Acute herpes zoster: Difference between revisions
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[[File:Zoster.jpeg|thumbnail|Herpes Zoster]] | [[File:Zoster.jpeg|thumbnail|Herpes Zoster]] | ||
== | == Differential Diagnosis == | ||
*[[Smallpox]] | |||
*[[Cellulitis]] | |||
*Contact Dermatitis | |||
*[[Measles]] | |||
== Diagnosis== | |||
*Further evaluation if disseminated VZV | *Further evaluation if disseminated VZV | ||
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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 | ||
== Treatment == | == Treatment == | ||
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*[[Herpes Viruses]] | *[[Herpes Viruses]] | ||
== | == References == | ||
<references/> | <references/> | ||
*Images provided by University of Iowa Dept. of Dermatology | *Images provided by University of Iowa Dept. of Dermatology | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 19:47, 26 May 2015
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 (see below) progresses to vesicles, may coalesce to bullae, in dermatomal distribution lasting 10-15 days
- Does not cross midline
- Typically affects chest/face
- Herpes Zoster Ophthalmicus
- Herpes Zoster Oticus (Ramsay Hunt Syndrome)
Differential Diagnosis
- Smallpox
- Cellulitis
- Contact Dermatitis
- Measles
Diagnosis
- 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
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[1]
- 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
References
- ↑ Cohen, J. Herpes Zoster. N Engl J Med 2013; 369:255-263. DOI: 10.1056/NEJMcp1302674
- Images provided by University of Iowa Dept. of Dermatology