Herpes zoster presentation by Dhananjay Mundhe

Short information about herpes zoster disease

1. Herpes Zoster Infection Presented By Mundhe Dhananjay Balaji Final Year B.Pharm Roll No.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: Varicella (chickenpox) Herpes zoster (shingle)

6. Signs And Symptoms The first signs of shingles may include: Headache Feeling generally unwell Myalgia 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 The characteristic skin rash may be diagnostic. Tissue culture technique- the virus may be isolated from fluid taken from newly developing vesicles Smear of vesicle fluid Microscopy

11. Acute Stage A rash will begin to develop, often causing a pain. Itching or tingling sensation in the area of the affected nerve. A fluid filled painful rash then develops a few days after and commonly occurs either on one side of the face or body. 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: Acyclovir ( Zovirax ) Valacyclovir (Valtrex) 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 Apply cool water compresses to the skin or soak in a bathtub filled with cool water Add finely ground oatmeal to the bathtub Apply calamine lotion to the affected areas. Trim your fingernails to avoid infection. 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 https://medicine.umich.edu/sites/default/files/content/downloads/RockwellPamelaDecember5UpdateHerpesZoster.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876683/ https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/herpes-zoster.pdf https://www.slideshare.net/gohilvishal912/herpes-zoster-52977690 https://www.slideshare.net/rozymea/herpes-zoster-shigella-ncm-104