Herpes Zoster (Shingles)

Caused by
varicella-zoster (same as chicken pox)

Characteristics
Linear vesicular lesions that do not cross the midline. Pain is described as burning, throbbing, or stabbing…some pts have intense itch

Most commonly involved site
1. thoracic dermatomes
2. lumbar dermatomes

T/F: Anyone who has had the chickenpox is at risk for shingles
True

The vaccine is effective/not effective
very effective

shingles is usually seen in what populations?
1. Elderly
2. Immunocompromised
3. Pts w/ underlying health problem

When shingles is seen in younger adults, think about
HIV or other immunocompromised condition

During the acute attack, the varicella-zoster virus is shed?!?
yes, patients can transmit the infection, but it is not communicable from person to person.

Huh?
Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can be spread from a person with active shingles to another person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.

How is the virus spead?
The virus is spread through direct contact with fluid from the rash blisters caused by shingles

Are you infectious before the blisters appear?
No

When are you no longer contagious?
Once the blisters crust over

Shingles is more/less contagious than chickenpox?
less…and risk of transmission is low if rash is kept covered

What should a patient do to prevent transmission if they have shingles?
Keep the rash covered.
Avoid touching or scratching the rash.
Wash your hands often to prevent the spread of varicella zoster virus.
Until your rash has developed crusts, avoid contact with
– pregnant women who have never had chickenpox or the chickenpox vaccine;
– premature or low birth weight infants; and
– people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

Although diagnosis is usually made clinically, if confirmation is needed, a ___ ___ can be ordered, and would show
Tzanck smear;
Giant multinucleated cells (a finding in all herpetic infections)

How do antivirals work with shingles?
High dose antivirals will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears.

How soon should antiviral therapy ideally be initiated?
the first 72 hours of outbreak

What med is often prescribed with the antiviral?
systemic corticosteroids … this combo results in more rapid resolution of pain but not of zoster lesions

What analgesics should be considered/offered for shingles?
Topical agents such as lidocaine gel 5%, Burow’s solution w/ a high potency NSAID or opiod, or combination of these provide considerable relief

What do you need to monitor the patient for
superinfection of lesions

When do you need expert consultation
If herpes zoster involves a facial or ocular dermatome

How long does it take for the rash to resolve?
14-21 days

What is postherpetic neuralgia?
pain persisting at least 1 mo after the rash has healed.

Risk factors for postherpetic neuralgia?
1. site of initial involvement
2. Severe rash
3. intense predromal pain
4. increasing age

Site of initial involvement associated w/ greatest risk for postherpetic neuralgia
*trigeminal or brachial plexus region*;
moderate risk w/ thoracic outbreak, and lower risk w/ jaw, neck, sacral and lumbar involvement

Zoster vaccine (Zostavax) is a
live, attenuated vaccine

Should you use the zoster vaccine in a patient with a history of shingles?
yes

zoster
zoster

shingles

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