Shingles (herpes zoster) most commonly comes about in older adults. The medical term for shingles is acute herpes zoster. Any person who has had the chickenpox infection or vaccine can get the herpes zoster virus that causes shingles. Roughly 20 percent of people who have had chickenpox will develop herpes zoster. Shingles or herpes zoster is a painful and sometimes debilitating viral disease that affects nearly one million Americans a year. The Herpes Zoster virus can stay in the body for a large number of years, frequently from the time of a childhood episode of the chickenpox. Patients with herpes zoster are infectious to those who lack immunity, but less so than patients with varicella. In contrast to herpes simplex I, the varicella-zoster virus (VZV) does not for the most part flare up more than once in adults with normally functioning immune systems. As people age, their immune system naturally weakens to some germs, such as herpes zoster. The virus usually lays dormant in nerve cells, but in certain people the virus reactivates years, or even decades, later and causes herpes zoster.
Like its close relative, HHV1, herpes zoster tends to infect skin cells and nerve cells. Reactivation of the latent virus in neurosensory ganglia produces the characteristic manifestations of herpes zoster, commonly known as shingles. Like other herpes viruses, the varicella-zoster virus has an initial infectious stage (chickenpox) followed by a dormant stage. In 1888, it was indicated by von Bokay that chickenpox and herpes zoster were due to the same causal agent, now known to be the VZV virus. Shingles (herpes zoster) is a viral infection of the nerve roots. Shingles is caused by a particular type of herpes virus, varicella zoster. Varicella zoster virus is a member of the herpesvirus family. VZV is an alphaherpesvirus that initiates two diseases, chickenpox and zoster (the reactivation of the virus that causes shingles).
There is no agreement on how acute herpes zoster (shingles) should be managed in general practice. Although anyone who has had chickenpox can subsequently have herpes zoster (shingles), it is much more typical in individuals older than 50 years. The virus causing herpes zoster (shingles) is already present from an earlier infection with chickenpox. Localized herpes zoster requires secretion precautions to guard against spreading of infection by direct contact with secretions from vesicles and from secretion-contaminated articles. In those with damaged immune systems, herpes zoster might be widespread (disseminated), causing serious illness.
Herpes Zoster Risk Factors
Immune-compromised persons, particularly those with human immunodeficiency virus (HIV) infection, have a significantly higher risk of developing herpes zoster ophthalmicus than the normal population. With more advanced immunodeficiency, herpes zoster tends to become generalized. The incidence of herpes zoster increases with age, and is associated with age-related typical waning in cell-mediated immunity. The incidence of herpes zoster in HIV-infected individuals is the same as age-matched HIV-negative persons. Approximately 10 percent to 15 percent of all patients with herpes zoster develop PHN, which, once established, can persist for many years. Up to 15 % of those who have had varicella disease will have herpes zoster at some point in their lives. If the person's immunity is intact, herpes zoster is mainly self-limited. Researchers noted a high incidence of herpes zoster in the wake of psychic trauma. Cancer places people at risk for herpes zoster. Chemotherapy also inflates the risk for herpes zoster.
Shingles and chickenpox are both caused by herpes zoster. The same virus that leads to chickenpox causes shingles (herpes zoster). Chicken pox is caused by the varicella zoster virus.
Antibiotic Treatment for Shingles
Acute pain responds to prompt treatment of herpes zoster, and immediate therapy lessens the duration of pain in PHN patients. Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster.
All patients with acute herpes zoster ophthalmicus should receive antiviral therapy with the intention of preventing ocular complications. Descyclovir, famcyclovir, valacyclovir, and pencyclovir are similar to acyclovir and may be used to treat herpes zoster. Tricyclic antidepressants help relieve several of the symptoms, including depression and pain, that affect herpes zoster sufferers with postherpetic neuralgia. Awareness of the complications associated with herpes zoster and recognition of the indications for antiviral treatment are essential. Doctors treat herpes zoster with antiviral medications to decrease the incidence and length of postherpetic neuralgia. Three antiviral drugs are available for the treatment of herpes zoster:
Famcyclovir or valacyclovir may be used to treat herpes zoster in older children who can swallow pills. Antibiotics prevent infection from other organisms that may get in your eyes while you have herpes zoster. Acyclovir halts progression of herpes zoster in immune compromised patients. Acyclovir is used to treat herpes infections of the skin, lip, and genitals, herpes zoster (shingles), and chickenpox. Valacyclovir and famciclovir are preferred over acyclovir in the treatment of herpes zoster because they have better pharmacokinetic properties and simpler timings for administration. Brivudin, a newer antiviral agent used in treating herpes zoster, is significantly better than standard acyclovir. Brivudin is also as effective as famcyclovir in alleviating acute signs and symptoms of herpes zoster.
- acyclovir (Zovirax)
- famcyclovir (Famvir)
- valacyclovir (Valtrex)
Many herpes zoster patients suffer from chronic pain associated with postherpetic neuralgia. Traditionally, doctors treat herpes zoster with antiviral medications to lessen the incidence and duration of postherpetic neuralgia. Postherpetic neuralgia (PHN) , the pain that sometimes lingers after a bout of shingles (herpes zoster), is the most typical and significant complication of herpes zoster.
In some cases a mild narcotic is needed to control the burning pain associated with herpes zoster. Aluminum acetate or soaks with burrow solution can be both soothing and cleansing in patients with herpes zoster. In contrast to their effect on herpes simplex infections, topical steroids do not exacerbate herpes zoster infections. A varicella-zoster virus vaccine reduced the burden of illness of herpes zoster in older adults. Zostavax is a vaccine intended for the prevention of herpes zoster (shingles) and herpes zoster related postherpetic neuralgia (PHN). The vaccine challenge reactivates cellular immunity to VZV, preventing or weakening occurrence of herpes zoster. The zoster vaccine markedly reduced mortality from herpes zoster and postherpetic neuralgia among older adults.
MRI findings in cases of herpes zoster myelitis are usually abnormal, but non-specific. The pain of Herpes Zoster can be quite intense as the nerve endings are affected. In contrast with the pain of trigeminal neuralgia, the pain of herpes zoster is enduring and sustained.
Shingles-Induced Eye and Ear Disease
If the eyes become involved (herpes zoster ophthalmicus), a significant infection can occur that is difficult to treat and can threaten vision. Ramsay Hunt syndrome (also called herpes zoster oticus) occurs when herpes zoster involves the nerves in the face and ears. Ramsay Hunt syndrome type I, also known as herpes zoster oticus, is a common complication of shingles. Ramsay Hunt syndrome occurs when herpes zoster causes facial paralysis and rash on the ear (herpes zoster oticus) or mouth. Because herpes zoster oticus is a rare disease with good prognosis for survival, there is little neuropathologic material available. Ten percent to 15% of cases of herpes zoster involve the ophthalmic branch of the trigeminal nerve. Antiviral therapy is mandatory for patients with herpes zoster ophthalmicus, mainly to prevent potentially sight-threatening ocular complications. Early diagnosis and care can help greatly in lessening serious complications from herpes zoster eye infections. Fortunately, blindness following herpes zoster is rare. A patient with herpes zoster on the face should see a physician immediately, because infection of the eye could lead to blindness. Without antivirals, 50%-70% of herpes zoster ophthalmicus cases develop ocular complications.
Studies are being undertaken to see if varicella vaccine can boost cellular immunity of older individuals so that herpes zoster can be prevented. The pain and discomfort of the active herpes zoster infection is the primary symptom and complication of herpes zoster. Additional potentially serious complications can result from herpes zoster. Encephalitis and pneumonia are rare complications of herpes zoster. Disseminated zoster is much more likely to occur in immune compromised individuals. As with disseminated chickenpox, disseminated herpes zoster, which migrates to other organs, can be serious to life-threatening, particularly if it affects the lungs. These patients can develop chronic herpes zoster, with formation of new lesions without the healing of the already existing ones. Inflammation of the membrane around the brain (meningitis) or in the brain itself (encephalitis) is a rare complication in people with herpes zoster. If it occurs as a consequence of herpes zoster, brain inflammation is likely to be mild except in immune compromised patients. Herpes zoster may recur, because the virus can stay in the nerve cells at the base of the spine for decades. Rarely, however, the pain of herpes zoster impacts sleep, mood, work, and overall quality of life.
Shingles lesions are usual at the onset but may turn into ulcers that do not heal. After a chickenpox infection, the virus remains dormant in sensory nerve cell bodies. The pain associated with herpes zoster is considered to be due to irritation of the sensory nerve fibers in which the virus reproduces.
People who have never had chickenpox can catch chickenpox if they have close contact with a person who has herpes zoster or shingles. By its very nature, herpes zoster infections are prone to return from time to time, especially when the immune system is compromised. Unlike herpes simplex I, the varicella-zoster virus does not for the most part flare up more than once in adults with normally functioning immune systems. People with herpes zoster are thought to be contagious to persons who have never had chickenpox. You experience herpes zoster or shingles from your own chickenpox virus, not from someone else. Having been approved, shingles vaccination will become the main strategy to prevent herpes zoster and postherpetic neuralgia. The incidence and severity of herpes zoster and PHN increase with advanced age. By providing Zostavax, the shingles vaccine for individuals over 60 years of age, it is hoped the incidence of shingles will significantly decrease in this population segment.