1、 Herpes Zoster1Definition 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.2Pathogen and Pathogenesis Pathogen Varicella-Zoster virus(VZV)is charact
2、erized by neurotropism and dermatotropism.3Pathogenesis 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,showing n
3、euralgia and clustered vesicles.4Clinical manifestationsProdrome:l headache and feverl hyperaesthesial pain in the affected area.5Features 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 band and quickly
4、 evolve to clear vesicles surrounded by erythema.6 The eruption may have few lesions or reach total confluence in the dermatome.Lesions may become hemorrhagic,necrotic,or bullous.7 The vesicles slowly become pustulars,and rupture to form crusts,which separate in two to four weeks,often with scarring
5、.The regional lymph nodes are enlarged and tender.8ComplicationsPostherpetic neuralgia(PHN)The pain persists after the skin lesions have healed,with the same quality as that of acute zoster pain.a month9Ophthalmic Zoster Ocular involvement is most commonly in the form of uveitis and keratitis.10Rams
6、ay 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 syndrome.The presenting features i
7、nclude:herpes auricularis,facial paralysis,and auditory symptoms.11 Incomplete herpes zoster There are may only neuralgia and papuloid lesions but with no blisters.12Disseminated Herpes Zosterl A generalized varicelliform eruption accompanying the segmental eruption.l It has been defined as more tha
8、n 20 lesions outside the affected dermatome.l It occurs chiefly in old or debilitated individuals,especially in patients with malignancy and AIDS.13Diagnosis and MisdiagnosisDiagnosis lTypical lesions:crops of clustered vesicles surrounded by erythema,forming in a discontinuous band,with enlarged re
9、gional lymph nodes.lThe distribution of a signal dorsal nerve root.l Obvious neuralgia14Misdiagnosis: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 pectoris15TreatmentlBed restlAntivir
10、ival therapy:acyclovir (ACV)0.2 5 times daily valacyclovir(VCV)1.0 3 times daily famciclovir(FCV)0.5 3 times daily for 7 days16lVitamin B:help to relief the inflammation of the involved nerve and relief the pain.TTFD 25mg tid VitB12 0.5mg im qdlAnalgesic:aspirin indomethacin 17lNerve blockslImprovin
11、g immune function:transfer factor(TF)lSystemic corticosteroid therapy:prednisone 10mg tidlPhysical therapy lTopical therapy:5%scl18In conclusion:v Definition Pathogenv Clinical manifestations Complicationsv Diagnosis and misdiagnosis Treatment19Definition Herpes zoster is caused by VZV,classically o
12、ccurs unilaterally within the distribution of a sensory nerve,with the features of clustered vesicles and neuralgia.20Pathogen Varicella-Zoster virus(VZV)is characterized by neurotropism and dermatotropism.21Clinical manifestationsProdromeTypical lesionsDistributionNeuralgia22 ComplicationsPostherpetic neuralgia(PHN)Ophthalmic ZosterDisseminated Herpes ZosterRamsay Hunt syndrome23Diagnosis and MisdiagnosisTreatmentl Bed restlAntivirival therapyl Vitamin Bl Analgesicl Nerve blocks24l Improving immune functionl Systemic corticosteroid therapy l Physical therapy l Topical therapy25 Thank you26
