild pain and nervous excitability, as well as for insomnia.

• Mint leaf, watch leaf - 2 parts each, valerian root and 1 part hop cones.
• Valerian root, mint leaves - 3 parts each, watch leaves - 4 parts.
• Valerian root - 2 parts, chamomile root - 3 parts, caraway fruit - 5 parts.
• Fennel fruits and chamomile flowers - 1 part each, marshmallow root, licorice root, wheatgrass rhizome - 2 parts each (recommended for children).
• Valerian root, motherwort herb, straws of green oats - 1 part each.
• Valerian root, hawthorn flowers, mint leaves, mistletoe herb, motherwort herb - 1 part each.
• Mint leaves - 1 part, heather herb, lemon balm leaves - 2 parts each, valerian root - 4 parts.
• Tartar leaves, green oat straw, caraway fruits - 2 parts each, hawthorn flowers, chamomile flowers - 1 part each.
• Motherwort herb, cumin herb, heather herb - 2 parts each, hop cones, caraway seeds - 1 part each.
• Heather leaves, creeper grass, thyme herb, valerian root - 2 parts each, chicory root - 1 part.

Collection of medicinal plants recommended for skin diseases

All of the following fees are prepared as follows: pour a tablespoon of herbs with boiling water, boil for 10-15 minutes, insist and cool to room temperature.

• Horsetail grass, marigold flowers, rosehip flower petals, oak bark, blackberry leaves, succession grass - 1 part each. Outwardly in the form of lotions for washing and inflamed skin with rashes.
• Oak bark, calamus rhizome - 1 part each. Outwardly with weeping rashes to relieve inflammation.

The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).