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    Anonymous
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    OVERVIEW
    Herpes zoster or shingles is a painful rash associated with blister formation caused by the same virus that causes chickenpox, termed the varicella zoster virus (VZV). Following resolution of chicken pox infection, the VZV remains in a dormant state in the nerves of the spinal cord or head and neck region

    A person who has had chicken pox infection can get herpes zoster or shingles at a later date when the immune system is weakened due to disease or other cause. Due to weak immunity of the host, the virus becomes reactivated and multiplies in the nerve cells and affects the area of the skin supplied which show the characteristic lesions of shingles

    About 1 out of 5 persons who have had chicken pox develop shingles. In the US alone about 1 million cases of shingles occur each year. Most individuals get shingles only once in their lifetime but a person can develop shingles a second or even a third time

    TRANSMISSION OF SHINGLES INFECTION
    Shingles per se cannot be passed from one person to another. However, a person with shingles can transmit the VZV and cause chicken pox in another person who has never had chicken pox infection or has not been vaccinated against chicken pox.

    Spread of virus occurs by direct contact with fluid from the blisters found in shingles. An individual having shingles infection cannot infect another person before the blisters appear. Once the rash has dried and crusted over, the person is no longer infectious.

    RISK FACTORS OF SHINGLES INFECTION
    • Elderly individuals over 60 years with weak immunity
    • Persons with underlying medical condition such as malignancy, leukemia, lymphoma, HIV infections
    • Diabetes mellitus
    • Persons receiving immunosuppressive treatment such as steroids following organ transplantation
    • Cancer chemotherapy

    SIGNS AND SYMPTOMS OF SHINGLES
    • Shingles is a painful blistering rash that develops on one side of the face or body. The blisters typically heal with scarring in 7 to 10 days and the rash clears up within 2 to 4 weeks.
    • About 3-4 days before the rash develops, people may have pain, itching, or tingling in the area where the rash forms.
    • Most commonly, the rash occurs as a single crop of lesions around either the left or the right side of the body. Sometimes one half of the face may be involved and if the brow region is involved, the eye may be affected.
    • Rarely, in patients having weak or suppressed immunity, the rash may be more widespread and resembles a chickenpox rash.

    Other symptoms of shingles can include
    • Fever with tiredness
    • Headache
    • Chills
    • Upset stomach
    • Loss of vision if nerve supplying eye is affected

    COMPLICATIONS OF SHINGLES
    • Postherpetic neuralgia – Severe skin sensitivity, called allodynia, resulting in sharp burning pain or itchiness over the area where the herpes zoster rash appeared. It may be be severe
    enough to sleep and interfere with daily activities
    • Vision loss
    • Ear pain
    • Ramsay Hunt syndrome – partial facial paralysis and hearing loss on one side. Most people recover with early treatment
    • Pneumonia
    • Inflammation of the brain and spinal cord, which causes weakness in legs and arms and back pain.

    DIAGNOSIS OF SHINGLES
    • Diagnosis is usually made based on a history of pain on one side of the body. A history of chicken pox in childhood may be contributory.
    • Physical examination showing characteristic distribution and appearance of rash.
    • In most cases, additional tests are not necessary to make a diagnosis but if the rash is atypical, blood tests may help in confirmation.
    • In specific instances such as organ transplant recipients and pregnant women, blood tests can help to diagnose the presence of a current infection by demonstrating a rise in titre of specific IgM antibodies for a short period during the illness followed by a decline
    • Blood tests can also detect whether persons who have had vaccination or previous varicella zoster infection have natural immunity by demonstrating measurable levels of IgG antibody
    • Although rarely done, tests to demonstrate virus include viral culture and viral DNA testing. Viral DNA testing is very sensitive and can detect and quantify the amount of virus. Viral culture is not very reliable.

    TREATMENT OF SHINGLES
    • Three oral antiviral drugs, famciclovir, valacyclovir, and acyclovir are approved to treat shingles and reduce the duration and severity of symptoms and hasten healing of the lesions.
    • Early treatment can also reduce the risk of complications such as post-herpetic neuralgia
    • Adequate rest and taking pain-killers such as nonsteroidal, anti-inflammatories can help reduce the pain
    • Wet compresses, colloidal oatmeal baths and calamine lotion may help alleviate some of the itching associated with herpes zoster
    • Applying an anaesthetic ointment (lidocaine 5%) before a topical analgesic cream (capsaicin cream) may help may be beneficial in post-herpetic neuralgia
    • Superimposed bacterial infection complicating shingles may require topical or oral antibiotics
    • Eye involvement will require a specialist ophthalmic check-up, and eye drops may be given

    PREVENTION OF SHINGLES
    • A live shingles vaccine, also called varicella zoster vaccine is available. The shingles vaccine is recommended for persons 60 years of age and above to prevent the varicella-zoster virus from re-activating and causing shingles.
    • The herpes zoster vaccination can prevent severe symptoms and complications such as postherpetic neuralgia and the effect lasts upto five years
    • Shingles vaccination is not recommended in persons with a weak immunity such as those with HIV/AIDS, persons on immunotherapy or chemotherapy
    • Shingles is contagious. Preventing spread is done by keeping the ras covered, frequent hand washing and avoiding contact with people who have not had chicken pox

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