Know about herpes zoster

Herpes Zoster, also known as Shingles or zona is infection of a nerve or nerve root causing severe burning pain on the affected part of the body. It is a viral infection caused by the chicken pox virus, i.e. the varicella zoster virus. One may have infection with chicken pox early in life, which may be mild or overt depending on the severity of the infection and resistance of the individual. The virus may lie dormant in the body though the infection may be resolved and manifest many years later as shingles. Shingles can occur at any age in either gender, but the severity of the disease increases with advancing age. There is inflammation of any nerve or its branches, in the body, manifesting as severe burning pain and itching over the affected part. Along with it, there may be abnormal sensations like tingling, pricking or loss of sensations. This is localized to one part of the body, which can be the back, chest, abdomen, face or any part. Outwardly one gets painful angry looking eruptions which later on become dry and fall off. In case of facial nerve involvement, there may be paralysis of the facial muscles on affected side. This causes deviation of the face and mouth to one side and inability to close the eyelid. The eyes are also not spared by zona. If the nerve to the eye is involved, one has severe pain, swelling and blisters around the affected eye. This is associated with blurred vision and photophobia along with pain. Blindness can occur as result of zona of the eyes. Similarly the nerve for hearing may be affected leading to temporary or permanent hearing loss. At times, there is superadded bacterial infection over the blisters resulting in small boils. This augments the pain. In some patients the pain subsides with resolution of the skin lesion. In some unfortunate individuals, the pain may persist for months together after healing of the blisters because the inflamed nerve takes a long time to recover. This is usually severe, causing much discomfort and disability in the person. Because of the severe pain which occurs due to the inflammation of the nerve, this condition is confused with many other conditions causing severe acute pain in the body, depending on the location. Herpes zoster can be confused with, acute pneumonia, muscle contusion, disc herniation, acute abdomen, e.t.c. and even a heart attack. I remember a middle aged patient who had consulted few years ago, with severe backache. He was thought to be having a disc herniation or severe spondylosis and given treatment for that. The pain persisted in spite of the strong pain killers given and everybody was wondering why he had no relief. After about three days of the pain, blisters emerged in a patch in the middle of the back and then it was clear that he had zona causing that pain. After a week or so, he recovered completely. Once a healthy person gets zona, it is once in a life time. But immune depressed persons like those suffering from HIV/AIDS or malignancy may even get two or more episodes of herpes zoster infection in their life time. Zona in immune depressed people may be more disseminated involving multiple segments. Herpes zoster infection can be easily diagnosed on the basis of typical clinical features. More advanced tests like polymerase chain reaction or fluorescent antibody tests, are also used where facilities exist. Immunization of children at 13 years or older for chicken pox, is helpful in preventing both chicken pox and herpes zoster infections. Vaccine against zoster is also available now. If one does develop zona, use of antiviral drug like acyclovir as soon as possible, reduces the severity of the disease and prevents complications. Though being a viral infection, it subsides by itself within a week or ten days. In addition drugs like carbamazepine, gabba pentin, e.t.c., help in reducing the pain. Skin lesions need good cleaning and application of antiseptic solutions to prevent superadded bacterial infection. People need to know about infections like zona so that in case they develop the infection, they can take timely medical interventions to prevent severity and its complications. rachna212002@yahoo.co.uk