Clinical Diagnosis Of Herpes Zoster Research Articles

HERPES ZOSTER IN ELDERLY PATIENT

Herpes zoster (HZ) is a viral infection caused by reactivation of the varicella zoster virus, latent in nerve cells, after an episode of varicella. A 62-year-old female patient complained of lesions on the tongue and lower lip with painful symptoms. Extraoral physical examination revealed skin crusts on mental, zygomatic, and labial commissure regions. The vermilion border of the lower lip on the same side also presented ulcerated lesions. Intraorally, an extensive erythematous area of erosion and ulcerated areas distributed on the dorsum and lateral border of the tongue on the left side that stopped at midline was observed. The patient reported painful symptoms in the left ear. A clinical diagnosis of HZ was established. Antiviral and analgesic medications were prescribed and an otorhinolaryngologist evaluation was requested, which diagnosed hearing loss. After healing of the lesions, the patient reported pain in the facial region on the affected side, diagnosed as postherpetic neuralgia, that was treated with laser therapy.

Herpes zoster in an immunocompetent infant with a history of varicella in early infancy and after a minor injury - case report and literature review

Introduction. Chickenpox is a common pediatric disease, while herpes zoster (HZ) is rare among children, especially among infants. HZ in infancy may appear after intrauterine or postnatal infection with varicella-zoster virus (VZV). We report on a case of HZ in an immunocompetent infant who had a history of chickenpox in early infancy. Case outline. A seven-month-old male infant was presented with skin changes in the left T1 and T2 dermatomes. Skin changes appeared eight days after the infant had a mild left-arm traction injury. The patient?s medical history revealed that he had a mild form of chickenpox at the age of three and a half months. After the clinical diagnosis of HZ was made, he was treated with oral acyclovir 20 mg/kg every six hours for five days and had complete recovery without any sequelae. Conclusion. Risk factors for pediatric HZ are immunosuppression and chickenpox during the first year of life. Local trauma is a reported risk for VZV reactivation among adults. To our best knowledge, our case is the first reported pediatric case in which the injury of the left arm precedes HZ appearance. Routine vaccination against chickenpox may be an important preventive measure because herd immunity will protect infants and immunocompromised children from getting chickenpox and thus HZ.

Study of clinical profile of herpes zoster in human immunodeficiency virus positive and negative patients at a rural-based tertiary care center, Gujarat.

Herpes zoster usually presents with typically grouped vesicles on erythematous base involving single dermatome with self-limiting nature in immunocompetent individuals while it may present in extensive form involving multiple dermatomes involvement or disseminated form in immunocompromised, especially in human immunodeficiency virus (HIV). The aim of this study was to study the prevalence of HIV in patients of herpes zoster, to compare the clinical presentation of herpes zoster in HIV-infected and noninfected patient. The study was carried out in the Department of Dermatology in a Teaching Institute of Gujarat, from June 2008 to May 2014 after ethical clearance. The study population included all the patients with a clinical diagnosis of herpes zoster. All the patients were investigated for HIV infection after written consent. Out of total 688 patients of herpes zoster, 35 (5.1%) were HIV-positive, 26 (74.3%) were males and 9 (25.7%) were females. Among HIV-positive patients, 29 (82.85%) patients had localized dermatomal involvement, 4 (11.42%) patients had multiple dermatomal involvement, and only 2 (5.71%) had disseminated zoster while among HIV-negative, 636 (97.40%) had localized dermatomal involvement, 14 (2.14%) patients had multiple dermatomal involvement, and 3 (0.45%) had disseminated zoster. Cervical dermatome was most commonly involved dermatome in patients of HIV. Disseminated and multiple dermatomal involvement was more commonly involved among HIV-positive patients when compared to HIV-negative patients.

Study of clinical profile of herpes zoster in human immunodeficiency virus positive and negative patients at a rural-based tertiary care center, Gujarat

Background:Herpes zoster usually presents with typically grouped vesicles on erythematous base involving single dermatome with self-limiting nature in immunocompetent individuals while it may present in extensive form involving multiple dermatomes involvement or disseminated form in immunocompromised, especially in human immunodeficiency virus (HIV).Aims and Objectives:The aim of this study was to study the prevalence of HIV in patients of herpes zoster, to compare the clinical presentation of herpes zoster in HIV-infected and noninfected patient.Materials and Methods:The study was carried out in the Department of Dermatology in a Teaching Institute of Gujarat, from June 2008 to May 2014 after ethical clearance. The study population included all the patients with a clinical diagnosis of herpes zoster. All the patients were investigated for HIV infection after written consent.Results:Out of total 688 patients of herpes zoster, 35 (5.1%) were HIV-positive, 26 (74.3%) were males and 9 (25.7%) were females. Among HIV-positive patients, 29 (82.85%) patients had localized dermatomal involvement, 4 (11.42%) patients had multiple dermatomal involvement, and only 2 (5.71%) had disseminated zoster while among HIV-negative, 636 (97.40%) had localized dermatomal involvement, 14 (2.14%) patients had multiple dermatomal involvement, and 3 (0.45%) had disseminated zoster. Cervical dermatome was most commonly involved dermatome in patients of HIV.Conclusion:Disseminated and multiple dermatomal involvement was more commonly involved among HIV-positive patients when compared to HIV-negative patients.

Herpes zoster in a 6-month-old infant with 13-year follow-up: a retrospective case report

Objective The purpose of this report is to present a case of herpes zoster in a 6-month-old infant, conservatively managed without oral antivirals, and its 13-year follow-up, demonstrating no sequelae or recurrences. Clinical Features A 6-month-old white female infant presented with a vesicular rash of the right lower extremity to a chiropractic office. The rash consisted of grouped vesicles on erythematous plaques, the characteristic herpetiform lesion, distributed in the S1 dermatome of the right lower extremity only. The infant's history was significant for exposure to chicken pox at age 1 week through siblings. Consequently, only one vesicle developed, representing subclinical chicken pox. The clinical diagnosis of herpes zoster was made. Intervention and Outcome The infant was treated conservatively at home. Treatment consisted of aluminum acetate (Burow) solution compresses 3 times each day, followed by a loose dressing. The lesions crusted in 1 week and completely resolved in 2 weeks. Follow-up, consisting of 13 years of observation, demonstrated no evidence of sequelae, such as postherpetic neuralgia, or recurrence. Conclusion Herpes zoster is uncommon in infants; however, it may occur. The presentation of the rash is characteristic; but otherwise, the condition differs from that in adults in that it is mild and not associated with postherpetic neuralgia. In uncomplicated cases, conservative treatment measures support the quick resolution with no sequelae.

Epidemiology and cost of herpes zoster and postherpetic neuralgia among patients treated in primary care centres in the valencian community of Spain

BackgroundData on the epidemiology and costs related to herpes zoster (HZ) and postherpetic neuralgia (PHN) in Spain are scarce; therefore, studies are needed to evaluate the epidemiological and economic impact of HZ and its most common complication, PHN. The present study aimed to estimate the clinical and economic burden of HZ and PHN in Valencia (Spain).MethodsWe prospectively analyzed the burden of HZ and PHN and their attributable costs in patients from 25 general practices in the Autonomous Community of Valencia serving 36,030 persons aged > 14 years. All patients with a clinical diagnosis of HZ who attended these centers between December 1st 2006 and November 30th 2007 were asked to participate. Patients included were followed for 1 year.ResultsOf the 130 cases of HZ followed up, continued pain was experienced by 47.6% (95% confidence interval (CI) = 35.6-56.7%) at 1 month after rash onset, by 14.5% (95% CI = 7.8-1.2%) at 3 months, by 9.0% (95% CI = 3.7-14.3%) at 6 months, and by 5.9% (95% CI = 1.5-10.3%) at 12 months. The percentage of patients with PHN increased with age, from 21.4% (95% CI = 8.3-40) in patients < 50 years to 59.2% (95% CI = 44.4-74) in patients ≥ 70 years. The estimated total cost for the 130 HZ cases during the follow-up period was €49,160 ($67,349). Mean cost per patient was €378 (range 53-2,830) ($517, range 73-3,877).ConclusionsThis study shows that PHN is a relatively common complication of HZ and that both conditions combined give rise to a significant clinical and economic burden for patients and providers.

Epidemiology of Herpes Zoster Infection among Patients Treated in Primary Care Centres in the Valencian Community (Spain)

BackgroundThere is little available data regarding the epidemiology of herpes zoster (HZ) in Spain. This study's main goal was to estimate the annual incidence of HZ in the Autonomous Community of Valencia.MethodsFrom December 1st 2006 to December 1st 2007, a prospective study was carried out in 24 primary health care centres that together provide care for a population of 36,030 persons aged >14 years. We included all adult patients with a clinical diagnosis of HZ who were seen at these centres during the one-year study period. Demographic (i.e., age, gender, and area of residence) and clinical data were also collected from these patients.ResultsA total of 146 cases of HZ were identified during the study period. The annual incidence of HZ was 4.1/1,000 individuals >14 years of age (95% confidence interval [CI]: 3.4-4.7). Cases of HZ were predominantly unilateral and most commonly affected women and people living in rural areas. The most frequently reported symptoms were pain, dysesthesia and itching. A total of 46% of patients also had underlying illnesses (e.g., chronic diseases and/or malignancy) and 24% of patients experienced complications, which were mostly ocular in nature. A total of 91% of patients were treated with antiviral drugs. The median time from symptoms onset to diagnosis was 6.3 days (range: 2.0-8.3).ConclusionsHZ is a common illness in our region (especially in the older population) that causes a significant clinical burden on primary care providers.

Facial herpes zoster infection precipitated by surgical manipulation of the trigeminal nerve during exploration of the posterior fossa: a case report

IntroductionWe present a case of herpes zoster infection (shingles) precipitated by surgical manipulation of the trigeminal nerve root during an attempted microvascular decompression procedure. The pathogenesis of this phenomenon, as well as the importance and role of prophylactic acyclovir in its management, are discussed.Case presentationA 54-year-old Caucasian man with a classical long-standing left-sided V2 and V3 division primary trigeminal neuralgia refractory to medical management, underwent posterior fossa exploration for microvascular decompression via a standard retromastoid craniectomy. The patient had immediate and complete relief from pain. Three days after the operation, he developed severely painful vesicles with V2 and V3 dermatomal distribution. Rather than the classical paroxysmal, lancinating type of trigeminal neuralgia, the pain experienced by the patient was of a constant burning nature. A clinical diagnosis of herpes zoster (shingles) was made after smear confirmation from microbiological testing. The patient was commenced on antiviral treatment with acyclovir. His vesicular rash and pain gradually subsided over the next two weeks. He remains asymptomatic one year later.ConclusionsPostoperative shingles precipitated by trigeminal nerve manipulation during surgery for trigeminal neuralgia can be a distressing and demoralizing experience for the patient. A careful preoperative history, early recognition, and prompt antiviral therapy is necessary.

Clinical and psychosocial correlates of post‐herpetic neuralgia

Post-herpetic neuralgia is the most challenging and debilitating complication of herpes zoster in the immunocompetent host. Because the effect of treatment is disappointing once the syndrome has developed, it is important to know which factors predict post-herpetic neuralgia occurrence to facilitate selection of herpes zoster patients with a higher risk of developing neuralgia and undertake preventative strategies. The present study aimed at identifying demographic, clinical and psychosocial correlates of post-herpetic neuralgia in a sample of 219 immunocompetent patients, who were examined by dermatologists in private practice in Italy and who completed a questionnaire designed to evaluate their clinical and psychosocial profile at the time of clinical diagnosis of herpes zoster and at a follow-up visit 6 months later. In a univariate analysis, post-herpetic neuralgia was associated significantly with older age, longer duration of prodromal pain, greater acute pain intensity, greater extent of rash, presence of abnormal sensations and use of systemic antiviral therapy. Compared to the values at herpes zoster onset, at the follow-up visit patients with post-herpetic neuralgia presented with similar high mean scores of pain intensity, anxiety and depression and greatly reduced quality of life, whereas patients without neuralgia presented with improved scores. In a multivariate model, older age, greater acute pain intensity, greater extent of rash and longer duration of prodromal pain were independently associated with post-herpetic neuralgia. The results of this study may help physicians to identify patients with a higher risk of developing post-herpetic neuralgia and undertaking preventative strategies.

Clinical Diagnosis of Herpes Zoster in Family Practice

Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice. Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confirmation of herpes zoster. Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confirmed serologically (positive predictive value of clinical judgment 90.8%; 95% confidence interval, 87.3%-94.3%). Independent clinical variables for serologically confirmed herpes zoster were severity and duration of rash at first examination. Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster.

Herpes zoster in a 10 year old child

This work is a case report of Herpes Zoster occurrence in a 10-year-old child.Herpes Zoster (Shingles) is caused by Herpes Virus Varicellae (Varicella Zoster Virus). The same virus causes both Varicella and Zoster. While Varicella is the primary infection, Zoster is the result of reactivation of the residual latent virus infection. Consequently, it is Varicella, and not Zoster, that is commonly observed in childhood. Therefore, this case of Herpes Zoster occurring in a 10-year-old child is of interest to the Dermatology community.A male child aged 10 years complained of skin rash involving the left hemithorax. Examination revealed the rash to consist of erythematous papules and vesicles. The eruption was confined only to T3 and T4 segments on the left side. The skin rash was present since 1 week and it was associated with mild pain. There were no other constitutional symptoms. At 2 years age, the child had suffered from chicken pox.A clinical diagnosis of Herpes Zoster was made and the child was put on Acyclovir and other supportive drugs. Skin rash cleared in 1 week without any scarring or residual damage.Although Zoster is believed to be primarily a disease of adulthood, this case suggests that it can occur in children as well. This work is a case report of Herpes Zoster occurrence in a 10-year-old child. Herpes Zoster (Shingles) is caused by Herpes Virus Varicellae (Varicella Zoster Virus). The same virus causes both Varicella and Zoster. While Varicella is the primary infection, Zoster is the result of reactivation of the residual latent virus infection. Consequently, it is Varicella, and not Zoster, that is commonly observed in childhood. Therefore, this case of Herpes Zoster occurring in a 10-year-old child is of interest to the Dermatology community. A male child aged 10 years complained of skin rash involving the left hemithorax. Examination revealed the rash to consist of erythematous papules and vesicles. The eruption was confined only to T3 and T4 segments on the left side. The skin rash was present since 1 week and it was associated with mild pain. There were no other constitutional symptoms. At 2 years age, the child had suffered from chicken pox. A clinical diagnosis of Herpes Zoster was made and the child was put on Acyclovir and other supportive drugs. Skin rash cleared in 1 week without any scarring or residual damage. Although Zoster is believed to be primarily a disease of adulthood, this case suggests that it can occur in children as well.

Herpes zoster and aseptic meningitis in a previously healthy child

We describe an 8-year-old boy with aseptic meningitis in association with herpes zoster, a rare complication in immunocompetent children. This previously healthy boy, who had a history of chickenpox at the age of 6 months, presented with grouped, painful vesicular lesions of the right thoracic dermatomes 7–9. A clinical diagnosis of herpes zoster was made and symptomatic local treatment was initiated. Five days later the child had an acute onset of intense headache. On physical examination, the boy was in a moderately well condition and subfebrile with an axillary body temperature of 37.8C; all other vital signs were normal. Herpes zoster of the right thoracic wall was still present, however, no vesicles could be found on the face, ear or mouth. Neurological examination revealed a stiffness of the neck with positive Kernig sign and constant bilateral fasciculation of the periorbicular muscles, albeit more pronounced on the right side. Peripheral facial muscle weakness was not present. Lumbar puncture revealed 47 leukocytes/ll with 87% lymphocytes and 13% polynuclear granulocytes. CSF glucose and protein levels were within the respective normal ranges. A differential diagnosis of aseptic meningitis caused by reactivated varicella zoster virus (VZV) or herpes encephalitis was made and treatment with acyclovir i.v. (1500 mg/m 2 /d in three divided doses) was started empirically. Periorbicular fasciculations stopped 6 h after the first dose of acyclovir. Bacterial culture of CSF yielded no growth. VZV DNA was recovered from CSF by polymerase chain reaction (PCR) whereas herpes simplex virus DNA was not detected. VZV antibodies in CSF were not analysed. However, the presence of VZV DNA in CSF was strong presumptive evidence of VZV infection of the central nervous system, and acyclovir treatment was continued for 7 days. The boy’s general condition normalised gradually over the next few days. During 12 months of follow-up, no neurological or cutaneous complications have occurred. Children who contract varicella in the 1st year of life are at increased risk for zoster during childhood, but it is

Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults

Among 111 immunocompetent patients referred to a general hospital setting with the clinical diagnosis of herpes zoster, viral cultures were obtained from 47 patients. Six of these patients (13 percent) had herpes simplex virus isolated, with four of the six infections involving the facial distribution, and the other two involving the T4 (breast) distribution. Excluding those in whom herpes simplex virus was isolated, the mean age (± SD) of the remaining 105 patients was 50 ± 19 years. Thirty-two percent of the patients were at least 65 years old; however, 39 percent were younger than 40 years of age. Thus, herpes zoster frequently occurs in young, immunocompetent adults. Also, since zosteriform rashes may be caused by herpes simplex virus, viral cultures of lesions are useful to differentiate infections caused by herpes simplex virus from those due to varicella-zoster virus. The need to distinguish between these two viruses may be important with the advent of antiviral drugs and for use of the proper epidemiologic isolation procedures.

Cutaneous Sarcoid Granuloma Formation in Herpes Zoster Scars

Sarcoid granulomas have been reported to occur in sites of previous folliculitis,¹surgical scars,²and venipuncture.³To our knowledge, this is the first time it has been reported to occur in a site of previous herpes zoster. <h3>Report of a Case</h3> A 52-year-old woman was seen for evaluation of a shiny papular zosteriform eruption on the right upper thorax. Five months previously the patient had been seen in the medical clinic of the Ohio State University Hospital, Columbus, with the chief complaint of painful and slightly tender blisters with some degree of hyperesthesia on the right upper thorax. Physical examination at that time had disclosed a segmental papulovesicular eruption along the C-5 through T-2 dermatomes. A clinical diagnosis of herpes zoster was made and viral cultures were obtained. Tzanck preparation and/or biopsy material was not obtained. The lesions cleared in approximately three weeks without any therapy. The

Cutaneous sarcoid granuloma formation in herpes zoster scars

Sarcoid granulomas have been reported to occur in sites of previous folliculitis,¹surgical scars,²and venipuncture.³To our knowledge, this is the first time it has been reported to occur in a site of previous herpes zoster. <h3>Report of a Case</h3> A 52-year-old woman was seen for evaluation of a shiny papular zosteriform eruption on the right upper thorax. Five months previously the patient had been seen in the medical clinic of the Ohio State University Hospital, Columbus, with the chief complaint of painful and slightly tender blisters with some degree of hyperesthesia on the right upper thorax. Physical examination at that time had disclosed a segmental papulovesicular eruption along the C-5 through T-2 dermatomes. A clinical diagnosis of herpes zoster was made and viral cultures were obtained. Tzanck preparation and/or biopsy material was not obtained. The lesions cleared in approximately three weeks without any therapy. The

Herpes zoster and recurrent herpes simplex.

87 patients with the clinical diagnosis of herpes zoster were seen during a one-year period in 8 general practices in Glasgow, the rate per 1 000 practice population being approximately 2.4. Of these, 78 (90%) had serological evidence of active infection with herpes zoster. A history of recurrent herpes simplex was obtained in 25 (32%) of the 78 patients with confirmed herpes zoster; 63 (81%) of these 78 had complement-fixing (CF) antibodies to herpes simplex. Thus, latent herpes simplex infection did not prevent herpes zoster nor modify the severity of herpes zoster. In most of the patients CF antibodt to varicella-zoster was not detected within 5 days from appearance of the rash. After the acute phase of the illness CF antibody titres fell fairly rapidly, the geometric mean titre being 189 at 2-4 weeks after the rash, 27 from 3-6 months, and 8 from 12-18 months. The rapid rise and decline in CF antibody after herpes zoster infection compared with the unchanging CF titres associated with recurrent herpes simplex infection suggest that varicella-zoster and herpes simplex virus differ in their mechanism of latency.

Herpes Zoster Generalisatus Pneumonia

Although but a single virus is thought to be responsible for both varicella and herpes zoster, we have found no case report of viral pneumonitis associated with the latter, even when it has become generalized. We wish here to report such a case occurring in a patient with long-standing Hodgkin's disease. Report of Case A 45-year-old white housewife with Hodgkin's disease since 1954 was admitted to the medical service of the Stanford Medical Center on Oct. 20, 1960, because of acute dyspnea, high fever, and cough. Asymptomatic except for generalized pruritus, 11 days prior to admission the patient developed a painful eruption involving the right posterior inframandibular area and a low-grade fever. A clinical diagnosis of herpes zoster was made. She was treated with Protamide, Pituitrin, thiamine, immune serum globulin, streptokinase-streptodornase, and topical but not systemic adrenal corticosteroids. Vesicles appeared, coalesced, became hemorrhagic and necrotic, and rapidly covered the entire