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Herpes zoster
From Wikipedia, the free encyclopedia
(Redirected from Shingles)
Herpes zoster (or zoster), commonly known as shingles, is a viral disease characterised by a painful skin rash with blisters in a limited area on one side of the body. It is caused by varicella zoster virus (VZV), which is also the virus that causes chickenpox. After a chickenpox infection the virus can lodge permanently in nerve cell bodies without causing any symptoms, although it is not known exactly how this happens. At times of reduced immuno-competence, years or decades later, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The nerve cell bodies of dorsal root, cranial nerve or autonomic ganglion may contain the latent virus,and the virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome causing a shingles rash. Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.
Throughout the world the incidence rate of herpes zoster ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals, increasing to 3.9–11.8 per 1,000 person-years among those older than 65 years.
Signs and symptoms
The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis. These symptoms are commonly followed by sensations of burning pain, itching, and hypersensitivity. The pain may be extreme in the affected nerve below. These sensations are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain. In most cases, after 1-2 days (but sometimes as long as 3 weeks) the initial phase is followed by the addition of the characteristic skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first, the rash is visually similar to the first appearance of hives; however, unlike hives, herpes zoster causes skin changes limited to a dermatome (an area of skin supplied by one spinal nerve), normally resulting in a stripe or belt-like pattern limited to one side of the body and not crossing the midline.
The rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, crust over within seven to ten days, and usually the crusts fall off and the skin heals, but sometimes after severe blistering scarring and discoloured skin remain.
Herpes zoster may have additional symptoms, depending on the dermatome involved. Herpes zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10–25% of cases. It is caused by the virus reactivating in the ophthalmic division of the trigeminal nerve. In a minority of patients, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain. Herpes zoster oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).
Zoster sine herpete describes a patient that has all symptoms of herpes zoster except the characteristic rash.
Source: http://en.wikipedia.org/wiki/Herpes_zoster
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