A Clinical study of 100 cases of Herpes Zoster.

Chandrakala, C (2008) A Clinical study of 100 cases of Herpes Zoster. Masters thesis, Madras Medical College, Chennai.


Download (277kB) | Preview


INTRODUCTION : Varicella-Zoster virus (VZV) is the etiologic agent of two diseases, Varicella (Chicken pox) and Zoster (Shingles). Varicella which occurs after the initial encounter with Varicella Zoster virus, is a disease manifested by a pruritic rash accompanied by fever and other systemic signs and symptoms that are usually mild to moderate nature. 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, VZV establishes latent infection in sensory nerve ganglion. Zoster results when the latent virus reactivates and returns from the ganglion to infect the skin. Most often VZV reactivates in the settings of relative immunologic compromise, as occurs with aging, or following disease or various therapies, such as steroids, cancer chemotherapy transplantation and irradiation. The diagnosis is clinical: very few other diseases mimic herpes zoster, especially in the localization of the rash, which is otherwise quite similar in appearance and initial effect of that of poison oak or poison ivy. In case of doubt, diagnostic tests can be performed. Such lab tests may be necessary because, depending on the affected sensory nerve, the pain that is experienced before the onset of rash may be misdiagnosed as pleurisy, myocardial infarction, appendicitis or migraine headache. A physician can take a viral culture of a fresh lesion, (or) perform a microscopic examination of the blister base material called a Tzanck preparation. In a complete blood count, there may be an elevated number of white blood cells, which is an indirect sign of infection. There may also be a rise in the antibody to the virus, which could also give indication to the virus. Currently, there is no complete cure available for herpes zoster, nor a treatment to effectively eliminate the virus from the body. However, there are some treatments that can mitigate the length of the disease and alleviate certain side effects. AIMS OF THE STUDY : The study of herpes zoster was undertaken to findout: 1. Age incidence 2. Sex Incidence 3. Prevalence of prodromal symptoms 4. Predominant complaints given by patients. 5. Prevalence of constitutional symptoms. 6. Pattern of dermatomal involvement. 7. Prevalence of association with HIV. 8. Association with cutaneous disease, if any. 9. Association with systemic disease, if any. 10. Duration of time taken for resolution of lesions. 11. Prevalence of complications. CONCLUSION : 1. In this study herpes zoster mainly occurred in second, third and fourth decades of life. More than two third (73%) of cases occurred in individuals below the age of 50 years. 2. Male preponderance in incidence was found with the sex ratio of 2.5:1 3. Prodromal symptoms were present in 85% of patients and dermatomal pain was the commonest prodromal symptom. 4. Most common presenting symptom was pain in 99% of cases, followed by vesiculation in 98% of cases. 5. Constitutional symptoms were noted in 75% of cases and majority of cases were in younger age group. 6. Thoracic dermatome was the most common dermatome involved and sacral segment was the least common dermatome affected. 7. HIV infection was present in 16% of total cases. Out of this, 10% of cases were already diagnosed as HIV positive and developed herpes zoster during the course of HIV disease and herpes zoster was the presenting disease of HIV infection in 6% of cases. This indicates the importance of HIV testing in all patients presenting with herpes zoster, especially in patients below the age of 50 years. 8. No significant association of herpes zoster was found with any other skin disorder in this study. 9. The most common systemic diseases noted were diabetes mellitus, hypertension and are considered coincidental. Other systemic diseases associated with herpes zoster were SLE bronchial asthma, tuberculosis, chronic renal failure and hepatitis B infection. Steroid therapy given for certain systemic disorders and decreased CMI acted as provocative factor for herpes zoster. 10. Duration of time taken for resolution or healing of the lesions, ranged from 2 to 4 weeks. 11. Post herpetic neuralgia was the commonest complication (47.5%) and the incidence of PHN increased with increasing age. The other complications noted were secondary bacterial infection, scarring and motor zoster (facial palsy).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Herpes Zoster ; Clinical study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 02:31
Last Modified: 05 Jul 2017 08:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/949

Actions (login required)

View Item View Item