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A 73-year-old female patient presented with asymmetric herpes zoster. She was treated successfully with systemic immunostimulants, vitamin B1 tablets and topical etheric acetyl-salicylic acid solution. No underlying malignancy, immunodeficiency or other systemic diseases could be detected.
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The clinical diagnosis, etiology and predisposing factors of these common viral skin diseases are discussed with special emphasis on new therapeutic approaches.
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The authors analyse the inpatient findings accumulated from 2,179 observations on herpes zoster cases for 10 years. The clinico-epidemiological characterization of herpes zoster patients as the potential source of chickenpox infection is presented. The clinical data speak for the droplet transfer of the agent (varicella zoster virus) in this infection, which has permitted the formulation of exact practical recommendations of quarantine and isolation measures in the focus of herpes zoster.
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Herpes zoster is rare in otherwise healthy children, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk factors for childhood herpes zoster. However, some controversies persist about risk factors, diagnosis, and the natural history of childhood disease. In a 2-year prospective study, 18 children with herpes zoster were clinically diagnosed in outpatient consultations in a hospital dermatology unit. Data about age, dermatome involvement, underlying disease, and history of previous varicella were recorded. Tzanck smears, biopsy specimens, and sera were obtained from 18, 4, and 10 children, respectively. The varicella zoster virus major envelope glycoprotein gE was detected in 16 of 18 smears and all four biopsies. Herpes simplex virus I was demonstrated in one of the smears. The established risk factors for childhood herpes zoster were only found in one child. Evidence for previous full-blown varicella and varicella with few lesions was recorded in 7 and 4 of the 17 immunocompetent children, respectively. No history of varicella was recalled in 6 of 17 cases, although a serologic clue of past varicella infection (IgM negative, IgG positive) was disclosed. Recurrent herpes zoster was diagnosed in one immunocompromised child. Zoster-associated pain was localized and the disease severity remained mild in all children. Established risk factors for childhood herpes zoster were only rarely found in our series of patients. In contrast, unrecognized varicella and varicella with few lesions were frequently recorded and may represent additional risk factors for shingles in childhood. Zosteriform herpes simplex virus infections should be differentiated from childhood herpes zoster, emphasizing the importance of precise viral identification.
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Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.
Herpes zoster is a disorder frequently encountered in adults. The natural history is often poorly appreciated and management is frustrating. Recent studies have critically evaluated newer therapeutic modalities. The epidemiology, clinical manifestations, complications and therapeutic alternatives of herpes zoster deserve review.
Herpes Zoster is a viral disease of the skin and mucosa characterized by grouped vesicula eruptions and neuralgic pain along a peripheral nerve. A case of Herpes Zoster in the right region along the second and third trigeminal nerve branches of a 24-year-old male was reported. The first disorder appeared as a grouped vesicular eruption in the center of the lower lip. This was followed by a cutaneous lesion in the area of the right second trigeminal nerve branch. From the first day of hospitalization, the patient began receiving a daily dose of 2500mg of immunoglobulin. The administration of immunoglobulin, cured the oral and cutaneous lesion.
Herpes zoster has been associated rarely with somatic and visceral motor complications, including segmental motor paralysis, neurogenic bladder dysfunction and, unusually, colonic pseudo-obstruction. We report a patient who developed acute pseudo-obstruction of the colon which followed the appearance of dermatomal herpes zoster.
Herpes zoster is an infection caused by the varicella virus. Inflammatory reaction can involve the spinal cord and anterior horn cells causing varied neurological disorders including urological alterations. We reviewed 57 patients who suffered herpes zoster between 1984 and 1991. 15 of them (26%) showed urological manifestations: 2 cases acute urinary retention, 3 patients urinary incontinence and 10 cases had a cystitis-like syndrome. The clinical findings and diagnostic procedures are studied. The possible etiological mechanisms are discussed. The literature is reviewed.
Herpes zoster (HZ) is a virotic disease caused by Herpesvirus varicellae. The objective of this study was to determine the factors that trigger the disease, and the systemic and oral alterations present in Brazilian patients with herpes zoster. A total of 30 patients with HZ and 100 control patients with other diseases were studied. Of the 30 patients with HZ, 13 were male (43.3%) and 17 were female (56.7%), with an average age of 43.2 (range 3-78). The patients were submitted to general clinical, dermatological and intraoral examinations. Only 50% of the HZ patients reported emotional stress at the onset of the disease. A total of 3.7% of the patients were positive for HIV and 11.1% for systemic malignant neoplasm. Cutaneous lesions were found on the thorax (68.3%), face (20%), lower limbs (10%) and upper limbs (6.7%). Specific oral involvement such as oral HZ was not found. The presence of the disease may indicate a non-diagnosed malignant neoplasm and/or association with AIDS.
Herpes zoster is a relatively common disease which affects predominantly the middle-aged and elderly. The segmentally distributed cutaneous eruption, sensory changes, and pain make up the well known zoster syndrome. Motor loss is another aspect of this syndrome which is less well known but occurs in a significant number of cases, and is probably far more frequent than is recognised because the weakness is readily obscured by pain. Four cases of herpes zoster with motor involvement are described. Two cases had zoster paresis affecting the arm and hand, and one of these had, in limb, and one case had urinary retention owing to an atonic bladder. These cases serve to illustrate many of the clinical features of the zoster syndrome with motor involvement. The significant functional implications of unrecognised motor deficit, particularly in the elderly, are a prominent feature and highlight the importance of early accurate diagnosis and management. The pathogenesis and clinical features of this syndrome are discussed in the literature review.
Herpes zoster ("shingles") is usually a benign, self-limited disease. However, it can be debilitating or even fatal. The potentially serious complications of ocular involvement or postherpetic neuralgia and the confusing therapeutic regimens that are often advocated make this a complicated subject. Dissemination is more common in immunosuppressed and elderly febrile patients, and the complications are more serious. Herpes zoster patients may benefit from treatment with vidarabine, currently the only antiviral agent approved for use in this disease. Corticosteroids may be helpful in selected patients.
Herpes zoster infection may be complicated by motor involvement, the most common example of this being facial palsy in the Ramsay Hunt syndrome. Segmental lower motor neurone weakness is an uncommon disorder which does occur in the limbs, such paralysis usually occurring in the same segments as the dermatomes involved, or in those immediately contiguous. Nine cases of limb weakness are described, the weakness often being severe and accompanied by wasting and segmental reflex impairment. Long tract signs were absent. The cervical region was affected more commonly than the lumbosacral area. The prognosis for recovery was usually good. The condition reflects anterior horn cell or anterior nerve root involvement by the herpes zoster virus at the same or adjacent segmental levels as the sensory lesion.