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Flashcards in Shingles Deck (16)
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1
Q

What is the epidemiology of shingles?

A

More common in the over 65s and immunocompromised

2
Q

What is the aetiology and pathophysiology of shingles?

A

Caused by varicella zoster virus (VZV) reactivating (herpes virus 3); a double-stranded DNA virus

Lies dormant in the dorsal root ganglia of the spine, becomes reactivated and migrates down sensory nerves

Anyone who has previously had chickenpox may develop shingles

Can occur in childhood but more common in elderly

Once one episode has occurred, secondary reactivation is rare – 1%

3
Q

What are some triggers for shingles?

A

Often affects people with poor immunity

Pressure on nerve root

Radiotherapy at the level of the nerve root

Spinal surgery

Infection

Injury (not necessarily to the spine)

Contact with someone with VZV

4
Q

What is the time course of a shingles episode?

A

Symptoms subside as eruption disappears

Uncomplicated cases last 2-3wks in children/young adults and 3-4 in older patients

5
Q

How does shingles present?

A

Pain – stabbing/burining, itching, paraesthesia; can be painless in children

Headache, fever, malaise; enlarge local lymph nodes

Rash – develops up to 3 days following pain unilateral (most frequently), thoracic/cervical/ophthalmic/lumbosacral areas most commonly affected, confined to a specific dermatome and not crossing the midline, red papules that blister/become pustular then crust over

6
Q

What are some complications of shingles?

A

Bilateral/several dermatomal involvement

Deep blisters that destroy skin – scarring

Muscle weakness - facial nerve palsy = most common = Ramsay Hunt syndrome

Infection of internal organs including encephalitis, hepatitis etc – disseminated VZV

Post herpetic neuralgia

7
Q

What is post herpetic neuralgia?

A

Persistence/recurrence of pain in same area more than 1 month after the onset of herpes

Increasingly common with age – 1/3 people

Particularly likely in facial

Continuous burning sensation, increased sensitivity, shooting pain, or itch (neuropathic pruritis)

May respond to topical anaesthetics/capsaicin, amitriptyline, gabapentin/pregabalin, BOTOX, acupuncture

8
Q

How do you investigate shingles?

A

Usually clinical Dx

Viral PCR of lesion swabs

Can be confused with: Herpes simplex; Dermatitis herpetiformis; Impetigo; Contact dermatitis; Candidiasis; Drug reactions; Scabies; Insect bites

9
Q

How do you manage shingles?

A

Paracetamol + rest

Keep rash clean/dry to reduce infection risk; PO ABx for any secondary bacterial infections

Wear loose fitting clothing; cool compress; no plasters

10
Q

What antiviral treatment can be used for shingles?

A

Reduction of pain and duration if started within 1-3 days of

Acyclovir 800mg 5x day 7 days
i) Also valaciclovir and famciclovir

11
Q

How do you manage the shingles infection risk?

A

Herpes zoster is infection to people who have not had chickenpox
i) Especially bad for pregnant women so avoid

Away from the ill/immunocompromised

Away from babies less than 1 month old (unless its yours)

Stay off school/work until the rash scabs – only infections whilst oozing fluid

You cant get shingles from someone with chickenpox but you can get chickenpox from someone with shingles if you haven’t had it before

12
Q

What is the vaccination procedure for shingles?

A

Risks of complications are greater in elderly – NHS zoster vaccination available for 70< cuts risk of infection by 50%

In those that get it but are vaccinated – less severe and post hepatic neuralgia rarer

13
Q

What is Ramsay hunt syndrome?

A

Rare peripheral facial neuropathy secondary to VZV reactivating in the geniculate ganglion of CN7 supplying facial nerve

5/100,000; F>M; more common with age

12% of all facial nerve palsies; 2nd most common cause of non-traumatic facial paralysis

14
Q

How does Ramsay Hunt syndrome present?

A

General unwellness

Unilateral facial weakness – sometimes several days before blisters; painful blisters in the ipsilateral ear canal or mouth (though may be absent); loss of sensation/taste in the anterior 2/3rds of the tongue; dry eyes/mouth;

Occasional involvement of CN8 – dizziness, N+V; can spread to other CNs

15
Q

How is Ramsay Hunt diagnosed?

A

Usually clinical Dx

Confirmation with VZV PCR assay using ear exudate useful for distinguishing zoster sine herpete (without blisters) from Bell’s palsy

16
Q

What is the treatment and prognosis for Ramsay hunt?

A

Treatment same as shingles

Poorer prognosis than Bell’s palsy – complete recovery less likely if antiviral treatment not started within 72hrs of onset