Herpes Zoster

(Shingles / Acute Posterior Ganglionitis) DEFINITION Herpes Zoster, commonly known as shingles, is caused by the same virus responsible for chickenpox, the Varicella-zoster virus. After the initial exposure, herpes zoster lies dormant in certain nerve fibers. It may become active as a result of many factors such as aging, stress, suppression of the immune system, and certain medications. ETIOLOGIC AGENT Varicella-zozter (V-Z) virus 1. 2. This agent has been found to cause two disease, varicell and herpes zoster. The virus occurs in partially immune individuals due to previous varicella infection.

INCUBATION PERIOD The incubation period of herpes zoster is unknown, but is believed to be 13 to 17 days.

PERIOD OF COMMUNICABILITY Herpes zoster is communicable a day before the appearance of the first rash until five to six days after the last crust disappears. MODE OF TRANSMISSION 1. Herpes zoster can be transmitted through direct contact, specially, through droplet infection and airborne spread. 2. It can also be transmitted through indirect contact, e.g., articles freshly soiled by secretions and discharges from an infected person.

PATHOGENESIS The virus is identical with the causative agent of chickenpox. After the primary infection, the varicella zoster virus may persist in a dormant state in the dorsal nerve root ganglia. The virus may later emerge from the site, either spontaneous or in association with immunosuppressant, to cause herpes zoster. It produces localized vesicular skin lesions confined to a dermatome and serve neurologic pain in the peripheral areas innervated by the nerves arising in the inflamed root ganglion. This infection usually occurs in adults.

CLINICAL MANIFESTATION Any part of the trunk may be affected, but the thoracic segment is commonly involved. other areas that may be affected are the extremities and branches of the 5th and 7th cranial nerves. the virus affects the ganglion of the posterior nerve roots or the extramedullary cranial nerve ganglion.

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The erythematous base of the skin lesion appears first. it is followed by the appearance of the vesicles within 24 hours. A cluster of vesicles appears to form patches which caolesce to form an irregular, band like distribution along the course of involved dermatomes. Eruptions are unilateral and never cross the midline of the body. The vesicles become pustular, break down, and form crusts. Lesion ma last for one to two weeks. Pain of varying is a presenting symptom in about two thirds of parients. Pain occurs from one to five days prior to the development of rash and is neuralgic and paroxymal in type. The pain may be described as burning or stabbing. Patient may complain of pruritus. The pain is usually worse at night and is intensified by movement. Fever, malaise, anorexia, and headache occur for one or more days. Regional lymph nodes are involved in the early stage of the disease. When the ophthalmic (5th cranial)nerve is affected, corneal anesthesia may condition is known as Gasserian ganglionitis. Paralysis of the facial nerve and vesicles in the external auditory canal affects nerve. The condition is called Ramsay-Hunt Syndrome. occur, and the

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the 7th cranial

DIAGNOSTIC EXAM 1. 2. The characteristics skin rash may be diagnostic. Tissue culture technique the virus may be isolated from fluid taken from newly developing vesicles. Smear of vesicles fluid Microscopy

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COMPLICATIONS 1. 2. 3. Encephalitis Paralytic ileus, bladder paralysis Opthalmic herpes, which may lead to blindness

MODALITIES OF TREATMENT 1. 2. 3. 4. Symptomatic Antiviral drugs Analgesics to control pain Anti inflammatory

NURSING MANAGEMENT 1. 2. 3. 4. 5. 6. Keep the patient comfortable position. Keep the patient in strict isolation. Apply cool, wet dressings with NSS to pruritic lesions. Efforts should made to prevent secondary infecion. Prevent entrance of microorganisms into the lesions, especially if they broken. Assess the degree of pain. To avoid neuralgic pain, do not delay the administration of pain relievers as prescribed. 7. Encouraged sufficient bed rest and provide supportive care to promote proper healing of lesions. 8. Provide the patient with a diversionary activity to take his mind off the pain and pruritus.

COMMON NURSING DIAGNOSES 1. 2. 3. 4. 5. 6. 7. Pain Alteration of comfort Body image disturbances Risk of infection Impaired physical mobility Impaired skin integrity Altered role performance

PREVENTION 1. Immunization against chickenpox. 2. Avoid exposure to a patient suffering from either varicella or herpes zoster. 3. Increase the patient's immune resistance.