OVERVIEW
- VZV = an alpha herpes virus
- 90% of adults have evidence of infection
- spread via droplet excreted from the throat of patients with chicken pox OR via contact with vesicle fluid in chicken pox or shingles.
- after infection:
- asymptomatic
- chicken pox
- shingles (herpes zoster)
- site of latency = nerve cell body (spinal cord and cranial nerves)
CLINICAL FEATURES
Chickenpox
- febrile response
- vesicular rash that appears in crops
- generalized lymphadenopathy
Shingles
- blistering rash that always stops at the midline
- risk factors: increased age, immunosuppression or deficiency, stress
INVESTIGATIONS
- clinical diagnosis
- viral isolation from tissue culture
- electron microscopy
- antigen detection
MANAGEMENT
- aciclovir
- prevention = immunization with live vaccine or zoster immunoglobulin
COMPLICATIONS
- chicken pox -> pneumonia, congenital varicella or neonatal chicken pox
- shingles -> post-herpetic neuralgia, zoster keratitis, motor-nerve paralysis
Risk factors for developing pneumonia
- Smoker
- Contact with index case
- > 100 spots
- Duration of fever
- Chronic Lung Disease
- 3rd trimester pregnancy
- Immunosuppression
Critical Care
Compendium
LITFL posts by
Hi Chris,
Firstly thanks for the great work!!
My Name is Andrew, I’m a paramedic and in recent weeks I have come across pt’s with shingles. Because a lot of the patients are elderly some are poor historians but majority were prescribed an SSRI for their shingles.
Could you please shed some light on this?
Regards
Andrew Haynes