Post on 02-Jun-2018
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HERPES ZOSTER
drg. Zaiviani Juniani K, Mkes
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DEFINITION
Herpes Zoster or shingles is an acute
inflammatory viral disease
Etiology
The causative organism is Varicella-
Zoster virus (human herpesvirus 3)
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HERPES ZOSTER (SHINGLES)
Caused by reactivation of a latent varicellazoster virus infection
Can occur years or decades after illness withchickenpox
Generally associated with normal aging andwith anything that causes reducedimmunocompetence
Lifetime risk of 32% in the United States Estimated 1 million cases zoster diagnosed
annually in the U.S.
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CLINICAL FEATURES
The thoracic, cervical, trigeminal, andlumbosacral dermatomes are the mostfrequently affected.
Oral Lesions occur if the second andthird branches of the trigeminal nerveare involved.
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ORAL LESIONS
Itching sensation and pain, which may
simulate pulpitis.
Ulcers heal in 2-3 weeks
Unilateral cluster of vesicles which rupture in
2-3 days, leaving painful ulcers surrounded
by a red zone
Post-herpetic trigeminal neuralgia and
osteomyelitis of the jaw bone are the most
common complication
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SKIN LESIONS
Intense pain associated with pruritus,
tingling, and tenderness
Painful eruption of vesicles or erythematous
bases which develop along a sensory
dermatome
Rash typically involves a single dermatome
and does not cross the midline but mayinvolve multiple dermatomes
Postherpenic neuralgia in 10-15% of cases
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COSTITUTIONAL SYMPTOMS
Fever
Malaise
Headache
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DIAGNOSIS
The diagnosis is usually made clinically
but may be aided by culture. Direct
fluorescent antibody test, serology,PCR.
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DIFFERENTIAL DIAGNOSIS
Herpetic gingivostomatitis
Necrotizing Ulcerative Gingivitis
Varicella Erythema multiforme
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TREATMENT
Patients should be isolated and stay
on the bed for 1 week
The diagnosis should be made andtreatment begun as early as
possible
Immunocompromised patients must
be hospitalized.
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SUGGESTED THER PIES
Antivirals :Valacyclovir 1 g three times dailty for 7 daysand famciclovir 500 mg three times daily for 7days are the drugs of the choice bcause of themore convenient does regimens than acyclovirTraditionally, oral acyclovir 800mg 5times daily
for 7 1 day has been used in treatment ofherpes zoster. High-dose acyclovir (30mg/kg
per day) for at least 7 days is recommendedfor the treatment of herpes zoster forimmunocompromised patients
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Analgesics, transquilizers, tricyclic anti-
depressant, anti-epileptics (carbamazepine,
gabapentin) has been used as a pain relief
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VERICELLA
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HERPES ZOSTER
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