As people get older, 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. Patients with herpes zoster are contagious 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 typically flare up more than once in adults with normally functioning immune systems. Shingles (herpes zoster) most commonly comes about in older adults. The medical term for shingles is acute 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. Any person who has had the chickenpox infection or vaccine can obtain the herpes zoster virus that causes shingles. Roughly 20 percent of people who have had chickenpox will develop herpes zoster.
Shingles-Induced Eye and Ear Disease
Early diagnosis and care can assist greatly in reducing serious complications from herpes zoster eye infections. Fortunately, blindness following herpes zoster is rare. 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 typical complication of shingles. Ramsay Hunt syndrome occurs when herpes zoster leads to 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, primarily to prevent potentially sight-threatening ocular complications. A patient with herpes zoster on the face should see a physician right away, because infection of the eye may lead to blindness. Without antivirals, 50%-70% of herpes zoster ophthalmicus cases develop ocular complications.
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 length of postherpetic neuralgia. Postherpetic neuralgia (PHN) , the pain that sometimes lingers after a bout of shingles (herpes zoster), is the most typical and substantial complication of herpes zoster.
Like its close relative, HHV1, herpes zoster likes 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. 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 causes two diseases, chickenpox and zoster (the reactivation of the virus that causes 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.
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 incidence 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 typically abnormal, but non-specific. The pain of Herpes Zoster can be quite severe as the nerve endings are affected. In contrast with the pain of trigeminal neuralgia, the pain of herpes zoster is steady and sustained.
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 begin treatment as soon as possible after a diagnosis of herpes zoster.
Awareness of the complications associated with herpes zoster and recognition of the indications for antiviral treatment are important. Doctors treat herpes zoster with antiviral medications to decrease the occurrence 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 stops 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. All patients with acute herpes zoster ophthalmicus should receive antiviral therapy with the goal 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 influence herpes zoster sufferers with postherpetic neuralgia.
- acyclovir (Zovirax)
- famcyclovir (Famvir)
- valacyclovir (Valtrex)
Shingles lesions are typical 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 characteristic with herpes zoster is understood to be due to irritation of the sensory nerve fibers in which the virus reproduces.
Herpes Zoster Risk Factors
Researchers noted a high incidence of herpes zoster after psychic trauma. Cancer places people at risk for herpes zoster. Chemotherapy increases the risk for herpes zoster. 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 usually self-limited. The occurrence of herpes zoster goes up with age, and is associated with age-related natural 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. Immune compromised persons, particularly those with human immunodeficiency virus (HIV) infection, have a much higher risk of developing herpes zoster ophthalmicus than the normal population. With more advanced immunodeficiency, herpes zoster tends to become generalized.
Although anyone who has had chickenpox can subsequently have herpes zoster (shingles), it is much more common in individuals older than 50 years. The virus causing herpes zoster (shingles) is already present from an earlier infection with chickenpox. There is no consensus on how acute herpes zoster (shingles) should be managed in general practice. Localized herpes zoster requires secretion precautions to guard against disseminating 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.
Shingles and chickenpox are caused by herpes zoster. The same virus that leads to chickenpox causes shingles (herpes zoster). Chicken pox is caused by the varicella zoster virus.
The pain and discomfort of the active herpes zoster infection is the primary symptom and complication of herpes zoster. Further potentially serious complications can result from herpes zoster. Encephalitis and pneumonia are rare complications of herpes zoster. Studies are being undertaken to see if varicella vaccine can boost cellular immunity of older individuals so that herpes zoster can be prevented. Disseminated zoster is a great deal 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, especially 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 result of herpes zoster, brain inflammation tends 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.
The incidence and severity of herpes zoster and PHN increase with advanced age. The virus that causes shingles (herpes zoster) can be passed on to others, but they will develop chickenpox, not shingles. Unlike herpes simplex I, the varicella-zoster virus does not typically 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. Once approved, vaccination will become the primary strategy to prevent herpes zoster and post-herpetic neuralgia. 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 weakened.