References Differentials & Testing

The varicella zoster virus (VZV) is a DNA virus that is

caused by the human herpes virus 3. The virus usually
infects people during childhood and causes varicella
(chickenpox). After causing vesicular lesions of the skin,
the virus enters the dorsal root ganglia and lays dormant
in neuronal cell bodies. Due to acquired cell-mediated
immunity, the virus remains latent well throughout the
majority of life. The disease can be reactivated due to
numerous risk factors (Adams, Parnapy &Bautista, 2010).
The herpes zoster (HZ) infection is estimated to affect
one in three people during their lifetime. Two thirds of
people who develop this disease are over the age of 60
(Adams, Parnapy & Bautista, 2010).
There are approximately 1,000,000 cases of the HZ
disease that affect both men and women within the United
States annually (CDC, 2011).

Epidemiology
Risks & Transmission
Prevention
Risks
Anyone who has had the varicella-zoster virus in the
past (ex. children who were previously infected with
chickenpox; VZV)
Older adults; the risk increases with age due to a
natural decrease in overall immunity. The risk for
post-herpetic neuralgia (PHN) increases after the age
of 50
Those who are immunocompromised or
immunosuppressed (ex. HIV, AIDS, etc.)
Transmission
HZ can be spread from a person with an active
infection to a person who has never had the VZV. In
this instance, the person exposed to the virus might
develop chickenpox, but they would not develop
shingles.
The virus is only spread through direct contact with
uid from the rash blisters.
A person with active HZ can spread the virus when the
rash is in the blister-phase.
Transmission is not possible prior to the rash stage of
HZ. Once the rash has developed crusts, the person is
no longer contagious.
HZ is less contagious than the VZV, and the risk of a
person with shingles spreading the virus is low if the
rash is covered.
Herpes Zoster Virus

Tosha Wolfe, RN BSN, MSN-FNP student
Madeline Lane, RN BSN, MSN-FNP student
Faculty Sponsor: Dr. Kristine Anstine, PhD, APRN-BC
References available upon request
Rash
Before the rash develops, there is often pain, itching, or
tingling in the area where the rash will develop. This may
happen up to 1 to 5 days before the rash even appears.
The rash usually only occurs on one side of the face or
body.
The rash forms blisters that typically scab over in 710
days and clears up within 24 weeks.
In rare cases (usually among people with weakened
immune systems), the rash may be more widespread
and look similar to a chickenpox rash. The rash can
also affect the eye and cause loss of vision (A
diagnostic emergency).
Other symptoms can include:
Fever
Headache
Chills
Upset stomach
Medications & Guidelines
Antiviral Agents
Best if initiated within 72 hours of acute skin eruption.
Non-curative, but may decrease duration and symptoms,
and prevent or reduce PHN.
Valacyclovir 1 gm TID x 7 days
Acyclovir 800mg q4 hours x 7days
Famciclovir 500mg TID x 7 days
Analgesics
NSAIDs, acetaminophen, Tramadol, opioids.
Home Therapies
Benadryl (for itch), lotions (calamine), soothing baths
(Aveeno)
PHN pain treatment
Tricyclic antidepressants (amitriptyline, nortriptyline,
desipramine, maprotiline), Gabapentin (Neurotin),
Pregabalin (Lyrica) or Lidoderm patch or capsaicin
patch (Qutenza).
Signs and Symptoms
Differential Diagnosis
Rash: Contact dermatitis, Coxsackievirus, Herpes
simplex virus, Dermatitis herpetiformis, Eczema
herpeticum, Impetigo, Varicella
Pain: Depending upon distribution; angina, diabetic
neuropathy, pleuritis, cholecystitis
Testing
Diagnosis is based on clinical presentation
TzanckTtest: rapid conrmation, but does not distinguish
between HZ and HSV.
The Direct Fluorescent Antibody (DFA) test
Polymerase Chain Reaction (PCR) analysis
Varicella-Zoster specic IgM (serum)
Viral culture of rash
The only way to prevent HZ is through a live, attenuated
vaccine (Zostavax)
Zostavax is recommended for patients >60 yrs old,
regardless of varicella history. It is usually covered by
insurance on or after age 60.
Possible Complications
Post Herpetic Neuralgia
HZ Opthalmicus
Dissiminated HZ
Bacterial superinfection