1、Pathogen and Pathogenesis Pathogen Varicella-Zoster virus(VZV)is characterized 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 i
2、mmune function,traveling down the sensory nerve into the skin,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,cr
3、ops of clustered red papules form in a discontinuous band 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 fo
4、rm crusts,which separate in two to four weeks,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 monthand papuloid lesions but withOcula
5、r involvement is mostThe eruption may have fewVZV,classically occurs unilaterallyDefinitionlesions or reach total confluenceVZV causes varicella in childhood,andComplicationsseparate in two to four weeks,oftenpain in the affected area.Antivirival therapy:and papuloid lesions but withOphthalmic Zoste
6、rIn conclusion:the skin,showing neuralgia andhyperaesthesiacharacterized by neurotropism andAntivirival therapyThe pain persists after the skinFeatures of lesionsOphthalmic Zoster Ocular involvement is most commonly in the form of uveitis and keratitis.Ramsay Hunt syndrome l Results from involvement
7、 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 include:herpes auricularis,facial paralysis,
8、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 has been defined as more than 20 lesions outside the affected dermatome.l It
9、 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 discontinuous band,with enlarged regional lymph nodes.lThe distribution of a signal d
10、orsal 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 pectorisTreatmentlBed restlAntivirival therapy:acyclovir (ACV)0.2 5 times daily valacycl
11、ovir(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 indomethacin lNerve blockslImproving immune function:transfer factor(TF)lSystemic corticoster
12、oid therapy:prednisone 10mg tidlPhysical therapy lTopical therapy:5%sclIn conclusion:v Definition Pathogenv Clinical manifestations Complicationsv Diagnosis and misdiagnosis TreatmentDefinition Herpes zoster is caused by VZV,classically occurs unilaterally within the distribution of a sensory nerve,
13、with the features of clustered vesicles and monly in the form of uveitisImproving immune functionComplicationsdermatotropism.and papuloid lesions but withOphthalmic Zostervalacyclovir(VCV)1.The pain persists after the skindermatotropism.Physical therapyclustered vesicles and neuralgia.The eruption m
14、ay have fewpain in the affected area.Ramsay Hunt syndromeLesions may becomeImproving immune function:quality as that of acute zoster pain.The presenting features include:herpes auricularis,facial paralysis,and auditory symptoms.The vesicles slowly become pustulars,replicate later in life,taking adva
15、ntageby erythema,forming in a discontinuousPathogen Varicella-Zoster virus(VZV)is characterized by neurotropism and dermatotropism.Clinical manifestationsProdromeTypical lesionsDistributionNeuralgia ComplicationsPostherpetic neuralgia(PHN)Ophthalmic ZosterDisseminated Herpes ZosterRamsay Hunt syndro
16、meDiagnosis and MisdiagnosisTreatmentl Bed restlAntivirival therapyl Vitamin Bl Analgesicl Nerve blocksl Improving immune functionl Systemic corticosteroid therapy l Physical therapy l Topical therapy Thank youPathogen and Pathogenesis Pathogen Varicella-Zoster virus(VZV)is characterized by neurotro
17、pism and dermatotropism.Clinical manifestationsProdrome:l headache and feverl hyperaesthesial pain in the affected area.The vesicles slowly become pustulars,and rupture to form crusts,which separate in two to four weeks,often with scarring.The regional lymph nodes are enlarged and tender.Ophthalmic
18、Zoster Ocular involvement is most commonly in the form of uveitis and keratitis.AppendicitisThe eruption may have fewPhysical therapyAngina pectorisTreatmentIt occurs chiefly in old orOphthalmic ZosterVitamin B:help to relief the inflammation of the involved nerve and relief the pain.Topical therapy
19、with scarring.in the dermatome.Postherpetic neuralgia(PHN)ComplicationsPhysical therapyVitB12 0.VZV,classically occurs unilaterallyand papuloid lesions but withObvious neuralgiaDistributioncommonly in the form of uveitischaracterized by neurotropism andno blisters.valacyclovir(VCV)1.indomethacinTher
20、e are may only neuralgiaindomethacinIncomplete herpes zosterenlarged and tender.famciclovir(FCV)0.famciclovir(FCV)0.The vesicles slowly become pustulars,characterized by neurotropism andPhysical therapyClinical manifestationsAngina pectorisHerpetic inflammation of the geniculate ganglion is felt to
21、be the cause of this syndrome.characterized by neurotropism andThe presenting features include:herpes auricularis,facial paralysis,and auditory symptoms.Ophthalmic ZosterThe vesicles slowly become pustulars,Antivirival therapyThe eruption may have few Incomplete herpes zoster There are may only neur
22、algia and papuloid lesions but with no blisters.Physical therapydermatotropism.famciclovir(FCV)0.and keratitis.Clinical manifestations0 3 times dailyDisseminated Herpes Zosterclustered vesicles and neuralgia.dermatotropism.nerve,with the features ofpain in the affected area.pain in the affected area
23、.diseases,depending on different part.Typical lesions:Herpes zoster is caused byThe eruption may have fewPathogenOphthalmic ZosterOphthalmic Zostercharacterized by neurotropism andThe vesicles slowly become pustulars,clustered vesicles and neuralgia.Disseminated Herpes ZosterIncomplete herpes zoster
24、Ophthalmic ZosterPhysical therapyPain ususlly precedes the eruptionVitamin B:help to relief the inflammation of the involved nerve and relief the pain.indomethacinTypical lesionslesions or reach total confluenceindomethacindiseases,depending on different part.Features of lesionsClinical manifestationshyperaesthesiaComplicationsa monthPathogen and PathogenesisOphthalmic ZosterOphthalmic Zosterfamciclovir(FCV)0.Topical therapylNerve blockslImproving immune function:transfer factor(TF)lSystemic corticosteroid therapy:prednisone 10mg tidlPhysical therapy lTopical therapy:5%scl
