What Is Disseminated Herpes Zoster?

Shingles is an acute infectious skin disease caused by the varicella-zoster virus. Chickenpox develops in children who are not immune to the virus. Some patients become infected with the virus without symptoms. Because the virus is neurotropic, it can lurk in the neurons of the spinal nerve's posterior root ganglia for a long time after infection. When the resistance is low or tired, infected, and cold, the virus can grow and reproduce again and move along the nerve fibers to the skin. Causes intense inflammation of affected nerves and skin. The rash is generally unilateral and distributed by nerve segments. It consists of clustered herpes and is accompanied by pain; the older the person, the more severe the neuralgia. The disease is common in adults and is more common in spring and autumn. Incidence increased significantly with age.

Basic Information

English name

herpes zoster

Visiting department

dermatology

Multiple groups

Adults

Common causes

Virus enters blood through respiratory mucosa to form viremia

Common symptoms

The skin rash is distributed along the nerve, and the pain is intolerable

Causes of shingles

Human is the sole host of varicella-zoster virus. The virus enters the blood through the respiratory mucosa to form viremia, and varicella or latent infection occurs. Later, the virus can lie in the spinal cord root ganglia or cranial nerve sensory ganglia for a long time. When the body is subjected to some kind of stimulus (such as trauma, fatigue, malignant tumor, or weakness after illness), the latent virus is activated, and the sensory nerve axon descends to the inner area of the nerve to replicate and produce blister. At the same time, inflammation and necrosis of the affected nerve occur, and neuralgia occurs. After the disease is cured, a longer-lasting immunity can be obtained, so it usually does not recur.

Clinical manifestations of shingles

Typical performance

There may be systemic symptoms such as mild fatigue, low fever, and poor appetite before the rash. The affected skin may feel sensation of burning or neuralgia, and there is obvious pain sensitivity, which lasts for 1 to 3 days. It may also occur without prodromal symptoms. The most common sites are the intercostal, cervical, trigeminal, and lumbosacral nerves. The affected area often appears first with flushing spots, and soon appears miliary to soybean-sized papules, clustered and not fused, and then quickly turns into blisters, the blister wall is tense and shiny, the blister fluid is clarified, the periphery is surrounded by redness, and the blisters in each cluster The skin is normal; the skin lesions are arranged in a band along a peripheral nerve, and most of them occur on one side of the body, and generally do not exceed the midline. Neuralgia is one of the characteristics of this disease, which can appear before the onset or accompanied by skin lesions. Older patients are often more severe. The course of the disease is usually 2 to 3 weeks, with temporary blush or pigmentation left after the blisters have dried up and the scabs have fallen off.

2. Special performance

(1) Herpes zoster is a virus that invades the trigeminal nerve branch of the eye, which is more common in the elderly. The pain is severe and can involve corneal ulcerative keratitis.

(2) Herpes zoster is caused by the virus invading the facial nerve and the auditory nerve, and is manifested as external ear canal or tympanic herpes. When the geniculate ganglion is involved in the motor and sensory nerve fibers of the facial nerve, a triad of facial paralysis, ear pain, and external ear canal herpes can occur, which is called Ramsay-Hunt syndrome.

(3) Postherpetic neuralgia Herpes zoster is often accompanied by neuralgia, which can occur before the rash, during the rash, and after the skin has healed, but it usually disappears after the skin has completely subsided or disappears within 1 month. A few patients have neuralgia that lasts for more than 1 month, and is called postherpetic neuralgia.

(4) Other atypical shingles are related to the difference in the patient's body resistance, and can be expressed as frustration (no skin lesions and only neuralgia), incomplete type (only erythema, papules, and blisters disappear). Large Blistering, hemorrhagic, gangrene, and pandemic (simultaneously involving more than 2 ganglia to produce contralateral or ipsilateral multiple skin lesions); the virus can spread through the blood to produce widespread varicella-like rash and invade the lungs and brain Other organs are called disseminated shingles.

Shingles diagnosis

1. Clustered blisters appeared on the diseased skin, which were distributed along the peripheral nerve on one side.

2. There is obvious neuralgia with local lymphadenopathy.

3. The middle skin is normal.

Differential diagnosis of shingles

1. The disease sometimes needs to be distinguished from herpes simplex, which occurs at the junction of the skin and mucous membranes. The distribution is irregular, the blisters are small and easy to break, and the pain is not common. They are more common in the course of fever (especially high fever). Easy to relapse.

2. Occasionally, it is confused with contact dermatitis, but the latter has a history of contact. The rash has nothing to do with nerve distribution, conscious burning, itching, and no neuralgia.

3. In the prodromal stage of herpes zoster and herpes zoster herpes, those with significant neuralgia are likely to be misdiagnosed as intercostal neuralgia, pleurisy, and acute appendicitis such as acute abdomen, which requires attention.

4. Herpes simplex usually has the same site and has a history of multiple relapses, but this phenomenon does not appear in patients with shingles without obvious immunodeficiency. Isolating a virus or detecting VZV, HSV antigen or DNA from vesicular fluid is the only reliable method for differential diagnosis.

Shingles complications

Concurrent bacterial infection

Shingles lesions that occur in specific areas, such as the eyes, can have serious consequences. If secondary bacterial infections occur, pancreatitis or even meningitis can occur, resulting in sequelae such as decreased vision, blindness, and facial paralysis.

2. Postherpetic neuralgia

Herpes zoster is mostly distributed in the front of the head, the first branch of the trigeminal nerve, which can cause hair loss and permanent scarring. After the skin lesions of herpes zoster have healed, the pain can persist for some time. Some elderly patients can suffer from neuralgia for several months or years, which can seriously affect sleep and mood. The degree of pain is heavier. Those with longer duration can cause mental anxiety and depression.

3. May induce keratitis, corneal ulcers, and conjunctivitis

Shingles can occur in the trigeminal nerve segment of the face. There is a nerve fiber in the trigeminal nerve, namely the eye nerve fiber. Part of the nerve fiber is distributed in the cornea, conjunctiva and even the entire eyeball of the human eyeball. Infections can occur with keratitis, corneal ulcers, and conjunctivitis. Patients can suffer from photophobia, tears, and eye pain, which can cause vision loss. In severe cases, pancreatitis can lead to blindness. When herpes virus infects the motor nerve fibers in the facial nerve, facial paralysis will occur, and the affected side's eyes cannot be closed, the affected side's facial expressions are dull, the corners of the mouth are skewed to the healthy side, and it is impossible to perform air blowing.

4. Causes inner ear dysfunction

Shingles that occur in the ear and ear canal can cause symptoms of inner ear dysfunction. The patient presented with dizziness, nausea, vomiting, hearing impairment, and nystagmus.

5. Causes viral encephalitis and meningitis

When the herpes virus invades the central nervous system from the nerve roots in the spinal cord, that is, the human brain's parenchyma and meninges, viral encephalitis and meningitis will occur, manifested as severe headache, jet-like vomiting, convulsions, and limb convulsions. And consciousness, coma, and danger to life. When the herpes virus invades visceral nerve fibers from the nerve roots in the spinal cord to the body, it can cause acute gastroenteritis, cystitis, and prostatitis, manifested as abdominal cramps, dysuria, and urinary retention.

Shingles prevention

Drug therapy

(1) Antiviral drugs Acyclovir, valacyclovir or famciclovir can be selected.

(2) Neuralgia drug treatment Antidepressants The main drugs are paroxetine (Celote), fluoxetine (Baiyoujie), fluvoxamine, sertraline, etc. Anticonvulsants include carbamazepine, Valproate Narcotic analgesics Analgesics represented by morphine. The available drugs are morphine (mescontin), oxymorphone (oxcontin), oxycodone, fentanyl (Dorigi), dihydroetofi, lugek, etc. Non-narcotic analgesics include NSAIDs, tramadol, aconite alkaloids, and capsaicin.

2. Nerve block

When severe pain medications are difficult to control, direct and effective sensory block therapy should be considered. The choice of block location should depend on the extent of the lesion and the response to treatment. The general principle should be from shallow to deep, from simple to complex, from the peripheral to the neural stem and nerve root.

3. Nerve damage

Radiofrequency temperature-controlled thermocoagulation for nerve damage is the most direct and effective method of treatment. Nerve damage treatment also includes medial thalamus stereotactic radiation therapy (gamma knife or X knife), surgical subdural spinal cord dorsal root damage, pituitary damage, sympathetic stem ganglion damage, etc.