A Study of Clinical Spectrum of 30 cases of Herpeszoster and Therapeutic Trial of Acyclovir Vs Famcyclovir of 10 cases each

Indradevi, R (2010) A Study of Clinical Spectrum of 30 cases of Herpeszoster and Therapeutic Trial of Acyclovir Vs Famcyclovir of 10 cases each. Masters thesis, Chengalpattu Medical College, Chengalpattu.

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Abstract

INTRODUCTION : Varicella Zoster virus (VZV) belongs to Herpesviridae family (Sub family: Alpha herpesviridae). Herpes viruses measure approximately 200 nm in diameter and contain linear, double stranded DNA core enclosed within a protein capsid, covered by a tegument and glycoprotein containing envelope. Biological properties unique to herpes viruses include latency and reactivation. Varicella zoster (Chicken Pox) and Herpes zoster (Shingles) are caused by same varicella zoster virus. Herpes zoster is a localized disease characterised by multiple superficial painful grouped vesicles on an erythematous base involving a particular dermatome due to reactivation of varicella zoster virus that is lying dormant in sensory ganglion. Most often Varicella is a self-limited infection of childhood. Zoster is mainly a disease of adults. A prerequisite for developing zoster is a prior episode of varicella, which on occasion may have been sub-clinical. During Varicella infection, Varicella zoster virus remains latent inside the sensory nerve ganglion. Zoster results when the latent virus reactivates and returns from the ganglion to infect the skin. Most often Varicella zoster virus reactivation occurs in the setting of relative immunological compromise, such as aging, local trauma immunosuppression (Steroids, HIV), frontal sinusitis, radiation and tumor involvement of spinal cord. AIM OF THE STUDY : A. The Study of clinical spectrum of Herpes zoster was undertaken to find out: 1. Age Distribution, 2. Sex Distribution, 3. Prevalence of Prodromal symptoms, 4. Prevalence of presenting complaints and, Constitutional symptoms, 5. Pattern of dermatomal involvement, 6. Prevalence of Risk factors, 7. Association with cutaneous and systemic diseases if any, 8. Prevalence of complications. B. Therapeutic Trial : To compare the efficacy of Famcyclovir 500 mg 3 times daily Vs Acyclovir 800 mg 5 times daily for 7 days of 10 cases each. MATERIALS & METHODS : A. Clinical Study : The study was conducted between August 2007 and July 2009 at the department of dermatology, Chengalpattu Medical College, Chengalpattu, on 30 cases of herpes zoster. All cases of herpes zoster attending skin out patient department and referred cases of zoster from other department were studied. Preliminary information including demographic data was taken from all patients followed by a clinical examination. This included general physical examination, complete systemic examination and thorough dermatological examination. A detailed history regarding the prodromal and presenting symptoms, day of occurrence of skin lesions, nature of pain and its intensity and duration, and other symptoms if any, were elicited and recorded. Also, history of chicken pox and previous attack of herpes zoster was noted. History suggestive of provocative factors like drug, recent trauma, surgical manipulation of spine, irradiation, immunosuppression, and tumor involvement of cord and ganglion are noted. Patients were screened for signs and symptoms of cutaneous, systemic and neoplastic diseases and also diabetes mellitus, pulmonary tuberculosis and exposure to the risk of sexually transmitted diseases, A thorough dermatological examination regarding the following features like segment (s) involvement, morphological pattern of lesions, presence of tenderness/hyperesthesia, lymphnode enlargement, dissemination of lesion in other areas of the body and other dermatological diseases related or unrelated to zoster. Whenever necessary, opinions from ophthalmologist, neurologist, chest physician and general physician were sought. Diagnosis of herpes zoster lesion was made clinically. Investigations such as Tzanck Smear (in Leishman’s Stain), skin biopsy, complete hemogram, urine examination, blood sugar, blood VDRL, ELISA and radiological examinations were carried out in relevant patients. All Patients were treated with acyclovir 800 mg 5 times daily For 7-10 days. Antibiotics, analgesics were also instituted in some of cases, with topical application included calamine lotion, 1% silver sulfadiazine. All the patients were treated in the outpatient department and subsequently they were followed depending upon the cases and complications encountered, till the resolution of signs and symptoms. Complications like secondary bacterial infection, ulceration, delayed healing, scarring, and post herpetic neuralgia were also noted and treated accordingly. A. Therapeutic trial : This randomized prospective comparative study was carried out at Chengalpattu Medical College, Chengalpattu, during the year from August 2008 to August 2009 on 20 herpes zoster patients. The patients were assigned into two groups. Group I : Includes 10 patients in whom Acyclovir 800 mg 5 times a day was given for 7 days. Group II : Includes 10 patients in which Famcyclovir 500 mg 3 times a day was given for 7 days. Inclusion criteria: The following patients were included in the study 1. Age over 18 years, 2. Patients presenting within 72 hrs of onset of lesions. Exclusion criteria: 1. Patients with visceral involvement, 2. Patients with motor neuropathies, encephalitis or cerebro vascular complication, 3. Pregnancy or lactating females, 4. Patients with concurrent malignancies, 5. Patients with auto immune diseases. Efficacy assessment: Patients were evaluated for pain and healing of cutaneous lesion on each of 7 days which receiving treatment and every other day for 7 days post therapy then every 7 days for at least a total of 4 months. CONCLUSION : In this study, herpes zoster mainly occurred in fifth and sixth decades of life. • No sex preponderance in incidence was found with the sex ratio of 1.3:1 • Prodromal symptoms were present in 76 % of cases and pain was the commonest prodromal symptom. • Most common presenting symptom was pain followed by skin rash. • Thoracic dermatome was the most common dermatome involved and sacral segment was the least common dermatome affected. • The risk factors noted were diabetes, HIV infection and steroid therapy. • HIV infection was present in 2 cases. Out of 2 cases, 1 case was already diagnosed as HIV positive and developed herpes zoster during the course of HIV disease. This indicates the importance of HIV testing in all patients presenting with herpes zoster, especially in patients below age of 50 years. • The systemic diseases associated with herpes zoster were hypertension, bronchial asthma and tuberculosis. • No significant association of herpes zoster was found with any other skin disorder in this study. • Duration of time taken for resolution of lesions, ranged from 2 to 3 weeks. • Post herpetic neuralgia was noted in patients with increasing age. Therapeutic Trial : This study indicates that Famcyclovir is more effective than Acyclovir interms of parameters such as incidence and duration of post herpetic neuralgia, patient’s compliance and adverse effects. However, there was no statistical significant difference in the duration of resolution of lesions between acyclovir and famcyclovir treated patients (P=0.78).

Item Type: Thesis (Masters)
Uncontrolled Keywords: A Study of Clinical Spectrum of 30 cases of Herpeszoster and Therapeutic Trial of Acyclovir Vs Famcyclovir of 10 cases each
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 04:01
Last Modified: 03 Mar 2018 03:15
URI: http://repository-tnmgrmu.ac.in/id/eprint/5977

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