Herpes Zoster

Herpes Zoster is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Commonly known as shingles and abbreviated HZV
  • Incidence of 3–5 per 1,000 person-years; 6–8 per 1,000 person-years in patients 60 or older
  • Commonly characterized by unilateral eruption of painful vesicles along a single dermatome although atypical presentations exist including glioma formation
  • Increased risk of dissemination, complications, and death in immunocompromised hosts
  • Risk factors include:
    • Female gender
    • White race
    • Family history in a dose-dependent manner
    • Presence of autoimmune diseases
    • Comorbid conditions including CKD, DM, COPD, asthma, depression
    • Physical injury
    • Statin use
  • Increased risk of stroke and myocardial infarction in the 3–12 mo following occurrence due to HZV-induced vasculopathy in those aged >50

Etiology

  • Caused by varicella zoster virus (VZV), a dsDNA virus in the Herpesviridae family
  • Reactivation of dormant virus in dorsal root, cranial nerve, and autonomic nerve ganglia
  • Majority of cases in patients with a history of chickenpox (VZV) but also seen as recurrence from prior vaccination

Pregnancy Considerations
HZV during pregnancy is not associated with maternal or obstetric morbidity


Pediatric Considerations
May occur in childhood, most commonly when primary varicella occurred in utero or in the first 6 mo of life

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Basics

Description

  • Commonly known as shingles and abbreviated HZV
  • Incidence of 3–5 per 1,000 person-years; 6–8 per 1,000 person-years in patients 60 or older
  • Commonly characterized by unilateral eruption of painful vesicles along a single dermatome although atypical presentations exist including glioma formation
  • Increased risk of dissemination, complications, and death in immunocompromised hosts
  • Risk factors include:
    • Female gender
    • White race
    • Family history in a dose-dependent manner
    • Presence of autoimmune diseases
    • Comorbid conditions including CKD, DM, COPD, asthma, depression
    • Physical injury
    • Statin use
  • Increased risk of stroke and myocardial infarction in the 3–12 mo following occurrence due to HZV-induced vasculopathy in those aged >50

Etiology

  • Caused by varicella zoster virus (VZV), a dsDNA virus in the Herpesviridae family
  • Reactivation of dormant virus in dorsal root, cranial nerve, and autonomic nerve ganglia
  • Majority of cases in patients with a history of chickenpox (VZV) but also seen as recurrence from prior vaccination

Pregnancy Considerations
HZV during pregnancy is not associated with maternal or obstetric morbidity


Pediatric Considerations
May occur in childhood, most commonly when primary varicella occurred in utero or in the first 6 mo of life

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