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Pathophysiology
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
vii – The varicella zoster virus, which causes chickenpox, most often remains dormant in the trigeminal and dorsal root ganglia long after the initial infection subsides. In the immune-compromised individual, it may reactivate in a characteristic distribution of a specific dermatome. The severe, itchy and painful rash then becomes indicative of shingles.15
Skin infections
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Shankila Mittal, Rashmi Sarkar
The disorder often starts with paraesthesias or pain in the distribution of one or more dermatomes. Erythema followed by vesicles appears in segmental distribution (Figure 3.21). Later, the vesicles become pustular and then crust.ComplicationsPost-herpetic neuralgia: about 25–30% of patients with shingles continue to have pain and paraesthesiae in the affected dermatome long after the skin lesions have disappeared.Secondary bacterial infectionTreatment: Acyclovir reduces duration and severity of pain and healing time for rash if started within 72 hrs of onset of rash (same dose as varicella).Prevention: FDA has approved zoster vaccine in 2006 for adults over 60 years of age.
A Treatise on the Role of Herpesvirus in Neurodegeneration
Published in Abhai Kumar, Debasis Bagchi, Antioxidants and Functional Foods for Neurodegenerative Disorders, 2021
Bernard W. Downs, Manashi Bagchi, Bruce S. Morrison, Jeffrey Galvin, Steve Kushner, Debasis Bagchi, Kenneth Blum
Human alpha-herpes virus 3 (also known as varicella-zoster virus, VZV), one of the nine herpesviruses, affects humans [7,44]. It has been demonstrated to be responsible for chickenpox, mostly affecting children, teens, and young adults, and shingles in adults and rarely in children. In the United States, approximately 90% of adults acquired this virus in childhood, however, presently, most of the children and young adults are vaccinated with the live virus vaccine. Based on immunocytochemistry and in-situ hybridization data, Gray et al. [45] reported that VZV infected the CNS in 11 patients suffering from acquired immunodeficiency syndrome (AIDS). These researchers concluded that VZV infection of the CNS takes place regularly in AIDS patients. They further indicated that in non-AIDS patients VZV may spread to the CNS following a different pathway.
An unusual case of lower trunk brachial plexus zoster reactivation
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Samantha J. Burch, Elizabeth Shepard, Angelo B. Lipira
Herpes zoster, or shingles, is a common condition caused by reactivation of the varicella-zoster virus (VZV), a double-stranded DNA alphaherpesvirus [1]. Shingles is characterized by a two to three day prodrome of neuropathic pain prior to the eruption of vesicular skin lesions, although cutaneous findings are not required for diagnosis [2]. These skin lesions classically present in a dermatomal pattern, as VZV remains latent in the dorsal root ganglia after primary infection. While VZV primarily affects sensory nerves, motor weakness may be present in 1–5% of patients with herpes zoster [3]. Segmental Zoster Paresis involves motor weakness in the same dermatomal distribution as the vesicular rash, most commonly affecting the face and upper extremity [4]. Motor symptoms in the upper extremities following herpes zoster can also be classified as a mononeuropathy, radiculopathy, or brachial plexopathy, which are confirmed and monitored by electrophysiologic testing or MRI [3]. In most cases, neuropathic pain and motor symptoms resolve with time, however a subset of patients can experience postherpetic neuralgia (PHN) or persistent motor deficits, for reasons that remain poorly understood [5].
Recalcitrant Herpes Zoster Ophthalmicus in a Patient Discovered to Have Underlying Functional Natural Killer Cell Deficiency
Published in Ocular Immunology and Inflammation, 2022
Brent J. Deibert, Kurtis C. Johnson, Luke W. Desilet, Andrew C. Rorie
Natural killer cells are a vital part of the innate immune response. These cells are especially important in the body’s protection from viral infections. Varicella zoster virus (VZV) is essentially ubiquitous in the aging population. In those who experienced a childhood infection with VZV, known as chicken pox, the virus typically reactivates as the immune system wanes with age and is unable to keep the dormant virus contained. The re-activation of this virus causes the disease shingles, which presents as painful, dermatomal, vesicular lesion. This disease can affect almost every part of the body and is especially problematic when the eye is affected. In cases of immunodeficiency the course of the disease can be altered regarding age of onset or re-occurrence of the disease. Despite appropriate response from the adaptive immune system, deficiencies in cells of the innate response that preform viral surveillance can have a large impact on the disease course that would normally be self-limited.
Rhabdomyolysis after recombinant zoster vaccination: a rare adverse reaction
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Nishan Rajaratnam, Swati Govil, Rutwik Patel, Mohamed Ahmed, Sameh Elias
Herpes zoster, or shingles, is a frequent late sequela of varicella infection causing a painful rash. To prevent this outcome, the shingles vaccination has been recommended for older adults in the USA since 2006 in the form of an attenuated vaccine. In 2017, a new recombinant vaccine was approved, even for patients who had already received the attenuated version. It is recommended for adults above 50 years and reduces the risk of shingles by about 90% [1]. The vaccine is commonly known to cause mild, rather than severe, side effects such as injection site pain and erythema, headache, and nausea [1]. Rhabdomyolysis is classified as acute muscle injury that causes a release of electrolytes, myoglobin, and enzymes such as creatine phosphokinase (CPK) into circulation. It typically presents as muscle soreness, fatigue and may lead to kidney injury. We present a rare case of a patient developing rhabdomyolysis after administration of the recombinant zoster vaccination.