Herpes zoster (shingles) | What we need to know

16.10.2024

Herpes zoster (shingles) is an acute epidermo-neurovirus. It is the varicella zoster virus that also causes chicken pox, most often in childhood.

Table of Contents

Herpes zoster develops in people who had chickenpox as a child because the varicella zoster virus can be stored in nerve structures for decades without showing symptoms. When the immune status deteriorates, the virus is activated.

Who belongs to the risk group?

People who had chickenpox as a child have a higher risk of developing herpes zoster. Risk groups also include:

Immunocompromised persons - HIV-infected, cancer patients, organ transplant patients
People over 50 years of age
Post-traumatic conditions
Persons under the influence of stress

After transmission of smallpox, the virus does not leave the body, but remains in the ganglia (nerve nodes) of the roots of the nerves of the spinal cord. The reasons for the reactivation of the virus have not been fully determined, although the listed factors may cause its activation and the development of herpes zoster.

Is it possible to get herpes zoster several times?

Yes, it is possible. Recurrences of the viral process often occur without discharge.

Symptoms

Early symptoms are:

Fever
Chills
headache
Fatigue
sensitivity to light
Gastrointestinal disorders

A few days after the onset of the disease, the following symptoms are added:

Sensation of skin itching and burning
Redness of the skin of the affected area
Fluid-filled blisters that burst and peel easily
Moderate to severe pain in the affected area

The disease often begins with a pain syndrome. The pain is of strong intensity, has a periodic character. It is accompanied by general symptoms: fever, headache, muscle pain, followed by a blistering rash after 3-4 days, the location of which corresponds to the dermatome of the nerve (area of the skin innervated by the nerve).

The rash usually develops in the following areas: intercostal areas, abdomen, limbs, face - to the projection of the trigeminal nerve (eyeball area). In case of a weakened immune status, the rash may be generalized – all over the body.

The blistering rash will regress in 7-10 days and the integrity of the damaged skin will be restored in an average of 2-4 weeks. The pain is intense burning. In some patients, it lasts for weeks and months. It is called post-herpetic neuralgia and is the most common complication of herpes zoster.

Spread of varicella zoster virus

The varicella zoster virus is spread through direct skin-to-skin contact, breaking the integrity of blisters and spilling their contents. The spread of the virus by air-droplet is very rare.

The infected person is contagious to other people until the blisters dry up and become covered with fluff.

Diagnostics and laboratory tests

The rash of herpes zoster is so specific that it allows for an accurate diagnostics immediately after its development. In rare cases, a rash may not develop, making diagnostics difficult.

During herpes zoster, differential diagnostics is necessary: simple herpes, contact dermatitis, folliculitis, skin infections, insect bites, skin candidiasis, and others.

Diagnosis of herpes zoster is complicated in immunocompromised people, children and sometimes adolescents, because the disease proceeds with atypical manifestations.

The PCR study of varicella zoster virus DNA is important for the correct diagnostics of the disease. It is possible to use different research materials - blood, bladder contents, cerebrospinal fluid, amniotic fluid - for PJR research.

Serological diagnostics of herpes zoster is based on the detection of IgG and IgM antibodies in the blood. The use of the serodiagnostic method is limited and is provided only if it is not possible to collect the material for PCR research.

Serological diagnostics of herpes zoster is recommended for atypical manifestations of the disease, such as: pneumonia, infections of the central nervous system, development of zoster in pregnant women or newborns. Evaluation by serological tests is informative for evaluating the effectiveness of vaccination. The detection of IgG antibodies after vaccination confirms the effectiveness of immunization.

Complications of herpes zoster

The pain syndrome may continue after the viral discharge is cleared. Post-herpetic neuralgia develops in 10% of cases, and in some patients it is severe for years. The mechanisms of development of neuralgia have not been fully studied.

Other complications include:

Other types of nerve damage: numbness or tingling
Complication of viral discharge with bacterial infection
Eye and ear damage when there is a blistering rash nearby

Treatment of herpes zoster

Because the disease is easily contagious, the primary goal of treatment is to isolate the infected person. It is important to relieve the pain, treat the discharge - to protect against the development of local infections.

As soon as the disease appears, it is important to consult a doctor in order to accurately assess the rash, make a diagnostics and prescribe treatment.

How is postherpetic neuralgia treated?

Treatment includes the combined use of local remedies (medicinal ointments), as well as anti-inflammatory non-steroids, antidepressants and anticonvulsants. Taking painkillers in isolation does not give an effect in case of post-herpetic neuralgia.

In case of particularly intense pain, it is recommended to use a blockade in the area of the spinal nerve or steroid injection.

disease prevention

In order to prevent the disease, it is recommended to use recombinant zoster vaccine for immunization.

Who should get the varicella zoster vaccine?

People over 50 years of age
Those who have already passed the infection once
People who do not have accurate information about whether or not they had chickenpox in childhood

Who should not get the varicella zoster vaccine?

Varicella zoster vaccination is not recommended:

In persons with severe allergic reactions to the vaccine
in pregnant women and nursing mothers
In persons with current herpes zoster infection
In the active phase of another viral or bacterial process

What are the side effects of vaccination?

Severe side effects during vaccination are quite rare. If one or more of the following symptoms develop, it is necessary for the patient to contact the emergency medical service: