Herpes zoster vaccine and the incidence of recurrent herpes. Image courtesy of the centers for disease control and prevention. Postherpetic neuralgia phn, defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of hz. Cuba 20012003 2001 2002 2003 provincias casos tasas casos tasas casos tasas. The incidence of herpes zoster hz is increasing and poses a significant health concern to aging populations. Viral meningitis may be suspected on the basis of epidemiologic data, clinical features, and initial cerebrospinal csf studies, but clinical features cannot reliably differentiate viral from bacterial meningitis. More detailed understanding of herpes zoster hz is called for in the context of an increasing observed frequency of disease, and ongoing discussions regarding potential consequences of the disease. Herpes zoster results from reactivation of the va ricella zoster virus. Herpes meningoencephalitis is an infection of the brain and brain covering meninges caused by the herpes simplex virus. This virus can be spread by sexual contact or from an. Herpes viruses include the herpes simplex viruses hsvs and varicella zoster virus the same virus that causes chickenpox and shingles. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent herpes zoster episode. Herpes zoster malattie infettive manuali msd edizione.
Varicellazoster virus encephalitis is a serious complication with an incidence of 1 to 2 per 10,000 cases of varicella in healthy persons and is. Herpes zoster encephalitis an overview sciencedirect. Herpes zoster and recurrent herpes zoster open forum. Complications of herpes zoster in children kanamori. It is more commom in elderly and inmunocompromised patients. Mollarets meningitis is a recurrent or chronic inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The potentially serious nature of herpes zoster hz and the longterm complication postherpetic neuralgia phn are often underestimated. Estudio epidemiologico nacional sobre herpes zoster en espana. Varicella outbreak control guidelines july 2014 page 1 of 14 varicella outbreak control guidelines infectious agent virus. Charleston, sc as is the case with herpes simplex, the diverse array of remedies proposed for herpes zoster hz raises doubts as to their overall efficacy. Mullooly jp, riedlinger k, chun c, weinmann s, houston h. It is a frequent condition in older adults, leading to undesirable adverse outcomes. Fewer than 4% of patients have another outbreak of zoster, but many, particularly older patients, have persistent. Herpes zoster is caused by the reactivation of the latent varicellazoster virus.
Objectives and methods as early diagnostic detection is mandatory to prevent longterm sequelae, any clinical indication is helpful to identify patients that are at higher risk of the development of. Herpes zoster is caused by the reactivation of the latent varicella zoster virus. Abstract herpes zoster hz results from the reactivation of the varicella zoster virus latent in the sensory ganglia when cellmediated immunity is altered. The disease may also be caused by herpes virus type 2 hsv2. We report an unusual case of an immunocompetent young adult presenting with occipital headache and zoster rash, without preherpetic and postherpetic neuralgia, who was diagnosed with varicella meningitis on polymerase chain. Phn may last a year or longer after the episode of zoster. Transmission from patients with varicella and herpes zoster primarily via respiratory route following aerosolization of infective viral particles from skin lesions, also direct contact. Encephalitis is caused by the herpes simplex virus. Background herpes zoster hz is caused by reactivation of latent varicellazoster virus vzv infection. Furthermore, mild cases of herpes simplex virus hsv me, traditionally considered a devastating infection, are frequently reported.
Su complicada posologia lo relega solo a tratamientos intravenosos en casos complicados. O herpeszoster hz e uma doenca infecciosa relativamente comum provocada pela reativacao do vvz caracterizada por manifestacoes cutaneas dolorosas 36. Rapid antiviral therapy initiated within 72 h of rash onset has been shown to accelerate rash healing, reduce the duration of acute pain and, to some extent, attenuate the development and duration of phn. Pain is the predominant symptom in all phases of hz disease, being reported by up. Viral meningitis accounts for approximately 26,000 to 42,000 hospitalizations each year in the united states, affecting mainly infants younger than one year, children 510 years of age, and the immunocompromised. We report varicella zoster virus vzv meningitis in a healthy adult woman with no antecedent rash and with hypoglycorrhachia. Pdf risk factors for aseptic meningitis in herpes zoster. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. This case describes an uncommon presentation of herpes zoster in an adolescent with viral meningitis and concomitant genital shingles. Symptoms can include headache, fever, changes in consciousness, confusion, neck stiffness, sensitivity to light, seizures, and changes in mood, personality, or. A viral prodrome is common, including headache, malaise, and photophobia followed by pain. The most common symptoms are fever, headache, and neck stiffness.
A painful rash, usually crops of vesicles on an erythematous base, develops on one or more adjacent dermatomes. Background acute meningoencephalitis me from varicella zoster virus vzv reactivation is a rare and serious complication of herpes zoster hz. Herpes zoster vaccine and the incidence of recurrent herpes zoster in an immunocompetent elderly population article in the journal of infectious diseases 2062. Varicella zoster virus vzv, a member of the herpes virus group clinical manifestations primary infection chickenpox symptoms prodrome o a. Introduction varicellazoster virus vzv is a herpes virus causing varicella, which latently persists in the nervous system through. Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation allobmt. He complained of acute headache, nausea, and vomiting. Here we report a young otherwise healthy man diagnosed with a vzv meningitis without rash.
Herpes zoster can occur at any age but most commonly affects the elderly population. More than 90% of adults in the united states have serologic evidence of vzv infection. Por tanto, e muito importante prevenir, diagnosticar e tratar precocemente o hz e suas complicacoes. Varicellazoster virus reactivation leads to herpes zoster the main complication of which is postherpetic neuralgia phn. Herpes zoster, also known as shingles, results from reactivation of latent vzv that gained access to sensory ganglia during varicella. Herpes zoster ophthalmicus is a latent vzv infection involving the ophthalmic division of the trigeminal nerve. The impact of herpes zoster and postherpetic neuralgia on. The chickenpox virus is also called varicella zoster. Varicella meningitis with concomitant genital shingles in. It is a medical emergency that requires treatment right away. Vzv was isolated from vesicular fluid of both chickenpox and zoster lesions in cell culture by thomas weller in 1954. Typically, it affects elderly, immunocompromised population. Varicella virus is a neurotropic virus that can reactivate later in life to cause zoster or shingles. The appropriate treatment was indicated and either the lesions or the associated symptoms disappeared.
A metaanalysis of stroke risk following herpes zoster. Herpes zoster is caused by reactivation of the varicella zoster virus the cause of chickenpox from its latent phase. Herpes zoster postherpetic neuralgia phn, or pain in the area of the ocurrence that persists after the lesions have resolved, is a distressing complication of zoster. Varicella can infrequently lead to encephalitis resulting in seizures and coma estimated. Subsequent laboratory studies of the virus led to the development of a. Meningitis caused by varicella zoster virus vzv is rare in healthy population. To describe the clinical manifestations, cerebrospinal fluid csf characteristics, imaging studies and prognostic factors of adverse clinical outcomes aco among adults with herpes simplex virus hsv or varicella zoster virus vzv cns infections.
Since mollarets meningitis is a recurrent, benign noncancerous, aseptic meningitis, it is also referred to as benign recurrent lymphocytic meningitis. We previously reported that reactivation of vzv caused herpes zoster hz in all age groups, especially in the elderly, at rates of 38 per personyears in a study of 48 388 patients with hz. Varicella zoster virus is responsible for about 11% of those cases. Hzassociated aseptic meningitis, a rare complication of hz, can require hospitalization and a long treatment period. Herpes zoster is characterized by a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution. A 15yearold immunocompetent girl with background of wellcontrolled graves disease presented with 3 days of fever, frontal headache, terminal neck stiffness and photophobia. The virus has the capacity to persist in the body as a latent infection after the primary. Two days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400 mg three times a. Shingles, or herpes zoster, is a painful rash caused by the chickenpox virus. Cerebrospinal fluid csf examination revealed the presence of vzv dna, antivzv immunoglobulin g igg antibody, and.
Herpes zoster with skin lesions and meningitis caused by 2. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Approximately one in three persons in the general population will develop zoster during their lifetime. Incidence of herpes zoster and associated events including. The epidemiology, clinical manifestations, diagnosis, and prevention of herpes zoster are discussed elsewhere. The objective of this article is to provide evidencebased recommendations for the management of patients with herpes zoster. A case of disseminated zoster in an immunocompetent patient. Approximately 1 mil lion new cases of zoster occur in the united states annu ally. Mar 15, 2012 varicella zoster virus vzv is increasingly recognized as an important etiology of sporadic viral meningoencephalitis me. Herpes zoster with progression to acute varicella zoster. Risk factors for aseptic meningitis in herpe s zoster patients article pdf available in annals of dermatology 293. Varicellazoster virus vzv infection causes varicella and results in latent infection in the sensory ganglia.
Herpes simplex and varicella zoster cns infections. The frequency of hz among children who receive varicella vaccine is uncertain, although some experts have suggested that it is much lower than the. Herpes viruses are the other common cause of viral meningitis in adolescents and adults in developed countries2. It was named for pierre mollaret, the french neurologist who first described it. Jul 15, 2012 the risk of herpes zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. A viral prodrome is common, including headache, malaise, and photophobia. The main com plication of herpes zoster is the postherpetic neu. Only a few cases have been described in the literature, most of which involved adult or elderly patients. Varicella zoster meningoencephalitis following treatment. This book focuses on the similarities in tissue tropisms and character of the lesions of the two viruses.
Recommendations for the management of herpes zoster. The potential manifestations include chickenpox, herpes zoster, postherpetic neuralgia, aseptic meningitis and encephalitis, ramsay hunt syndrome, and herpes ophthalmicus. Nov 29, 2019 risk for zoster up before diagnosis, during treatment of hematologic cancer. The previously dormant virus travels from the dorsal root ganglion and down the sensory nerves to the skin to cause the classic single, unilateral dermatome rash that is typically associated with a shingles infection. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. The reactivated vzv may travel down the ophthalmic division to the nasociliary nerve, which innervates the tip of the nose and surface of the globe of the eye. Clinical manifestations and treatment provides an authoritative and updated clinical observation on two viruses herpes simplex varicella and zoster.
Thus, populationbased data on incidence and complications of hz are needed. Herpes zoster hz caused by reactivation of latent vaccinestrain varicella zoster virus vzv in sensory ganglia constitutes an additional, usually late, complication of varicella vaccination. This was preceded by 4 days of pain and itch over vaginal and anal region. Several studies suggest an increased risk of stroke following zoster infection, but the results are conflicting. Etiologic agent herpes zoster shingles is caused by the same virus as chickenpox, the varicella zoster virus vzv. Varicella zoster virus meningitis with hypoglycorrhachia. Caso clinico varicela y herpes zoster en una paciente con. The development of neurological complications due to varicella zoster virus vzv reactivation is relatively uncommon, particularly in the case of immunocompetent patients. A case of meningitis due to varicella zoster virus. Shingles herpes zoster 2 shingles herpes zoster 1 the disease and its epidemiology i. The clinical course of herpes zoster, in patients of primary health care and younger than 60 years of age, is beningn and without complications. Most are caused by herpes simplex virus type 1 hsv1, the virus that also causes cold sores.1449 938 802 1041 1336 551 885 599 251 1140 1226 609 625 1120 1385 999 128 662 29 1108 1503 1323 711 325 1351 1076 731 559 736 139 1195 312 697 779