Abstract
Varicella zoster virus (VZV) is an ancient virus. Herpes viruses have existed since the Devonian period, 400 milion years ago [1], when living creatures were represented by sharks, fish, amphibians. The origins of the ancestral VZV date from about 70-100 milion years ago (Cretaceous period) [2], the living creatures were dinosaurs, reptiles, snakes, amphibians, birds and mammals. Between 50-70 milion years ago VZV evolved in ancestral primates (derived from small mammals). In Africa 6 milion years ago VZV existed in hominids, then Homo erectus and finally Homo sapiens carried for a long period of time VZV. Homo sapiens migrated from Africa to China, India, subsequently to Europe. In North America Homo sapiens brought VZV from Asia (via Bering land bridge) 10.00015.000 years ago [2]. VZV causes two different disease: chickenpox (typically occurs in children) and herpes zoster (shingles) most often in adults and elderly persons (by the reactivation of latent VZV). Herpes zoster is a neurocutaneous disease characterised by cutaneous lesionsin a the areas of a cranial or spinal nerve. A few short remarks: usually a prodrome of dermatomal pain precedes the appearance of the rash and subsequent of typical lesions; the duration and intensity of zoster pain vary greatly even in immnucompetent persons, sometimes postherpetic neuralgia (PHN) may persist months-years and requires neurological consult; there are patients who experience acute segmental neuralgia without cutaneous eruption (zoster sine herpete); in these cases the rise of VZV antibodies represents a proof of diagnosis; zoster oticus is rare, even in immnuocompromised persons; facial paresis is reported in zoster oticus in immunocompetent patients; viral culture is the golden diagnostic standard; PCR detects VZV-DNA in fluids and tissues in some difficult cases; direct immunfluorescence assay with labeled VZV-specific monoclonal antibodies is rare recommended in practice, where we prefer Tzanck-test; Tzanck test is simple, not expensive, easy to perform, but unable to distinguish between VZV and HSV (herpes simplex virus) infection; extremely rare we perform skin biopsy to confirm diagnosis, even in zoster oticus; regarding the treatment we prescribe also Brivudin 125mg/ day 7 days to limit acute symptoms, to prevent PHN and complications of herpes.
Highlights
Ramsay Hunt syndrome (RHS) is first described byJames Ramsay Hunt in 1907 [1]
It is caused by the reactivation of latent varicella-zoster virus (VZV) that has remained dormant within sensory root ganglia of the sensory branch of the facial nerve
Herpes zoster, called shingles is the consequence of reactivation of latent VZV from the dorsal root ganglia
Summary
James Ramsay Hunt in 1907 [1] It is caused by the reactivation of latent varicella-zoster virus (VZV) that has remained dormant within sensory root ganglia (commonly the geniculate ganglion) of the sensory branch of the facial nerve. Involvement of sensory branch of the geniculate ganglion of facial nerve leads Herpes zoster (HZ) oticus which is known as RHS. 3-days history of vesicular lesions with erythematous base on neck It was followed by the spread of vesicular eruption to involve external external auditory meatus of right side, and pinna over 2-days. He had vesicles but not pustules, with crusting and swelling, in the distribution of the cervical division of VII (facial) cranial nerve. In the 5 days, the eruption of new vesicles ceased, the rash started to resolve and his clinical status improved
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