Herpes zoster infection

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Herpes zoster (shingles) infection

Zoster infection is caused by the chickenpox virus, known as varicella-zoster virus (VZV). When a person is exposed to VZV for the first time, he develops chickenpox with symptoms of fever, widespread rash and blisters.

The individual develops partial immunity and the symptoms resolve by 10-15 days. However the virus is not completely eliminated from the body. The virus enters the nerve cells and lies dormant.

Once a person contracts chickenpox, he remains infected for life, though being asymptomatic. In some individuals the dormant virus gets reactivated causing blisters and pain in the dermatomic area. The exact cause of the reactivation of the virus is not known. Recurrent outbreaks of herpes zoster are rare and their occurrence indicates certain underlying serious multiple medical problems.

The reactivated virus starts replicating itself and the virions move along the nerve and reach the dermatome. After reaching the skin they cause rash and then blisters. The infection damages the nerve fibers and causes neuralgic pain. Though the blisters rupture and heal by about 2-3 weeks, the postherpetic neuralgia may last for several days, or last many months, even years.

herpes zoster infection on neck

Zoster infection can cause chickenpox in people who have not contracted chickenpox by that time. Skin injury at the dermatome sometimes revives the zoster. Secondary bacterial/fungal diseases can occur if the blister area is injured by scratching.

Herpes zoster in old age

Old age associated conditions and overall decrease in immunity may be the primary triggering factors for the revived infection. Old age conditions involving poor nutrition, protein malnutrition, decreased absorption and assimilation can lead to high susceptibility. With the increase in age the severity of the episode and intensity of neuralgic pain may increase many fold.

Immunosuppression

Individuals with immunosuppressive diseases and immunodeficiency disorders, such as hypogammaglobulinemia, agammaglobulinemia, HIV/AIDS and many types of cancers can suffer from recurrent VZV infection. Individuals with generalized autoimmune diseases are also vulnerable.

Patients taking immunosuppressive medicines as in the case of organ transplant are also vulnerable to shingles attack. The long term use of corticosteroids can also trigger zoster.

Complications

VZV infection sometimes involves nerves supplying the face and serious condition like herpes zoster ophthalmicus occur causing ophthalmic complications. The eye infection is a medical emergency which can lead to vision loss. Similarly affecting the inner ear, herpes zoster oticus can lead to hearing loss. Manifestation on facial nerves can also lead to partial/total facial paralysis.

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