Short information about herpes zoster disease

1. Herpes Zoster Infection
Presented By
Mundhe Dhananjay Balaji
FinalYearB.Pharm
RollNo.60
PRN:- 1131920046416
Dattakala Shikshan Sanstha’s
Dattakala College of Pharmacy

2. Content
Introduction
Virus
Epidemiology
Pathophysiology
Causes and Risk Factors
Clinical Symptoms
Diagnosis
Acute Stage
Complications
Management of HZ
Treatment
Prevention
Prognosis
 Reference

3. Introduction
• Herpes zoster/shingles is a viral infection of the nerve cells
and surrounding skin, caused by the varicella zoster virus that
also causes chickenpox.
• After a person recovers from chickenpox infection, the virus
remains dormant in the nerve cells and can reactivate at a later
stage when the immune system is weakened.
• Reactivation can be associated with older age, having
chickenpox before 18 month of age or immunosuppression.

4. Herpes Zoster Virus
Herpes zoster, or shingles, is a common viral infection of the
nerves, which results in a painful rash of small blisters on a strip
of skin anywhere on the body. Even after the rash is gone, the
pain may continue for months. Shingles is relatively rare in
children.
Primary infection results in varicella (chickenpox).
Recurrent infection results in herpes zoster (shingles).

5. Varicella zoster virus
• Varicella-zoster virus (VZV) infection causes two
clinically distinct forms of disease:
1. Varicella (chickenpox)
2. Herpes zoster (shingle)

6. Signs And Symptoms
o The first signs of shingles may
include:
Headache
Feeling generally unwell
Myalgia
o Shingles Symptoms :
Red, blistering rash that typically
emerges along on side of the torso.
Burning, tingling, or pain in the affected
area.
Sensitivity to light
Fever and/or headache

7. Mode Of Transmission
Herpes zoster can be transmitted through direct contact,
specifically, through droplet infection and airborne spread.
 It can also be transmitted through indirect contact, e.g., articles
freshly soiled by secretions and discharges from an infected
person.

8. Pathophysiology
 VZV enters through the respiratory tract
 Viral replication in regional lymph nodes
 Primary viremia in bloodstream
 Further viral replication in liver and spleen
 Secondary viremia
 Enter into nerve endings and transport to dorsal root ganglia (DRG) where
it lies DORMANT in sensory nerve ganglia, dorsal root.
 Reactivation in dorsal root ganglia
 Infection of nerves and dermatomy
 Herpes zoster

9. Causes and Risk Factors
• Age:-Common in people older than 50.
• Diseases:-That weaken the immune system, such as
HIV/AIDS and cancer.
• Cancer treatments:-Undergoing radiation or
chemotherapy can lower the resistance to diseases and
may trigger shingles.
• Immunosuppresant Drugs:- Prolonged use of
steroids, such as prednisone.

10. Diagnosis
Diagnostic Exam
i. The characteristic skin rash may be diagnostic.
ii. Tissue culture technique- the virus may be isolated from fluid
taken from newly developing vesicles
iii. Smear of vesicle fluid
iv. Microscopy

11. Acute Stage
A. A rash will begin to develop, often causing a pain.
B. Itching or tingling sensation in the area of the affected
nerve.
C. A fluid filled painful rash then develops a few days after
and commonly occurs either on one side of the face or
body.
D. Fluid-filled blisters that break open and crust over in 7-
10 days and this clears within 2-4 weeks.Herpes Zoster
Blisters.

12. Complications
 Post herpetic neuralgia (PHN):-
Post herpetic neuralgia can cause severe nerve pain that
persists after the rash. PHN occurs most often in elderly
people and in people whose immune systems have been
compromised
 Ophthalmic shingles:-
Shingles in or around an eye can cause painful eye
infections.

13. Management of HZ
Antiviral medication to reduce pain and complications. Should
be started within 24 hours of first symptoms.
These medications include:
o Acyclovir (Zovirax)
o Valacyclovir (Valtrex)
o Famciclovir (Famvir)

14. Management of Post Herpetic Neuralgia
Tricyclic antidepressants, such as amitriptyline.
Opioids, such as methadone, morphine.
Lidocaine patch.
Anticonvulsants, such as gabapentin.
Antidepressants , Seroxat 20
Capsaicin cream.
Topical anesthetics, including benzocaine.Benzodent

15. Non Pharmacological Treatment
o Apply cool water compresses to the skin or
soak in a bathtub filled with cool water
o Add finely ground oatmeal to the bathtub
o Apply calamine lotion to the affected areas.
o Trim your fingernails to avoid infection.
o Wear loose-fitting clothing.

16. Medication
Conservative management
Antiviral: Acyclovir, famciclovir, valacyclovir within 72 h of
rash on skin
Corticosteroids: Prednisoone
Analgesics: NSAIDs, acetaminophen, opiods,
Topical therapy: Lidocaine, 8% capsaicin, acyclovir ointment
Combination therapy: Acyclovir + UVB, acyclovir
prednisolone

17. Prevention
 Shingles vaccine (Zostavax)
 It is given to people 60 years of age and older who have
already had the chickenpox.
 The shingles vaccine is a live vaccine given as a single
injection, usually in the upper arm. The most common side
effects of the shingles vaccine are redness, pain, tenderness
and swelling at the injection site, and headache

18. Continued…
Vaccine Storage and Handling
Before reconstitution, both lyophilized antigen
component vials and adjuvant suspension component vials
should be stored refrigerated between 2°C and 8°C (36°F
and 46°F) and protected from light. After reconstitution, use
immediately or store refrigerated between 2°C and 8°C
(36°F and 46°F). Discard if not used within 6 hours of
reconstitution or if frozen. Manufacturer package inserts
contain additional information

19. Prognosis
• Many cases of shingles go away by themselves, with
or without treatment.
• The rash and pain should be gone in two to three
weeks.
• However, shingles may last longer and be more
likely to recur if the person is older, especially older
than 50 years of age, or if they have a serious medical
problem.

20. References
1) https://medicine.umich.edu/sites/default/files/content/downl
oads/RockwellPamelaDecember5UpdateHerpesZoster.pdf
2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876683/
3) https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/he
rpes-zoster.pdf
4) https://www.slideshare.net/gohilvishal912/herpes-zoster-
52977690
5) https://www.slideshare.net/rozymea/herpes-zoster-shigella-
ncm-104