1、Herpes ZosterTeaching Contents Definition Etiology Pathogenesis Clinical manifestations Diagnosis Differential diagnosis TreatmentDefinition Herpes Zoster is a viral infection characterized by neuralgic pain and clustered vesicles situated unilaterally along the distribution of a sensory nerve.Etiol
2、ogy Varicella-Zoster Virus(VZV)Human herpes virus type 3(HHV-3)Dorsal root ganglionPathogenesis VaricellaLatent infectionHerpes zosterPathogenesis The following may cause the VZV to become active：l Agingl Stress l Fatigue l Diseases that affect the immune systeml Anticancer and immunosuppression tre
3、atments Clinical ManifestationsTypical manifestationsSpecial manifestationssymptomslesions ophthalmic zosterotic zosterpostherpetic neuralgia(PHN)othersTypical Manifestationssymptoms Prodrome:fever,headache,malaise sensations of burning pain,itching,hyperesthesia Pain:characteristic symptom precedes
4、 or accompanies the eruption of rash more severe in older patients usually subsides before the rush has healedTypical Manifestationslesions erythema and papulesclustered vesicles pustulescrustsscar12-24hs3-4ds7-10dsTypical Manifestationslesions Distribution:unilateral(on one side of the body)dermato
5、mal(an area of skin supplied by one spinal nerve)DermatomeTypical Manifestationslesions Distribution:unilateral(on one side of the body)dermatomal(an area of skin supplied by one spinal nerve)Typical Manifestationslesions Site of predilection:Thoracic dermatome 55%Cranial dermatome 20%(trigeminal ne
6、rve)Lumbar dermatome 15%Sacral dermatome 5%Special Manifestation Ophthalmic zoster Potentially the most devastating form of herpes zoster.The ophthalmic branch of the trigeminal nerve is affected.Conjunctivitis,keratitis,uveitis,optic nerve palsies,blindness.Special Manifestation Otic zoster VZV rea
7、ctivate in the facial and auditory nerves Vesicles are in and around the ear Ear painSpecial Manifestation Otic zoster the geniculate ganglion is involved peripheral facial palsy,pain in the ear and face,and vesicles in the ear or mouth auditory and vestibular symptoms Ramsay hunt syndrome:facial pa
8、lsySpecial Manifestation PHN Postherpetic neuralgia（PHN）the pain persists after the rash has healed the most common complication of herpes zoster the pain can be mild or severe the incidence and duration are age dependent Special Manifestation othersZoster sine herpete:patient has all of the symptom
9、s except rash Disseminated zoster:more than 20 vesicles outside of the involved dermatome Generalized zoster:the lesions involve several non-adjacent dermatomes and cross the midline DiagnosisLaboratory tests:detection of VZV specific IgM antibody in blood PCR for VZV DNA in vesicle viral culture in
10、 vesicleClinical manifestations:grouped vesicles in unilateral dermatomal distributionpain Differential DiagnosisBefore rash appears:kidney stones pleurisy gallstones appendicitis heart attack After rash appears:contact dermatitis herpes simplex Impetigo TreatmentThe goals of treatment are to:shorte
11、n the duration of the eruptive stage or rash speed up healing of the lesions relieve patient discomfort shorten the incidence and duration of PHN reduce complications TreatmentSelf-care at home Systemic treatmentsAntiviral drugsSystemic corticosteroids Pain relieversTopical treatmentsCool compressTo
12、pical creamsEye dropsTreatmentSelf-care at homel Bed restl Try to relax and reduce stress l Do not scratch the rashl Wear loose cotton clothes Systemic therapyAntiviral drugs:reduce pain and help lesions heal faster Intravenous acyclovir:5-10mg/kg iv.q8h 7-10dsAcyclovir:800mg 5/day 7ds Famciclovir:2
13、50mg tid 7dsValacyclovir:1000mg tid 7ds Oral drugs:l ophthalmic zosterl disseminated zosterl Ramsay hunt syndromel patients failing in oral therapyl immunosuppressed patientsSystemic therapyPain relievers:l Tricyclic antidepressants:amitriptyline l Basic analgesics:Indomethacin l Narcotic agents:mor
14、phine l Nerve blocks l GabapentinSystemic therapySystemic corticosteroids l It can reduce inflammation and the duration of pain l It has not been proven to reduce PHN l In ophthalmic zoster,Ramsay hunt syndrome prednisone+antiviral medicinel Prednisone:10mg tid 3-5 dsTopical treatment Cool compress:
15、help vesicles dry faster decrease secondary bacterial infection cool compress applied 20 minutes several times a day Topical creams:help remove the crusts lidocaine cream and capsaicin cream can relieve pain Eye drops:when the eye is involvementSummary Etiology:VZV(HHV-3)Pathogenesis:VZVa non-immune
16、 personvaricellalatent infectiondorsal root ganglion cranial nerve ganglion (latent state)cell-mediated immunityVZV reactivatespainclustered vesiclesSummary Typical manifestations:paingrouped vesicles in unilateral dermatomal distribution Special manifestations:ophthalmic zosterotic zosterpostherpetic neuralgia(PHN)zoster sine herpetedisseminated zoster generalized zosterSummary Diagnosis:Treatment:Clinical manifestations +Laboratory testsSelf-care at homeAntiviral drugsPain relieversSystemic corticosteroidsCool compressTopical creamsEye drops
