HERPES

ZOSTER
virus
“SHINGLES”
DEFINITION

◦Herpes zoster, aka Shingles

◦caused by the same virus responsible for

chickenpox, Varicella-zoster virus

◦lies dormant in certain fibers after the initial

exposure of the virus
◦results from the activation of the following:
◦aging
◦stress
◦suppression of the immune system
◦medications

◦a latent infection in a partially immune person

from previous varicella infection
ETIOLOGY
◦ Agent: Varicella-zoster (V-Z) virus
◦ cause two diseases: varicella and
herpes zoster
◦ susceptible children – develops varicella
◦ adult persons – after contact with
varicella develops herpes zoster, usually
after 45 years of age
◦ occurs in partially immune
individuals from previous varicella
infection
SOURCE OF INFECTION
◦occur in well person but often seen with
chronic debilitating disease or with toxic
diseases
◦Can be spread from a person with shingles
at the active stage to someone who has
never had chickenpox
SOURCE OF INFECTION
◦ Possible triggers:
◦ Tuberculosis (TB)
◦ Lymphoma
◦ Disseminated Cancer
◦ Older age
◦ Cancer treatment
◦ Stress/trauma
◦ Immunosuppressive drugs
◦ Children who had chicken pox in infancy or whose
mothers had chickenpox late in pregnancy
MODE OF TRANSMISSION
◦direct contact – droplet and airborne
spread
◦indirect contact – articles freshly soiled by
secretions and discharges from an infected
person
PATHOGENESIS
◦virus is identical with the causative
agent of chickenpox
◦after the primary infection, varicella
persists in a dormant state in the dorsal
nerve root ganglia
◦at a later stage, virus emerges from the site,
either spontaneously or in association with
immunosuppression, to cause herpes zoster
◦produces localized vesicular skin lesions
confined to a dermatome and severe
neuralgic pain in the peripheral areas
innervated by the nerves arising in the
inflamed root ganglion (infection usually
occurs in adults)
INCUBATION PERIOD
◦unknown, but believed to be 13-17 days
PERIOD OF COMMUNICABILITY
◦a day before the appearance of the
first rash until 5-6 days after the last
crust disappears
COURSE OF THE DISEASE
◦pathognomonic sign: skin rash
◦first appearance: erythematous base of the skin
lesion
◦within 24 hours: appearance of the vesicle,
forming patches, coalesce to form an irregular
band like distribution along the course of
dermatomes, unilateral and sagittal eruptions;
becomes pustular, breakdown and form crusts
Skin rash Erythematous Formation of
base vesicles
◦affected areas:
◦thoracic segment – common
◦extremities
◦branches of the 5th and 7th cranial nerves
– affecting the ganglion of the posterior
nerve roots or the extramedullary cranial
nerve ganglion
◦prodromal period (1 or more days):
◦fever & chills
◦malaise
◦anorexia
◦headache
◦stabbing/burning pain (1-5 days prior to the
development of rash)
◦pruritus
◦regional lymph nodes/lymphadenopathy
◦later period:
◦Gasserian ganglionitis – when ophthalmic
(CN 5) nerve is affected, corneal
anesthesia occurs
◦Ramsay-Hunt Syndrome (Herpes zoster
oticus) – paralysis of the facial nerve and
vesicles in the external auditory canal
affecting the 7th CN (hearing loss)
 Gasserian Ramsay-Hunt
Ganglionitis Syndrome
COMPLICATIONS
◦ Encephalitis
◦ Paralytic Ileus, Bladder Paralysis
◦ Ophthalmic Herpes (leads to blindness)
◦ Paralysis – motor damage (CN damage) and
involvement of sacral areas causing urinary
retention
◦ Pneumonia
◦ Postherpetic neuralgia
◦ Transvers myelitis
◦ Death
DIAGNOSTIC EXAMS
◦characteristic skin rash may be
diagnostic
◦TISSUE CULTURE TECHNIQUE
◦SMEAR OF VESICLE FLUID
◦MICROSCOPY
NURSING DIAGNOSIS
◦ Pain
◦ Alteration of Comfort
◦ Body Image Disturbance
◦ Risk of Infection
◦ Impaired Physical Mobility
◦ Impaired Skin Integrity
◦ Altered Role Performance
MODALITIES OF TREATMENT
◦Symptomatic
◦Antiviral drugs - acyclovir
◦Analgesics/narcotics – to relieve pain
◦Anti-inflammatory
◦Antipruritic agent – Calamine lotion, Cetaphil
lotion, basic shake lotion, or 1:20 solution of
Burrow’s solution (cool compresses)
METHODS OF CONTROL
◦Immunization against chickenpox
◦Avoid exposure to a patient suffering
from either varicella or herpes zoster
◦Increase the patient’s immune
resistance
NURSING MANAGEMENT
◦ Keep patient comfortable and maintain meticulous
hygiene
◦ Strict isolation
◦ Apply cool, wet dressings with NSS to pruritic lesions
◦ Prevent secondary infection
◦ Prevent entrance of microorganism into lesions (esp.
If broken)
◦Assess degree of pain
◦Encourage sufficient bed rest
◦Supportive care
◦Provide diversionary activity
 Comparison between SHINGLES and VARICELLA
CLINICAL FEATURE CHICKENPOX HERPES ZOSTER

Causative Agent Varicella Virus Varicella zoster virus

A day before the eruption of the 1st rash up to 5 days after the
Period of Communicability
last crust

Evolution of Rashes Macule Papule Vesicle Pustule

 Clustered
 Appears first on the unexposed part
 Unilateral
Distribution of Rashes of the body
 Does not cross the sagittal portion of
 Generalized
the body

 Deep-seated burning pain (worst at

night)
Manifestation Itchy  Lymphadenopathy
 Gasserian Ganglionitis
 Ramsay-Hunt Syndrome

 Acyclovir (Zovirax)  Acyclovir (Zovirax)

Drug of Choice  Antipyretic (fever)  Analgesic (pain)
 Calamine lotion  Anti-inflammatory

 Management is geared towards the relief of itchiness

Nursing Management
 Prevention of secondary infection