Herpes zoster and rheumatic disease 4.72/5 (18)

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ICD-10 B02.9 (without complications)

Zoster

Zoster with blisters on the right side of the neck. Wikimedia. CC BY SA 3.0

Definition

Herpes zoster (shingles, shingles) is caused by varicella virus which also provides Chickenpox in children. The most common symptom of herpes zoster is a collection of painful blisters in the skin, almost always on a single side of the body.

  • The infection does not cause rheumatic symptoms, but in a weakened immune system such as during immunosuppressive, anti-rheumatic treatment, after organ transplantation or in HIV infection, an infection can get serious

Disease Cause

Symptoms

  • Early signs are new headaches, fever and fatigue
  • After a few days occur
    • Burning, painful rash with blisters and redness in an area on one side of the body, often by the stomach or hip area, shoulder or face is typical.
    • Hypersensibility in the affected area is not uncommon.
    • If the eye is attacked (Zoster ophtalmicus), fast treatment is especially important to avoid permanent damage to vision.
    • The brain can be attacked in the form of meningitis and brain inflammation (meningo-encephalitist) and / or vasculitis (vascular inflammation) in the brain. Signs of vasculitis in brain arteries can be stroke after an infection with Herpes zoster, especially among younger people without other risk factors (reference: Schink T, Behr S, 2016). Some people get persistent pain in the skin area (neuralgia) which were attacked, although the skin changes are no longer present.

Contamination

Herpes zoster is contagious

  • Persons (small children) who have not had chickenpox can get infected and get chickenpox
  • Adult susceptible persons may get herpes zoster outbreaks.
  • To reduce the risk of infection, it is recommended that the diseased person be isolated from persons who should not be infected and the affected skin areas covered with tight dressing (reference: Bjark P, 2017)

Diagnosis

The diagnosis is made by typical symptoms and by recognizing the rash. The distribution that will follow one dermatom is important. Special investigations with virus detection PCR or electron microscopy are rarely necessary. Suspected vasculitis in the brain is investigated by angiography, investigation of spinal fluid og MRI. Rarely, paralysis (usually transient) occurs in the facial nerve (nervous facial).

Incorrect diagnosis (similar conditions, differential diagnoses)

Treatment

Drugs against virus infection reduce severity and duration, but do not prevent the disease.

  • Aciclovir (Zovirax, Valtrex) is most commonly used
  • It is important for the effect that treatment begins early in the course of the disease

Prognosis

  • The rash usually vanishes after 2-5 weeks
  • About 20% gets persistent pain (neuralgia).
  • More severe nerve damage may occur in some cases.
  • Some people get bacterial infection in the wounds after herpes zoster

Literature

Infections (Bindevevsykdommer.no)


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