Herpes Zoster

Basics

Description

  • Commonly known as shingles and abbreviated HZV
  • Incidence of over 1,000,000 cases in the US annually and will impact 30% of Americans in their lifetime especially after age 50
  • 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:
    • Age over 50
    • Immunocompromised states (HIV, medications, auto-immune disease, and transplant patients)
    • Female sex
    • White race
    • Physical trauma
  • 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
  • The live-attenuated vaccine is not recommended during pregnancy

Pediatric Considerations

May occur in childhood, most commonly when primary varicella occurred in utero or in the 1st 6 mo of life

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