Shingles+(herpes+zoster)

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**Herpes Zoster** by Bianca M Diaz May 20th, 2010

**Abstract:** Shingles (herpes zoster virus) is an extremely painful viral infection of the nerve roots resulting in a skin rash caused by the same virus that causes chickenpox. The reactivated virus responsible for these conditions is called the Varicella zoster virus (VZV). After an individual has chickenpox, the virus lives in the nervous system where it "sleeps" (is dormant) in the nerve roots. In some people, it remains dormant forever. In others, a weakened immune system can cause the virus to "wake up," reproduce, and travel along the path of the nerve fiber to the skin's surface, resulting in a painful localized skin rash, usually with blisters (fluid filled sacks) on top of the reddish skin. Shingles usually occurs as a unilateral pain, burning, or tingling and blistering rash extending in a local pattern in the distribution of nerves. Common areas affected by shingles include the face, abdomen, back, buttocks, and chest. If the virus becomes active again, it can only cause shingles, not chickenpox. It is very contagious and can give someone chickenpox if they haven't had it yet. The majority of patients who get shingles are over the age of 60; it infrequently occurs in younger people.

**Introduction:** I knew I wanted to do some type of skin disease because i am personally affected by it. I've had a hemangioma since birth and it has never gone away. But because there is not much microbiology regaurding that subject i chose to do shingles because my twin sister is affected by them. I found out that shingles are caused by the same virus that causes chickenpox. Once a person has had chickenpox, the virus can live but remain inactive in certain nerve roots within the body. If it becomes active again, usually later in life it can cause shingles.

**Discussion:**

 Causes: No one knows for sure what causes the chickenpox virus to become reactivated to cause shingles (1). But research shows that stress, fatigue, a weakened immune system, cancer, radiation treatments, and injury of the skin where rash occurs may perhaps be triggers (5).

 Symptoms: Depending on the nerves involved, shingles can affect many parts of the body (2). The first symptom of shingles is often extreme sensitivity or pain in a broad band on one side of the body. The sensation can be itching, tingling, burning, constant aching, or a deep, shooting, or "lightning bolt" pain (4). Typically, one to three days after the pain starts, a rash with raised, red bumps and blisters erupts on the skin in the same distribution as the pain. They become pus-filled, then form scabs by 10-12 days. The rash disappears as the scabs fall off in the next two to three weeks, and scarring may result (1).

 Treatment: If you think you have shingles, you should see your doctor as soon as possible, because antiviral medication is effective only if given early. Do not scratch. This may increase the risk of secondary bacterial infection and scarring (1). Antihistamines and topical creams can relieve the itching. Pain medication is often necessary. Keep the area clean with mild soap and water. Application of petroleum jelly can aid in healing. Wear loose clothing to avoid extra pain from clothing rubbing against the rash. Avoid close skin-to-skin contact with others who have not had chickenpox, are ill, or who have a weakened immune system (4).

 Prevention: Prevention of shingles in people that have contracted chickenpox is difficult, since the factors that trigger reactivation are not yet defined (4). There are at least two methods that are currently used to reduce the incidence of shingles (2). First, the VZV vaccine, otherwise known as the chickenpox vaccine, may decrease the incidence of shingles by enhancing the immune system's ability to fight off VZV (about 70%-90% effective) or keep this virus inactive (1). This vaccine is usually administered to children, but the immunity may decline in about 15-20 years. Second, there is a new vaccine, Zostavax, which the U.S. Centers for Disease Control and Prevention (CDC) recommend that all adults of ages 60 and older obtain. Data shows that the vaccine prevents about 51% of shingles cases. It has been proven most effective in the 60--69 age group and is not given to patients with ongoing shingles because it is only effective in preventing or reducing complications of the disease before the virus is reactivated (3).

 Risk Factors: <span style="color: #000000; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 130%;">Anyone who had chickenpox is at risk for developing Shingles. Nearly all adults — 9 out of 10 — in the United States are at risk for Shingles. Additional risk factors for shingles include increasing age, and having a weakened immune system caused by such things as cancer and certain drugs (2).



<span style="color: #000000; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 130%;">It is estimated that in the United States, 1 million cases of Shingles occur every year. As you can see from the graph below, your risk of getting Shingles increases with age. Of those cases, almost half will occur in people 60 years of age or older. As the population ages, the number of cases of Shingles is likely to increase (4).

<span style="color: #ff0080; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 150%;"> Possible Complications: <span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 130%;">Potential complications that can be caused by shingles are scarring, bacterial skin infections, decrease or loss of vision or hearing, paralysis on one side of the face, muscle weakness, and long-term nerve pain called postherpetic neuralgia (PHN) (2). Long-term nerve pain, also called postherpetic neuralgia (PHN), is the most common complication that can occur after Shingles (2). This pain can range from moderate to severe, and vary from tenderness of the skin to a burning, throbbing, shooting, or stabbing pain. As you get older, your risk for long-term nerve pain may increase. For many people with PHN, the pain is so severe that the touch of soft clothing or even a slight breeze against the skin can be painful. Treating long-term nerve pain can be complex and may require more than one medication (2). <span style="color: #ff0080; font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 220%;"> **<span style="font-family: 'Lucida Sans Unicode','Lucida Grande',sans-serif; font-size: 130%;">Literature Cited: ** 1. Burton, Gwendolyn R.W., Engelkirk, Paul G. __Microbiology for the Health Sciences Sixth Edition__. Baltimore, Maryland: Lippincott Williams & Wilkins. 2000.

2. Case, Christine L., Funke, Berdell R., and Tortora, Gerard J. __Microbiology: An Introduction__. San Francisco: Peterson Education Inc. 2010.

3. Monson, Kirsti. __Zostavax Side Effects.__ January, 2010. []

4. Schoenstadt, Arthur. __Shingles.__ June, 2008. []

5. Wilson, Jennie. __Clinical Microbiology: An Introduction for Healthcare Professionals__. China: Harcourt Publishers Limited. 2000.

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