1、 Herpes ZosterDefinition Herpes zoster is caused by Varicella - Zoster virus (VZV) , classically occurs unilaterally within the distribution of a sensory nerve, being characterized by clustered vesicles and considerable neuralgia.Pathogen and Pathogenesis Pathogen Varicella-Zoster virus (VZV) is cha
2、racterized by neurotropism and dermatotropism. Pathogenesis VZV causes varicella in childhood , and establishes latency in sensory ganglia after the primary infection. VZV may replicate later in life, taking advantage of the decline in immune function, traveling down the sensory nerve into the skin
3、, showing neuralgia and clustered vesicles. Clinical manifestationsProdrome: l headache and feverl hyperaesthesial pain in the affected area. Features of lesions The eruption presents as papules and erythema in the dermatome. Over a few days, crops of clustered red papules form in a discontinuous ba
4、nd and quickly evolve to clear vesicles surrounded by erythema. The eruption may have few lesions or reach total confluence in the dermatome. Lesions may become hemorrhagic, necrotic, or bullous. The vesicles slowly become pustulars, and rupture to form crusts , which separate in two to four weeks,
5、often with scarring. The regional lymph nodes are enlarged and tender.ComplicationsPostherpetic neuralgia(PHN) The pain persists after the skin lesions have healed, with the same quality as that of acute zoster pain. a monthOphthalmic Zoster Ocular involvement is most commonly in the form of uveitis
6、 and keratitis. Ramsay Hunt syndrome l Results from involvement of the facial and auditory nerves by the VZV. l The presenting features include : herpes auricularis, facial paralysis, and auditory symptoms. VZV. Herpetic inflammation of the geniculate ganglion is felt to be the cause of this syndrom
7、e. The presenting features include : herpes auricularis, facial paralysis, and auditory symptoms. Incomplete herpes zoster There are may only neuralgia and papuloid lesions but with no blisters. Disseminated Herpes Zosterl A generalized varicelliform eruption accompanying the segmental eruption.l It
8、 has been defined as more than 20 lesions outside the affected dermatome.l It occurs chiefly in old or debilitated individuals, especially in patients with malignancy and AIDS.Diagnosis and MisdiagnosisDiagnosis lTypical lesions: crops of clustered vesicles surrounded by erythema, forming in a disco
9、ntinuous band, with enlarged regional lymph nodes.lThe distribution of a signal dorsal nerve root.l Obvious neuralgiaMisdiagnosis: Pain ususlly precedes the eruption by 3 or 4 days, sometimes it may be misdiagnosed to other diseases, depending on different part. Appendicitis Cholecystitis Angina pec
10、torisTreatmentlBed restlAntivirival therapy: acyclovir (ACV) 0.2 5 times daily valacyclovir(VCV) 1.0 3 times daily famciclovir (FCV) 0.5 3 times daily for 7 dayslVitamin B: help to relief the inflammation of the involved nerve and relief the pain. TTFD 25mg tid VitB12 0.5mg im qdlAnalgesic: aspirin
11、indomethacin lNerve blockslImproving immune function: transfer factor (TF)lSystemic corticosteroid therapy: prednisone 10mg tidlPhysical therapy lTopical therapy: 5% sclIn conclusion:v Definition Pathogenv Clinical manifestations Complicationsv Diagnosis and misdiagnosis TreatmentDefinition Herpes z
12、oster is caused by VZV, classically occurs unilaterally within the distribution of a sensory nerve, with the features of clustered vesicles and neuralgia.Pathogen Varicella-Zoster virus (VZV) is characterized by neurotropism and dermatotropism. Clinical manifestationsProdromeTypical lesionsDistribut
13、ionNeuralgia ComplicationsPostherpetic neuralgia(PHN)Ophthalmic ZosterDisseminated Herpes ZosterRamsay Hunt syndromeDiagnosis and MisdiagnosisTreatmentl Bed restlAntivirival therapyl Vitamin Bl Analgesicl Nerve blocksl Improving immune functionl Systemic corticosteroid therapy l Physical therapy l Topical therapy Thank you
