Herpes zoster is considered to be a viral disease that is characterized by herpetiform unilateral lesions in the form of rashes on the skin. Herpes zoster is characterized by intense pain syndrome. The causative agent of the disease is Zoster or varicella-zoster virus, which belongs to the family of herpesviruses. As a rule, the first meeting with the virus occurs in childhood, flowing in the form of chickenpox (chickenpox), after which the virus becomes latent (dormant).
Herpes zoster is known since ancient times, but at that time it was considered as a separate disease. Chickenpox for a long time was considered as smallpox. Although the symptomatic differences of these two diseases were described in the middle of the XVIII century. Basic differential diagnosis became available only at the end of the XIX century. The nature of chickenpox, as infectious, was proven in 1875 in studies on a voluntary group of people. Prerequisites for the opinion of the association of chicken pox with herpes zoster were proposed in 1888, when the appearance of chicken pox in children was noticed after contact with herpes zoster carriers in a clinical form.
But these conclusions received their final confirmation only in the late 1950s, when the same pathogen was isolated from patients who had both clinical forms of these two infectious diseases. However, data on epidemiology turned out to be the most affirmative: the incidence of chickenpox in the foci of herpes zoster was much higher than in the general population. In 1974, a weakened strain of the herpes virus Zoster was obtained in Japan, and in the beginning of 1980, clinical trials of vaccination against chickenpox began in the United States.
Children who have had chickenpox are still carriers of this virus. It is located in the ganglia of the spinal cord, in the cells of the neuroglia, and usually does not cause any special manifestations during normal immunity. After a certain number of years after the initial defeat by the virus of the body, its activation begins to occur with the virus passing from the nerve cells along their axons. After the virus reaches the end of the nerve cell, it causes the manifestation of an acute form on the skin, guided by the signals of the autonomic nervous system.
Herpes zoster is manifested as a rash on the skin that is accompanied by, sometimes, severe pain and severe itching. It should be noted that the difference between herpes zoster and herpes simplex (on the lips) lies in the pain syndrome and extensive lesions.
Shingles herpes causes
Herpes zoster is manifested several times more often against the background of low immunity. During the period of clinical manifestations, the virus has spread throughout the body and it can be determined in the contents of the rash, tear fluid and saliva.
After the penetration of the virus into the nervous system, its localization is observed mainly in the region of the peripheral neuron of the spinal ganglion and begins to spread throughout the nervous system. Partial denervation may also be present. In the posterior spinal ganglion, inflammation begins, involving hemorrhagic necrosis. During herpes zoster, not only peripheral nerves, the brain and spinal ganglia, but also the meninges with the brain substance are involved in the inflammatory process.
The process of how the herpes zoster virus goes into a latent state and how it is then activated is not particularly studied until now.
Herpes zoster has nothing to do with herpes simplex type 1.2 and is therefore caused by a completely different type of virus (Zoster virus), but all types of herpes virus belong to the same group – the group of herpes viruses.
The number of patients with herpes zoster virus today accounts for about 3 per 10,000 people in old age and about 15% of patients with immunodeficiency.
Herpes zoster has a tendency to relapse. At the same time, the virus retains the property of damaging both the nerve cells and the skin epithelium of the patient through the mucous membranes and the skin, further following the blood flow and lymph flow into the intervertebral tissues and ganglia of the spinal cord, where it is subsequently in a latent state.
Activation of herpes zoster occurs with a sharp decrease in immunity, as well as when taking medications to suppress the immune system (for cancer).
Oncological diseases in the form of: tumors of malignant genesis, metastasis, lymphogranulomatosis and
Transplantation of internal organs, viral ganglioneuritis, carriage of HIV infection, passing into the AIDS stage, contribute to the protracted clinical manifestation of herpes zoster. In general, for herpes infections, herpes zoster can be considered as one of its symptoms. That is, a patient who has at least once a year or more relapses of herpes zoster recurs, should first be tested for HIV status.
Cranial and intervertebral nerve ganglia are usually susceptible to viral lesions in herpes zoster. The DNA of the virus itself is able to penetrate inside the cell. And in certain cases it can lead to the development of meningoencephalitis and affect the mucous membrane of the internal organs.
But I want to note the fact that healthy people practically do not get herpes zoster. As for children, they also rarely suffer from this disease. About 5% of children with herpes zoster have cancer or HIV infection. Sometimes herpes zoster in children occurs already in infancy, and even in the neonatal period. As a rule, this is due to the fact that the woman has herpes zoster worsened during pregnancy, or she has had chickenpox.
According to the results of research conducted by American scientists, it turned out that children who received a vaccine against chicken pox at a younger age are almost not at risk of having herpes zoster. What can be said about children who just had chickenpox.
But, despite the fact that herpes zoster during pregnancy does not affect the developing fetus, this infection can pose a dangerous threat to the course of pregnancy and the subsequent state of the child in the perinatal period.
The herpes zoster virus infects one of the 3,500 children in the perinatal period.
Herpes zoster in children in the neonatal period is a consequence of the herpes suffered by their mothers during pregnancy, especially in the third trimester. Transmission of herpes zoster by hematogenous route (placental-uterine) or during childbirth can occur (if herpes affects the mucous membranes of the genital tract). Also, during breastfeeding, the virus is transmitted.
Signs of the development of herpes zoster in newborns can be detected a week after the transmission of the virus. When herpes zoster in children of the perinatal period, there is a rash of blisters on the skin and mucous membranes. Very often, the virus affects the conjunctiva of the eye, without causing a rash on the skin and mucous membranes, but persisting in the child’s body. The course of the disease for the baby is quite difficult and lasts about 10 days.
If a child is born premature, then a viral infection in the form of herpes zoster will occur much more difficult, affecting the brain (herpes encephalitis). The prognosis of herpes zoster in premature infants is unfavorable. About 70% of preterm are fatal.
But the treatment of herpes zoster in newborns with antiviral drugs reduces perinatal mortality by half. Treatment when a virus is detected in a newborn is prescribed immediately.
Treatment of herpes zoster in newborns with antiviral drugs reduces infant mortality by almost 50%.
Herpes infections are considered the most common infectious diseases in pregnant women, which can complicate the course of pregnancy. But herpes zoster during pregnancy is not so often, unlike herpes simplex.
The number of pregnant women who are carriers of the herpes simplex virus is growing rapidly (about 30% of all pregnant women). With them, the incidence of herpes zoster during pregnancy is increasing. In the case of primary infection with this type of herpes, the fetus may be damaged in the form of various deformities, chromosomal abnormalities, or fetal death.
During pregnancy, herpes zoster can lead to the development of 1,2 types of non-persistent herpes, or combined with them at the same time. That for a pregnant woman will bring the strongest pain and unbearable itching, with accompanying fever and general malaise.
Pregnancy itself is the cause of immunodeficiency. Under other conditions, that is, with increased immunity, pregnancy would be impossible. Nature designed a physiological decrease in immunity throughout pregnancy for successful gestation. Herpes zoster wakes up due to reduced immunity, and then, not in the first stages of its decline, but in chronic immunodeficiency, which can be observed during pregnancy.
As is clear from the foregoing, immunodeficiency, which can occur in various diseases and conditions at any age, can be a cause for the development or destruction of herpes zoster.
herpes zoster photo on the back
Herpes zoster symptoms
Symptoms of herpes zoster begins with common prodromal symptoms: dyspepsia, headache, a slight increase in body temperature, severe chills and general malaise. Later, itching and pain along nerve peripheral fibers can join. Characterized are itching and burning of the skin on the site of future bubbles. Such signs are recognized as very subjective, and the intensity of herpes manifestations may be different for each patient. The duration of the initial period does not exceed 5 days, but in children this period is even shorter than in adult patients.
After a short period of the prodromal phase, a significant rise in body temperature up to subfebrile numbers can be observed, with the addition of symptoms of intoxication of the body (muscle and headaches, anorexia). Along with this, along the course of several spinal ganglia, skin rashes may appear in the form of pink spots with severe pain, which, as a rule, do not merge and are 5 mm in diameter.
After a few hours, tightly grouped vesicles with serous color content begin to appear on the background of exanthems. The edges of these vesicles are usually uneven, and their base is hyperemic and edematous. Depending on the state of immunity and the degree of severity of herpes zoster, pain and an increase in regional (local) lymph nodes may join. Children can have pharyngitis, rhinitis and laryngitis, which greatly complicates the course of the disease.
Exanthemas are defined in the area of the projection of the nerve trunk. Often, unilateral damage to the nerve ganglion occurs, which is projected along the nerves of the intercostal, facial trigeminal nerve. There are cases when the nerve trunks of the extremities are involved in the lesion process with the subsequent development of neuritis. Fortunately, such cases are very rare. More often have exanthema in the groin.
With herpes zoster, it is possible to simultaneously identify a rash at various stages, ranging from redness and ending with areas of hyperpigmentation after vesicle healing. About a week later, the hyperemia of the skin around the vesicles subsides, and with it the puffiness, the fluid inside the vesicles becomes cloudy, they begin to dry up and crusts form at the site of their localization, after passing through which, slight skin pigmentation may occur. As a result, after 2-3 weeks from the onset of the disease, recovery occurs.
However, herpes zoster may also have a generalized form of manifestation.
Sometimes the form of generalized rash with herpes zoster is compared with the associated chickenpox, because the localization of the rash is noted not only along the nerve ganglia, but also on other skin areas and mucous membranes. If there is a generalized herpes zoster or its clinical manifestations last more than 21 days, it is necessary to examine the patient to determine the nature of immunodeficiency and the presence of cancer.
Herpes zoster may also have an abortive form, characterized by erythematous rashes along the nerve ganglia, which soon disappear after the appearance of vesicles. In this case, the general condition of the patient does not particularly suffer.
The bullous form of herpes zoster is characterized by large vesicles merging into large vesicles with serous contents. If the blood vessels are damaged, the contents of the serous, is converted into hemorrhagic, and in the event of a secondary infection – into purulent. In severe cases, these blisters can merge into solid tapes, which, upon drying out, can also cause secondary infection with the formation of a dark necrotic scab. The degree of severity of this form of herpes zoster depends on the location of exanthema. For example, with the defeat of the facial nerves join neuralgic acute pain, damage to the cornea of the eyes and eyelids.
The duration of herpes zoster in acute form is 2-3 weeks; with abortive form about a week; and in the case of a complicated form or course of a protracted nature – more than a month. Herpes zoster pains are burning, paroxysmal in nature, with greater intensity at night. Impaired skin sensitivity and local paresthesias are the most recognized symptoms of herpes zoster.
There are cases of damage to the oculomotor nerves, sphincter of the bladder and abdominal muscles. If serous meningitis begins to develop, then the changes in the study of cerebrospinal fluid sometimes do not correspond to the severity of symptoms in meningitis. In the acute form of herpes zoster the development of encephalitis and meningoencephalitis is possible.
When the ophthalmic form of herpes zoster can occur such disorders as damage to the ocular branch of the trigeminal nerve. With a symptom of Ramsey-Hunt, facial unilateral peripheral paralysis occurs with damage to the facial muscles and eruptions in the ear canal or on the mucous membranes of the oral cavity and throat. Also marked by intense pain in the external auditory canal, dizziness, and subsequently, complete or partial deafness.
In case of motor herpes zoster, a slight muscular weakness may be observed, myotoma damage together with dermatomes that are affected by a herpetic rash. Herpes zoster may have varying intensity of clinical manifestations, especially in people with weakened immune systems. Such patients may develop encephalitis, spinal cord damage. Arteries may be affected, causing hemiplegia.
Neuralgic pains with herpes zoster sometimes last up to six months. Rarely herpes zoster passes quickly and painlessly, although there are such cases, which is due to a good level of immunity.
Herpes zoster can cause complications in the form of: transverse myelitis, which eventually goes into motor paralysis. Herpes zoster in HIV-infected people, combining other immunodeficiency states, is much more difficult. The duration of the latent period before the appearance of rashes is about a week. Patients with lymphoma or lymphogranulomatosis are at high risk of developing herpes zoster. About 50% of them have herpes sores, which are spread over the entire surface of the body. 10% have the possibility of developing pneumonia viral, hepatitis and meningoencephalitis with other serious complications.
With herpes zoster, typical forms are distinguished: abortive, in which there are only rashes with blisters and pain syndrome is absent; blistering, in which rashes can appear as large blisters; hemorrhagic, in which the bubbles are filled with blood; gangrenous, in which there is a slight tissue necrosis, with the subsequent formation of scars for the rest of his life.
herpes zoster child photo
Herpes zoster in children, usually proceeds with the same symptoms as in adults. Young children fairly well tolerate herpes zoster without rash, but with pain and redness in some areas of the skin. Schoolchildren with herpes zoster affects in more serious forms, affecting the skin in the ear, which can lead to paralysis of the facial nerve.
The child ceases to be infectious and may return to classes at a time when all the rashes are covered with crusts, but for additional protection for others, the affected areas should be covered with a bandage.
In the diagnosis of herpes zoster, it is important to consider some of the nuances. Many under-qualified specialists confuse herpes zoster with renal colic, angina, and other similar diseases. Because, at the onset of the disease, herpes zoster is manifested by fever and sharp pains, while having minor affected areas with rashes.
For proper diagnosis, use: microscopy for the detection of herpes zoster virus, immunofluorescence method, cultural method, PCR diagnostics and serological method.
Herpes zoster treatment
A large number of cases of herpes zoster can result in spontaneous cure even in the absence of therapy. However, high-quality treatment of herpes zoster exists and can significantly alleviate the manifestations of the disease, as well as prevent the development of complications.
The objectives of therapy for this disease are: acceleration of recovery, prevention of complications, reduction of pain, reduction of the likelihood of postherpetic neuralgia.
Drug therapy is necessary for patients with a high risk of complications or a protracted course of the disease. These are persons with immunodeficiency states, elderly patients. The benefits of antiviral treatment in young and healthy patients have not been proven.
Cases of uncomplicated nature are treated on an outpatient basis. Hospitalization in a hospital is shown to those patients who have a suspicion of a disseminated process, with damage to the brain and eyes.
Famciclovir, Acyclovir, Valaciclovir are commonly used to treat herpes zoster. Valacyclovir appears to be the metabolic founder of Acyclovir and is transformed into it by the action of the production of enzymes by the liver. Acyclovir molecules have the unique ability to integrate into the DNA of a virus. Thus, its replication and reproduction of infected particles is stopped. Famciclovir enters the body in Penciclovir and acts in a similar way.
The safety and efficacy of using these drugs has been proven by numerous experiments in the treatment of herpes zoster. When starting therapy for three days from the first manifestations of rash, they can help reduce the severity of pain, reduce the duration of the disease and the likelihood of postherpetic neuralgia.
Famciclovir and Valaciclovir are used in a more convenient regimen than Acyclovir, but they are not well understood and cost more expensive. It is necessary to start using Acyclovir in the first 72 hours.
Pain relief from herpes zoster is one of the important points in treatment. High-quality pain relief makes it possible for the patient to breathe normally, move and helps reduce psychological discomfort. In the United States of America, narcotic analgesics, for example, Oxycodone, are prescribed for anesthesia.
The following non-narcotic analgesics can be used: Dexketoprofen, Naproxen, Ibuprofen, Ketorolac, Ketoprofen. These drugs are non-steroidal anti-inflammatory. For herpetic neuralgia, capsaicin-based drugs are very effective.
Anticonvulsant drugs are usually used for epilepsy, but they also have a certain ability to reduce neuropathic pain. For herpes zoster, Gabapentin and Pregabalin are used.
There is a positive trend in the use of antidepressants in the treatment of postherpetic neuralgia.
Corticosteroid medications reduce itching and inflammation. A number of studies have proven their ability in conjunction with the use of antiviral agents to reduce the clinical manifestations in the lungs and in moderately severe forms of the disease.
With herpes zoster, you can take a shower, but in no case a bath, as rashes can not be steamed. When skin itching, you can use compresses with Calamine. It is better to strip the area affected by rashes,
In the treatment of herpes zoster in children, especially newborns, it is important to take into account the perinatal age at which the appointment of certain drugs is strictly prohibited. The same goes for herpes zoster during pregnancy.
In the presence of symptoms and symptoms of herpes zoster in newborns, therapy is carried out immediately with the drug Acyclovir 50 mg / kg per day for 3 weeks. Conjunctivitis associated with herpes in children can be treated with Idoxuridine ointment.
During pregnancy, it is important to monitor the state of immunity and prevent its decline. Important is the reception of multivitamins, walks in the fresh air, the absolute rejection of bad habits. It is important for future mothers to remember that from the very beginning of pregnancy their immunity is greatly reduced for the physiological continuation of pregnancy, because under other conditions its continuation is impossible. Because it is important to protect themselves from a large number of crowds of people, especially in seasonal times of epidemics.
Also prophylactic treatment for patients with herpes zoster is considered prophylactic hardening, the use of physiotherapy and herbal medicine to maintain immunity. Quitting smoking and drinking alcohol will greatly help them in this.
It is worth remembering that herpes zoster is an incurable disease, but with good living conditions you can achieve a stable remission period and so on until the end of the patient’s life.