Herpes zoster history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
History
A detailed history must be taken regarding the onset of symptoms, the distribution and morphologic features of rash, accompanying symptoms, such as fever and pruritus. History of previous chicken pox infection must be obtained.
Common Symptoms
Shingles usually starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7–10 days and clears up within 2–4 weeks.
Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears. The pain may be extreme in the affected nerve, where the rash will later develop, and can be characterized as stinging, tingling, aching, numbing, or throbbing, and can be pronounced with quick stabs of intensity. During this phase, herpes zoster is frequently misdiagnosed as other diseases with similar symptoms, including heart attacks and renal colic.
Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eye and cause loss of vision.
Less Common Symptoms
Other symptoms of shingles can include:
- Fever
- Headache
- Chills
- Upset stomach
Some patients may have these symptoms along with pain, itching and tingling without developing the characteristic rash. This situation, known as "zoster sine herpete," can delay diagnosis and treatment.
Congenital Varicella Syndrome
Varicella infection in pregnant women could lead to viral transmission via the placenta and infection of the fetus. If infection occurs during the first 28 weeks of gestation, this can lead to fetal varicella syndrome (also known as congenital varicella syndrome).[1] Effects on the fetus can range in severity from underdeveloped toes and fingers to severe anal and bladder malformation. Possible problems include:
- Damage to brain: encephalitis,[2] microcephaly, hydrocephaly, aplasia of brain
- Damage to the eye: optic stalk, optic cup, and lens vesicles, microphthalmia, cataracts, chorioretinitis, optic atrophy
- Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's syndrome
- Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction
- Skin disorders: (cicatricial) skin lesions, hypopigmentation
Infection late in gestation or immediately following birth is referred to as "neonatal varicella".[3] Maternal infection is associated with premature delivery. The risk of the baby developing the disease is greatest following exposure to infection in the period 7 days prior to delivery and up to 7 days following the birth. The baby may also be exposed to the virus via infectious siblings or other contacts, but this is of less concern if the mother is immune. Newborns who develop symptoms are at a high risk of pneumonia and other serious complications of the disease.[4]
References
- ↑ Boussault P, Boralevi F, Labbe L, Sarlangue J, Taïeb A, Leaute-Labreze C (2007). "Chronic varicella-zoster skin infection complicating the congenital varicella syndrome". Pediatr Dermatol. 24 (4): 429–32. doi:10.1111/j.1525-1470.2007.00471.x. PMID 17845179.
- ↑ Matsuo T, Koyama M, Matsuo N (1990). "Acute retinal necrosis as a novel complication of chickenpox in adults". Br J Ophthalmol. 74 (7): 443–4. doi:10.1136/bjo.74.7.443. PMC 1042160. PMID 2378860. Unknown parameter
|month=ignored (help) - ↑ Sauerbrei A, Wutzler P (2001). "Neonatal varicella". J Perinatol. 21 (8): 545–9. doi:10.1038/sj.jp.7210599. PMID 11774017. Unknown parameter
|month=ignored (help) - ↑ Royal College of Obstetricians and Gynaecologists (2007). "Chickenpox in Pregnancy" (PDF). Retrieved 2009-07-22. Unknown parameter
|month=ignored (help)