Shingles is a painful skininfection similar to chickenpox caused by VaricellaZoster virus (VZV).Herpes Zoster is another name for shinglesdisease. Thedisease only affects individuals who have already suffered fromchickenpox. The skin infection is a result of reactivation of thedormant VaricellaVirus. Research hasindicated that it is clinically impossible for an individual todevelop the disease due to contact with a person with chickenpox.However, the reverse is possible whereby, an individual sufferingfrom shingles can trigger the development of chickenpoxon someone else after coming into contact with them. The possibilityof contracting or developing shinglesincreases as people get old. Coming into contact with infectedlesions can transmit shinglesdisease. Severalclinical trials have indicated that it is possible to prevent andtreat the disease. The vaccine is best-suited for people over the ageof 60.
Keywords:Shingles, Varicella Zoster Virus, Chickenpox, Lesions, Post-herpeticNeuralgia
Characteristics ofVaricellaZoster Virus
Varicella Zoster Virusbelongs to the family of herpesvirus(Yawn & Gilden,2013). The virus is highly contagious and prevalent in all regions ofthe world. The initial infection with the virus leads to severevaricella,commonly known as chickenpox.After the chickenpox has cured, the VZV forms a lifetime dormancy inthe ganglia dorsal root and the cranial nerve. It remains inactivefor months, years, or decades and may reappear to cause shinglesdisease. The virusreplicates in the lymph nodes and the nasopharynx, which is its mainentry point (Pommerville,2014). The initial viremiahappens a few days after the entry of the virus into the body. Afterthe multiplication of the viruses in the body, they disperse to otherorgans such as the spleen and liver.
The VZVfurther replicates in the viscerafollowed by a secondary viremia and infections of the skin beginsshortly. It is possible to culture the virus from the mononuclearcells of sick individuals within the first five days after the rashappears. The VaricellaZoster Virus has anincubation time of between 14 and 16 days. However, the period canextend by 10 to 21 days. Immunocompromised patients and persons whohave had a post-exposure treatment with a product containingvaricella antibodiesare prone to experiencing prolonged incubation periods. The factorsassociated with the re-emergence of the disease include intrauterineexposure to the virus, and fluidal contact with infected persons(Pederson, 2012).
TheVaricella ZosterVirus reachesthe upper respiratory surface and rapidly replicates to formthousands of viruses. After the rapid multiplication, the virusesenter the bloodstream where they come into contact with theendodermis. The viruses start by destroying the skin cells asobserved on the epidermis in the form of a rash. The rash that formson the skin surface contains leukocytesand serum (Pederson, 2012). When the small blister-like rash breaks,they infect other skin parts, and the rash continues spreading. Thevirus can stay in the body for up to six days before an individual isaware that they are infected. Also, the VaricellaZoster Virus is noteasily susceptible to medications and can also be misdiagnosedespecially when individuals only have pain sensation with no rash onthe skin. The virus may, at times, inflict pain for 90 days, hencebringing an extreme case of shingles referred to as post-herpeticneuralgia.
Transmission of Shingles
The disease’ lesions remaininfectious until they dry off and crust. When the wounds get covered,the probability of becoming contagious reduces. In immunocompromisedpatients, the infection is possible even after the lesions have driedand crusted. In these patients, the virus remains within the rash andcan be transmitted in two ways. One way is through coming into directtouch with the vesiclesfluid. The secondway is through indirect contact of the blister fluid which may occurin an airborne manner or through droplets from the crust lesions. Inthe case where a person with shingles comes into contact with one whohas never had chickenpox,they may infect them to develop chicken pox but not shinglesdisease (Cohen,2013). Individuals with post-herpeticneuralgia (PHN) oron the prodromal stage but do not have active lesions cannot transmitthe disease to others.
Signs and Symptoms ofShingles
The common signs that one hasshinglesdiseaseinclude itching or abnormal skin pain,whichoccurs within one to four days before the rash appears on theepidermis. The rash caused by shingles is dermatomal, acharacteristic that is constant with the reactivation from a cranialnerve ganglion. The common sites where the rash occurs includecervical, lumbar, and thoracic dermatomes (Cohen, 2013). However, therash is not limited to appear in these places and may be prevalent inother parts of the body. Individuals who are immunocompromiseddevelop scattered lesions around the infected areas. The pain anditching can either be continuous or come in episodes. Depending onthe severity of the disease and the site, the pain may lead toexpensive testing and eventual misdiagnosis of the disease. Someindividuals exhibit both pain and rash on the skin while others onlyhave one of the symptoms. For patients who only have experience painon the skin, it becomes tough diagnosing the problem (Cohen, 2013).The pain characteristics of shinglesdisease vary amongindividuals. Some of the common types of pain experienced by patientsinclude allodynia, paresthesia, dysesthesia, and hyperesthesia.Allodynia entails pain linked to non-painful stimulus while inparesthesia, patients experience increased tingling and burningsensation. On the other hand, dysesthesia involves a severe touchsensitivity whereas hyperesthesia entails extended pain response(Cohen, 2013). The rash dries and crumbles within seven to ten days.
Current Treatment andPrevention of Shingles
Non-severe shingles may betreated by oral famcicloviror valacyclovirin ambulatory care with strict follow-up. The reactivation of the VZVwithin the trigeminal ganglion may cause sight complications whereasthe inclusion of the geniculate ganglion can cause facial palsy. Forthese two cases, individuals are taken as in-patients to avoid anyfatalities. The patients receive IVacyclovir whilethose with trigeminal ganglion, there should be ophthalmologicconsultation to evade severe illness (Center et al., 2015).Disseminated invasive ailment must be treated as Varicellausing IVacyclovir. Theavailable shingles vaccine is available for persons who are 60 yearsold or more. As an individual gets old, the risk of severity ofshingles diseasealso increases thus it is recommended to take a vaccination beforethe disease attacks.
The pain caused by the rashpersists even after the rash disappears in persons with post-herpeticneuralgia. It is believed that the main reason for the continued painis the constant nerve irritation after the infection has gone. Thecondition is treated using topical creams, anti-depressants, andsteroids (Center et al., 2015). Some natural topical creams includeCapsaicin and Lidocaine. Capsaicin is the substance that makes hotpeppers have the burning sensation. The Food and Drug Administration(FDA) approved capsaicin for medicinal uses. Capsaicin is known toalleviate pain, especially for post-herpetic neuralgia patients. Itinhibits nerves from transmitting pain throughout the body. Thecapsaicin cream is applied to the infected body parts sparingly atleast three times every day for several weeks. The cream may cause aburning sensation on the skin surface during the first days, but itsoon wears off. Patients are advised to ensure that the cream doesnot come into contact with the nose or the eyes due to irritation(Winchester Hospital, 2015). Unvaccinated persons who have attainedthe age of 85 years are at a 50% risk of being infected with shinglesdisease.
The prevalence of Shinglesdisease increaseswith age whereby, elderly individuals are more likely to develop thedisease than the young persons. The disease is caused by thevaricella-zostervirus (VZV) and isa re-emergence of aggravated chickenpox.The common symptoms of the illness include constant itching andburning sensation on the skin. An individual with the disease mayinfect another one with chickenpox,but the reverse is not possible. The common modes of transmission arethrough coming into contact with infected lesions or blister fluids.The disease can be treated using famciclovir,valacyclovir or IVacyclovir. Forextreme cases of the illness (PostHerpetic Neuralgia),treatment is given in the form of anti-depressants, topical creams,and steroids. The available vaccines should mostly be used by elderlyindividuals above the age of 60 years.
Center, T. T., Care, S. H.,Monitor, H., Monitor, L., TEE, T. E., & Atherectomy, S. P. L.(2015) Shingles (Herpes Zoster).
Cohen, J. I. (2013). Herpeszoster. New England Journal of Medicine, 369(3), 255-263.
Pederson, S. (2012). Shinglesdisease (1st ed.). Bloomington: Booktango.
Pommerville, J. C. (2014).Fundamentals ofMicrobiology: body systems edition.Jones & Bartlett Publishers.
Winchester Hospital. (2015).Shingles (Herpes Zoster). Winchesterhospital.org. Retrieved 29 March2017, fromhttp://www.winchesterhospital.org/health-library/article?id=21722
Yawn, B. P., & Gilden, D.(2013). The global epidemiology of herpes zoster. Neurology,81(10), 928-930.