Acute herpes zoster: Difference between revisions
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== Background == | == Background == | ||
*Caused by Varicella Zoster Virus (VZV) causing varicella (chicken pox) and later zoster (shingles) | *Caused by Varicella Zoster Virus (VZV) causing varicella (chicken pox) and later zoster (shingles) | ||
*Virus is dormant in dorsal root ganglion and reactivates causing characteristic rash in dermatomal distribution | *Virus is dormant in dorsal root ganglion and reactivates causing characteristic rash in dermatomal distribution | ||
*Occurs once immunity to virus declines (elderly, | *Occurs once immunity to virus declines (elderly, immunosuppressed, post transplant, HIV) | ||
== Clinical Features == | == Clinical Features == | ||
*Prodrome: Headache, malaise, photophobia | *Prodrome: Headache, malaise, photophobia | ||
*Antecedent pruritis, paresthesia, pain to dermatome 2-3 days prior to rash | *Antecedent pruritis, paresthesia, pain to dermatome 2-3 days prior to rash | ||
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*Herpes Zoster Opthalmicus- See [[Herpes Zoster Ophthalmicus]] | *Herpes Zoster Opthalmicus- See [[Herpes Zoster Ophthalmicus]] | ||
*Herpes Zoster Oticus (Ramsay Hunt Syndrome) | *Herpes Zoster Oticus (Ramsay Hunt Syndrome) | ||
== Work-Up == | == Work-Up == | ||
*Further evaluation if disseminated VZV | |||
Further evaluation if disseminated VZV | |||
*Immunocompromised | *Immunocompromised | ||
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*Atypical illness/severe disease | *Atypical illness/severe disease | ||
**Viral Culture, antigen, PCR of vesicle fluid | **Viral Culture, antigen, PCR of vesicle fluid | ||
== DDx == | == DDx == | ||
*Smallpox | *Smallpox | ||
*Cellulitis | *Cellulitis | ||
*Contact Dermatitis | *Contact Dermatitis | ||
*Measles | *Measles | ||
== Treatment == | == Treatment == | ||
*Pain | |||
*PO narcotics | **PO narcotics | ||
* | *Antiviral | ||
**Reduces risk/duration of postherpetic neuralgia | |||
**Immunocompetent patients: | **Immunocompetent patients: | ||
***Give | ***Give acyclovir if <72hr of onset of rash or >72hr if new vesicles present/developing | ||
***Acyclovir 800mg PO 5x/day x | ***Acyclovir 800mg PO 5x/day x 7d | ||
** | **Immunosuppressed patients: | ||
***Give | ***Give antiviral therapy at any stage of onset of rash | ||
***Acyclovir 10 mg/kg IV q8h x | ***Acyclovir 10 mg/kg IV q8h OR 800mg PO 5x/day x 7d or foscarnet for acyclovir-resistant VZV, disseminated zoster, CNS involvement, ophthalmic involvement, advanced AIDS, recent transplant | ||
* | *Steroids not shown to be beneficial | ||
== Disposition == | == Disposition == | ||
*Admit for disseminated VZ, CNS involvement, severely immunosupressed | |||
==Complications== | |||
*Postherpetic neuralgia (risk increases with age), cellulitis, impetigo, necrotizing fasciitis | |||
==Prevention == | |||
*Pt is contagious until lesions are crusted over | |||
*Consider varicella-zoster immunoglobulin to immunosupressed, pregnant, neonate contacts | |||
*Zoster vaccination if >60 | |||
== Prevention | |||
*Pt | |||
*Consider varicella-zoster immunoglobulin to immunosupressed, pregnant, neonate contacts | |||
*Zoster vaccination if | |||
== See Also == | == See Also == | ||
*[[Herpes Zoster Ophthalmicus]] | |||
[[Herpes Zoster Ophthalmicus]] | |||
== Source == | == Source == | ||
*Tintinalli, Rosen's, eMedicine, Epocrates | |||
Tintinalli, Rosen's, eMedicine, Epocrates | |||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 12:18, 9 September 2012
Background
- Caused by Varicella Zoster Virus (VZV) causing varicella (chicken pox) and later zoster (shingles)
- Virus is dormant in dorsal root ganglion and reactivates causing characteristic rash in dermatomal distribution
- Occurs once immunity to virus declines (elderly, immunosuppressed, post transplant, HIV)
Clinical Features
- Prodrome: Headache, malaise, photophobia
- Antecedent pruritis, paresthesia, pain to dermatome 2-3 days prior to rash
- Maculopapular rash progresses to vesicles (and can coalesce to bullae) in dermatomal distribution lasting 10-15 days
- Does not cross midline
- Typically affects chest/face
- Herpes Zoster Opthalmicus- See Herpes Zoster Ophthalmicus
- Herpes Zoster Oticus (Ramsay Hunt Syndrome)
Work-Up
- Further evaluation if disseminated VZV
- Immunocompromised
- If more than 3 or more dermatomes affected
- If young, previously healthy adult-may be initial presentation with HIV
- Further evaluation for pneumonitis, hepatitis, encephalitis as clinically indicated
- Atypical illness/severe disease
- Viral Culture, antigen, PCR of vesicle fluid
DDx
- Smallpox
- Cellulitis
- Contact Dermatitis
- Measles
Treatment
- Pain
- PO narcotics
- Antiviral
- Reduces risk/duration of postherpetic neuralgia
- Immunocompetent patients:
- Give acyclovir if <72hr of onset of rash or >72hr if new vesicles present/developing
- Acyclovir 800mg PO 5x/day x 7d
- Immunosuppressed patients:
- Give antiviral therapy at any stage of onset of rash
- Acyclovir 10 mg/kg IV q8h OR 800mg PO 5x/day x 7d or foscarnet for acyclovir-resistant VZV, disseminated zoster, CNS involvement, ophthalmic involvement, advanced AIDS, recent transplant
- Steroids not shown to be beneficial
Disposition
- Admit for disseminated VZ, CNS involvement, severely immunosupressed
Complications
- Postherpetic neuralgia (risk increases with age), cellulitis, impetigo, necrotizing fasciitis
Prevention
- Pt is contagious until lesions are crusted over
- Consider varicella-zoster immunoglobulin to immunosupressed, pregnant, neonate contacts
- Zoster vaccination if >60
See Also
Source
- Tintinalli, Rosen's, eMedicine, Epocrates