Rarely, one of us does not remember how he had chickenpox in childhood. Many of us know that the herpes virus that causes chickenpox remains in our body for life. But not all of us realize that this insidious virus can cause a serious complication many years later, especially against the background of reduced immunity.
Herpes zoster (synonyms - "shingles", "herpes zoster") is caused by the Varicella Zoster virus, which is also the causative agent of chicken pox. Infection may be primary, or it may be due to the reactivation of a latent virus that is in the body after chickenpox. It occurs under the influence of various endogenous and exogenous factors that reduce immunity, including hypothermia, systemic diseases, metabolic disorders, malignant neoplasms, HIV infection, etc.
The incidence of herpes zoster is sporadic and occurs more often in the autumn-winter period of the year. Sick mainly older people with a history of chicken pox. The incidence index is 12–15 per 100,000 population. In a small proportion of patients, herpes recurs. Children who come into contact with sick people may develop chickenpox.
The incubation period for herpes zoster can be several years from the time of infection.
Clinical course
Clinically, the disease is manifested by general infectious symptoms (fever, chills, intoxication), skin lesions (bubble rashes) and severe pain syndrome, which is explained by the fact that Varicella Zoster, being a dermatoneurotropic virus, penetrates through the skin and mucous membranes, affects the spinal and cerebral ganglia, in severe cases - the anterior and posterior horns of the spinal cord and the brain.
In the clinical course, the prodromal period, the period of clinical manifestations and the period of residual effects are distinguished. The development of clinical symptoms is preceded by prodromal phenomena: fever, lethargy, malaise, headaches, often neuralgia (often intercostal nerves).
On the skin, along the sensory nerves, hyperemic spots appear, within which grouped vesicles with serous contents form, which then becomes cloudy, with further formation of pustules, then erosions and crusts form in their place. More often, along the course of the nerves, several edematous erythematous spots with vesiculation occur, which can remain isolated or merge with each other, forming ribbon-like lesions, located linearly and accompanied by a pain symptom. Pain can be dull, drawing, shooting, limited only to the lesion, or radiating. Foci with herpes zoster have different localization along the branches of the trigeminal nerve, on the trunk along the intercostal nerves, in the form of a unilateral lesion, on the face, neck, and scalp.
A characteristic feature of the disease is postherpetic neuralgia - the persistence of a pain symptom, in some cases for a very long time - up to several years, despite adequate therapy, after the resolution of the pathological process on the skin.
Symptoms and manifestations
Pathological picture of the skin is the same as with herpes simplex. In the ganglion cells, nerve fibers, posterior roots and posterior horns of the spinal cord, inflammatory infiltration develops, hemorrhages are noted, followed by dystrophy of nerve fibers; in the cerebrospinal fluid, an increased protein content is detected.
There are several clinical varieties of herpes zoster:
- bullous (several grouped bubbles merge with each other, forming a bubble with uneven outlines); hemorrhagic (vesicles with hemorrhagic contents, sometimes leave superficial scars);
- gangrenous (develops in debilitated and elderly people, characterized by a severe general condition of patients, long-term non-healing gangrenous ulcers, followed by scarring. A manifestation of the gangrenous form may be Hunt's syndrome, which is characterized by a combination of herpes zoster ear shell and external auditory canal with facial paralysis and symptoms of Meniere's disease);
- generalized (occurs in debilitated patients, as well as in people with depressed immunity against the background of long-term use of glucocorticosteroids, cytostatics. Clinically, along with typical foci, individual vesicles appear in various areas of the skin, resembling elements of chickenpox.
Diagnosis
Diagnosis, as a rule, is not difficult - unilateral location of herpetiform elements along the course of innervation on an edematous, hyperemic base, pain.
Herpes zoster is differentiated from eczema, chicken pox, herpes simplex, streptococcal impetigo. The signs on the basis of which herpes zoster is distinguished from eczema are the asymmetry of the lesion (with eczema - symmetry), the presence of pain (with eczema - itching), the herpetiform arrangement of the vesicles, in contrast to the scattered eczema. Histologically, ballooning dystrophy is detected in herpes and spongiosis in eczema.
Herpes zoster differs from chickenpox both in the nature of the main primary elements and in their location: in herpes they are localized along the course of the nerve, in smallpox there is a disseminated lesion. In chickenpox, the primary elements are small nodules that turn into vesicles with a central impression, and not herpetiform vesicles. The rashes are covered with thin crusts, when they fall off, slightly pinkish pigment spots and atrophic scars remain. Rashes appear jerkily, against the background of the temperature reaction of the body, therefore, on the face and trunk, rashes can be found in various stages of development, which is not typical for herpes zoster.
Treatment
Treatment of herpes zoster is carried out on an outpatient basis, it should be comprehensive and include both etiological and pathogenetic agents. Antiviral and immunomodulatory drugs are shown: alpizarin, acyclovir, isoprinazine, interferon, deoxyribonuclease, etc. The effectiveness of these drugs largely depends on the timing of the start of treatment: the earlier it is started, the more effective. Along with antiviral drugs, B vitamins are prescribed: B1, B6, B12, ascorbic acid, rutin, antihistamines, with a pain symptom - NSAIDs, analgesics.
With gangrenous and common forms of herpes zoster, as well as damage to the eyes, ear, treatment is carried out in a hospital. Also shown are angioprotectors, ganglionic blockers. In severe forms of herpes zoster, complicated by a secondary infection or aggravated by concomitant diseases, broad-spectrum antibiotics are used.
Of the physiotherapeutic agents, microwave irradiation of lesions, paravertebral ultrasound, UHF, UV irradiation, electrophoresis with novocaine, adrenaline, etc. are used.
Do not forget about local treatment: spot treatment with aniline dyes, lotions with interferon, antiviral ointments (in particular, alpizarin), which in complex treatment contribute to a faster recovery. After resolution of skin rashes, treatment is carried out by neuropathologists until the disappearance of neurological symptoms. The prognosis for herpes zoster is favorable, with the exception of gangrenous forms and forms complicated by meningoencephalitis.
According to the materials of the site http://www.rmj.ru/
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