HERPES VIRUS VARICELLAE AND CHICKENPOX

By: ELAINE N. ZAFE BATCH 2012 - 4B2

Signs and symptoms: Eruptive Pruritic rash Characteristics: various stages of evolution (Celestial Map) Macule Papule Vesicle Pustule Crust Centripetal Representation

VARICELLA ZOSTER VIRUS (SHINGLES/ ACUTE POST. GANGLIONITIS)

Etymology: Zoster = Greek zstr = "belt" or "girdle", after the characteristic belt-like dermatomal rash Shingles = Latin cingulus, a variant of Latin cingulum meaning "girdle" Definition:

The Pathogen: a double-stranded DNA virus: human herpesvirus-3 subfamily Alphaherpersviridae only one serotype is known humans are the only reservoir

Tx: Oral Acyclovir - 800mg 3x/ day in 5 days Calamine Lotion Antipyretics Antihistamines Dont give ASPIRIN !!! (Reye Syndrome) Nrs Mgmt: Is an acute viral infection of the sensory nerve caused by a variety of chickenpox virus Causative agent: Human herpesvirus 3 (alpha) or varicella zoster virus (VZV) Herpes Zoster Reactivation of varicella zoster virus Associated with: aging immunosuppression intrauterine exposure varicella at <18 month of age

Varicella Virus Herpesvirus (DNA) Primary infection results in varicella (chickenpox, mainly a childhood disease Recurrent infection results in herpes zoster (shingles) Short survival in environment

Incubation Period: 10 21 days Prolonged if vaccinated respiratory isolation prevent secondary infection of the skin lesion disinfection of belongings hand washing provide activities observe oral and nasal care

Period of Communicability: A day before 1st lesion eruption 5 days after last crop appearance

Incubation Period: Preventive Measures: Avoid exposures to infected persons Patient isolation 13 17 days

Transmission: The virus is transmitted by direct contact with the rash Airborne respiratory droplets vertical transmission (mother to baby) during pregnancy can transmit the virus for up to 48 hours before rash appears and remains contagious until all spots crust over little genetic variation no animal reservoir

Period of Communicability: A day before 1st rash until 5 6 days after last crop appearance

Prophylaxis: Varicella Vaccine: Varivax 1-1 yrs old Single dose 0.5cc SQ deltoid 13 yrs old Two doses (1 month interval)

Transmission: The virus is transmitted by direct contact with the rash Airborne respiratory droplets Indirect contact

Pathogenesis: Varicella Pathogenesis: Respiratory transmission of virus Replication in nasopharynx and regional lymph nodes Repeated episodes of viremia Following varicella, the virus persists in multiple tissues, sensory nerve ganglia, from where it may later be reactivated to cause herpes zoster (Shingles) Dormant VZV in dorsal nerve root ganglia Recurrence (immunosuppression) Produces localized vesicular skin lesions in dermatome and severe neuralgic pain in the peripheral areas innervated by the nerves arising in the inflamed root ganglia

Signs and symptoms: Erythematous Vesicles (after 1 day) Patches Eruptions (unilateral) Pustular Crusts (1-2 wks) Pain 1-5 days prior to rash Burning or stabbing Worse @ night upon movement Fever Malaise Anorexia Headache Opthalmic or 5th CN is affected = Corneal anesthesia Gasserian Ganglionitis

Facial palsy present as Loss of wrinkles on forehead Asymmetrical face. Unable to close eye. Bells phenomenon. Dribbling of saliva from angle of mouth. Epiphora. Hyperacusis. Loss of taste Tx: Acyclovir Analgesics Anti-inflammatory

Nrs Mgmt: strict isolation prevent secondary infection of the skin lesion disinfection of articles apply cool, wet dressings with NSS to pruritic lesions (KMO4: astringent, bactericidal, oxidant) assess degree of pain and to avoid neuralgic pain do not delay analgesic administration as prescribed encourage sufficient bed rest provide activities

CHICKENPOX PREVENTION VACCINATION FOR HERPES ZOSTER Signs and symptoms: ZOSTAVAX Vaccine Paralysis of the facial nerve and vesicles in the ext. auditory canal affects the 7th CN = Ramsay Hunt Syndrome It is live but weakened version of varicella vaccine Given as single dose to prevent herpes zoster at >60 yrs. Administered on upper arm SUBCUT. Effectivity in preventing HZoster ~50% at >60 yrs. ~18% at >80 yrs. Even if it do not prevent herpes zoster, it reduces complication post herpetic neuralgia, scaring and vision problem Side effect headache and local site reaction

It is characterized by 1) Pain and vesicle in ext. auditory canal 2) Loss of taste in ant. 2/3rd of tongue 3)Ipsilateral facial palsy May present as earache 2-3 day prior to Vesicular eruption.