Varicella Zoster ADO304 TAAK

7/28/2019 Varicella Zoster ADO304 TAAK

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Varicella-Zoster

Introduction:

Varicella-zoster is a type of herpesvirus that causes two distinct clinical syndromes. Primary infection

is manifested as varicella (chickenpox), whereas reactivation of latent varicella-zoster virus results in

a localized eruption known as herpes zoster (shingles). Thus we normally get chickenpoxs when we

are young(but can get this when we are older, additionally its more severe then too) and shingles

being the recurrence of this virus which means you have to have had this virus precipitating as

chickenpoxs before to get Herpes Zoster later on in life.

This virus is highly contagious and can be spread throught air by infecting people when they cought

or sneeze. It can also spread when if you touch the chickenpox or shingles (when you have not had

the virus before) sores and dont carefully wash your hands afterwards.

General Pathology:

After the primary VZV infection (chickenpoxs), latent infection is established in the sensory-nerve

ganglia. The trigeminal and thoracic dorsal root ganglia are the most common neuronal sites

involved; these dermatomes are also the most common sites of cutaneous herpes zoster.

During reactivation, thus when the patient immunesysteme is comprimized, of VZV the sensory

ganglia are sites of viral replication, with subsequent destruction of neurons and satellite cells which

lines the neurons. After this neurologic damage takes place VZV travels along the affected sensory

nerves to the skin, evading both the bodys innate and adaptive immune responses to spread fromcell to cell and ultimately produce the unilateral, vesicular dermatomal rash that is characteristic of

zoster.


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Complications of herpes zoster in immunocompetent hosts include postherpetic neuralgia,.[ 11]

Postherpetic neuralgia, a persistent pain syndrome occurring after the resolution of the zoster rash,

is perhaps the most challenging and debilitating complication; it can last for weeks, months, or even

years.This includes people being treated for cancer with chemotherapy or radiation, people who use steroids or

other medicines that suppress the immune system, and people who have HIV infection. Possible complications

are pneumonia or problems with the kidneys, heart, or joints. The brain and nervous system may be affected forexample encephalitis, myelitis, cranial-nerve palsies, and peripheral-nerve palsies. Sometimes an

infection of the skin develops because bacteria get into sores when they are scratched.

Systemic pathology:

The Vericella Zoster virus(VZV) is highly contagious, thus the chickenpoxs

Sometimes problems from herpes zoster happen for no known reason.

Chickenpox during pregnancy can cause birth defects or even cause the baby to be stillborn. If a baby is born

when the mother has chickenpox, the baby may get infected. If you are not immune, you may be given a shot of

Varicella-zoster immune globulin (VZIG). When given within 72 hours after exposure, this shot helps prevent

chickenpox or lessens its severity. The shot is safe for the mother and the baby.

The virus can become active again if your body's immune system is weakened by:

aging illness physical or emotional stress diseases such as AIDS or Hodgkin's disease fatigue poor nutrition chemotherapy or radiation sunburn certain medicines, such as steroids


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Ocular Pathology:

What are herpes zoster eye infections?

The virus can cause several eye problems, including:

blisters on or inside your eyelids damage to your cornea (the clear outer layer on the front of the eye) scleritis (swelling of the white part of the eye) uveitis (swelling of the iris, ciliary body, or the back part of the eye) glaucoma (increased pressure inside the eye) cataracts retinitis (inflammation of the retina in the back of the eye)

If the virus damages a nerve, you may have pain, numbness, or tingling for months or even years afterthe rash is healed. This is called postherpetic neuralgia. If your cornea is affected, it can become

permanently scarred. Early treatment with antiviral medicine can lessen pain and help heal blisters.

Numbness of the cornea and inflammation inside the eye can sometimes cause long-term eye problemsthat require careful follow up.

Expected Symptoms:

Symptoms when expose to primary varizella-zoster virus(CHICKENPOXS)

Symptoms usually appear 10 to 21 days after exposure to the virus.

The symptoms include:

a red, itchy, rash of blisters (sores) that usually appears first on the face, scalp, or trunk tiredness fever aches and pains mild headache feeling irritable

Symptoms when latent varizella-zoster virus reappear(HERPES ZOSTER OR SHINGLES)
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The symptoms include:

The first sign of shingles is often burning, sharp pain, tingling, or numbness in your skin on one side of your

body or face. The most common site is the back or upper abdomen. You may have severe itching or aching. You

also may feel tired and ill with fever, chills, headache, and upset stomach or belly pain.

One to 14 days after you start feeling pain, you will notice a rash of small blisters on reddened skin. Within a few

days after they appear, the blisters will turn yellow, then dry up and form scabs. Over the next 2 weeks the

scabs drop off, and the skin continues to heal over the next several days to weeks.

The blisters are almost always on just one side of the body.Shingles usually doesn't cross the midline of the

body. The rash also may appear on one side of your face or scalp. The painful rash may be in the area of yourear or eye. When shingles occurs on the head or scalp, symptoms can include headaches and weakness of oneside of the face, which causes that side of the face to look droopy. The symptoms usually go away eventually,but it may take many months

Symptoms of herpes zoster eye infections include:

blisters on the forehead, eyelids, or the nose with redness around the blisters swollen eyelids eye pain watery eyes red eyes sensitivity to light blurred vision

MANAGEMENT OF PX:

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms. Your provider will also examine your

skin. The diagnosis is usually obvious from the rash. To confirm the diagnosis, you may have lab tests to look for

the virus in fluid from a blister.

How is it treated?
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It is best to start treatment as soon as possible after you notice the rash. See your healthcare provider to discuss

treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within

the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will

last for a long time.

Your provider may also recommend or prescribe:

medicine for pain antibacterial salves or lotions to help prevent bacterial infection of the blisters.

TREATMENT OF PX:How can I take care of myself?

Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by yourhealthcare provider.

Put cool, moist washcloths on the rash. Rest in bed during the early stages if you have fever and other symptoms. Try not to let clothing or bed linens rub against the rash and irritate it. Call your healthcare provider right away if: You develop worsening pain or fever. You develop a severe headache, stiff neck, hearing loss, or changes in your ability to think. The blisters show signs of bacterial infection, such as increasing pain or redness, or yellow drainage

from the blister sites.

The blisters are close to the eyes or you have pain in your eyes or trouble seeing. You have trouble walking. You have trouble breathing or a severe cough. You have a fever over 101.5 F (38.6 C.) You have a rash involving your eye or difficulty looking at bright light. The blisters look infected. Signs or symptoms of infection include: Your skin is getting redder or more painful. You have red streaks spreading from the blisters. The blister area gets very warm to the touch. Pus or other fluid starts leaking from the blisters.

You have fever, chills, nausea, vomiting, or muscle aches.
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If you have had chickenpox, a vaccine, called Zostavax, is available for people 60 years of age andolder. The vaccine can help prevent or lessen the symptoms of shingles. It cannot be used to treat

shingles once you have it.

How can I take care of myself? CHICKENPOXS

For itching take a lukewarm bath every few hours for the first few days. Add 2 ounces (4tablespoons) of baking soda, cornstarch, or oatmeal (dry, uncooked oats) to a tub of water. Use

soap in one of the baths each day to clean as much bacteria off the skin as possible. Gently pat your

skin dry. Do not rub it dry. The bathtub should be cleaned before someone else uses it.

You can try using calamine lotion on sores to help relieve itching, but do not put it on your face. Put a towel-covered ice pack or cool moist washcloth on itchy areas for 20 to 30 minutes. Do not

share the towel or washcloth with anyone else. If itching is severe or is making it hard to sleep, take a nonprescription antihistamine, such as

Benadryl (diphenhydramine). Antihistamines may cause side effects, especially for older adults. Side

effects may include drowsiness, dizziness, confusion, dry mouth and eyes, constipation, and trouble

urinating. They may worsen other medical problems. Ask your provider to recommend a safe

antihistamine for you.

Trim your fingernails and wash your hands often with soap and warm water to help keep the rashfrom getting infected if you scratch it.

If you have sores in your mouth, eat foods that are cool, soft, and bland. Avoid any foods that areacidic, spicy, or salty.

Take a nonprescription pain reliever, such as acetaminophen, for headache, fever, or general achesand pains. Dont give any medicine that contains aspirin or salicylates to a child or teen. This

includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens

who take aspirin are at risk for a serious illness called Reye's syndrome.

Call 911 for emergency care if: You become confused, disoriented, or extremely sleepy or have trouble waking up. You have a severe headache or a stiff neck. You have trouble standing up or walking. You have a rash in one or both eyes or you are very sensitive to bright light. Call your healthcare provider right away if: You have trouble breathing or a severe cough. You are an adult and have a fever over 101.5 F (38.6 C). The blisters look infected: The area around a blister is red. A red streak is spreading from the blister. Pus (usually yellow) starts leaking from the blisters.
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INTERESTING FACT:

The VZV vaccine, originally developed and licensed as the "chickenpox vaccine" to prevent varicella,

is a live attenuated vaccine that is effective in preventing primary infection with wild-type VZV.

However, initial studies suggested that to elicit a significant and durable increase in cell-mediated

immunity in older adults, a higher titer of live attenuated virus would be required,[ 30] probably

because of the decreased responsiveness of older people to vaccination in general. As a result, a

new VZV vaccine (Zostavax, Merck) was developed specifically for protection against herpes zoster.

The commercially available zoster vaccine contains a minimum of 19,400 plaque-forming units per

dose.[ 31] In contrast, the minimum levels of VZV in the commercially available chickenpox vaccines

are either 9772 plaque-forming units per dose (in the quadrivalent measles, mumps, rubella, and

varicella vaccine [ProQuad, Merck])[ 32] or 1350 plaque-forming units per dose (in the monovalentvaricella vaccine [Varivax, Merck]).[ 33] INTERESTING FACT

Varicella Zoster ADO304 TAAK

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