Shingles is considered viral disease that is characterized by unilateral herpetiformis lesions in the form of rashes on the skin.Shingles is characterized by intense pain.The causative agent of the disease is considered Zoster virus or varicella zoster virus, which belongs to the family gerpevirusov.As a rule, the first meeting with the virus occurs in childhood, flowing in the form of chickenpox (varicella), after which the virus becomes latent (dormant).
Shingles is known since ancient times, but at the time it was considered as a separate disease.Chickenpox has long been considered to be smallpox.Although symptomatic differences between these two diseases have been described even in the middle of the XVIII century.The main differential diagnosis was made available only at the end of the XIX century.Character chickenpox as infection was proved in 1875 in studies on a voluntary group of people.Background to the opinion of the relationship varicella zoster were offered in 1888, when
But his final confirmation of these findings have received only at the end of the 1950s, when he was assigned the same pathogen from patients who had both clinical forms of these two infectious diseases.However, the most assertive were data on the epidemiology: incidence of chickenpox in the outbreaks of herpes zoster was much higher than among the population in general.In 1974, Japan was prepared attenuated strain of the virus herpes zoster, and in early 1980 in the United States have begun clinical trials of vaccines against chickenpox.
Kids who had chickenpox, you still are carriers of the virus.It is in the ganglia of the spinal cord glial cells and do not usually cause any manifestations at normal immunity.After a certain number of years after the initial virus infection of the body, it is beginning to happen with the activation of the virus passing from the nerve cells along their axons.Once the virus reaches the end of the nerve cell, it causes the display of an acute form on the skin, being guided by signals of the autonomic nervous system.
Shingles appears as a rash on the skin, accompanied by sometimes severe pain and severe itching.It should be noted that the difference between herpes zoster from herpes simplex (lips) is the pain and destruction of vast areas.
Shingles several times more often seen on the background of reduced immunity.During the clinical manifestations of the virus has spread throughout the body and its contents can be determined rashes, tear fluid and saliva.
Once the virus enters the nervous system, its location is observed mainly in the peripheral neurons of the spinal ganglia, and begins to spread throughout the nervous system.It may also present a partial denervation.Posterior spinal ganglion becomes inflamed, involving over a hemorrhagic necrosis.While herpes zoster in the inflammatory process involved not only the peripheral nerves, brain and spinal ganglia and meninges from the medulla.
process of the virus herpes zoster goes into a latent state, and how then activated, especially not been studied until now.
Shingles has no relation to the herpes simplex virus type 1,2 and therefore caused a completely different view of the virus (the virus Zoster), but all kinds of herpes virus belong to the same group - the group of herpes viruses.
number of patients with herpes zoster virus today accounts for about 3 per 10 000 people in old age and about 15% of patients with immunodeficiency.
Shingles has a tendency to relapse.Virus retains the property damage as nerve cells and skin epithelium of the patient through the mucous membranes and skin, then following the flow of blood and lymph in the current tissue and spinal ganglia of the spinal cord, where it is subsequently dormant.
activation of herpes zoster occurs when the sharp decline in immunity, as well as when taking drugs to suppress the immune system (for cancers).
Cancer in the form of a malignant tumor genesis, metastasis, lymphoma, etc.can give a sharp aggravation of the virus.And not by themselves, but because of the use of drugs that inhibit the growth of cancer cells (chemotherapy).Just radiotherapy contributes to the local development of herpes zoster, because when it happens like the death of cancerous cells and lymphocytes - killer cells, which help maintain immunity.
transplantation of internal organs, viral ganglionevrit, carriers of HIV passing to the stage of AIDS, promote prolonged clinical manifestation of herpes zoster.In general, HIV infection herpes zoster can be considered as one of its features.That is, patients who have at least once a year or more recurrences of herpes zoster occur, you must first be tested for HIV status.
viral infection with herpes zoster are usually exposed to cranial and spinal nerve ganglia.The very DNA of the virus is able to penetrate inside the cell.And in certain cases, may lead to the development of meningoencephalitis and affects the mucous internal organs.
But I want to note the fact that healthy people do not get sick almost shingles.As for children, they are also quite rarely suffer from this disease.About 5% of children with herpes zoster have cancer or HIV.Sometimes herpes zoster occurs in children as early as infancy, and even in the neonatal period.Typically, this is due to the fact that the woman became aggravated herpes zoster during pregnancy, or if it had been ill with chicken pox.
As a result of studies conducted by American scientists, found that children who at a young age put a vaccine against varicella, barely are at risk for herpes zoster.What can be said about the children who just had chickenpox.
But despite the fact that the herpes zoster during pregnancy has no effect on the developing fetus, this infection can be a dangerous threat to the pregnancy and for the subsequent condition of the child during the perinatal period.
virus herpes zoster affects one in 3,500 children in the perinatal period.
Shingles in children in the neonatal period is a consequence of suffering a virus from their mothers during pregnancy, especially during the third trimester.Transmission can occur by hematogenous herpes zoster (placental-uterine) or during childbirth (if herpes affects the mucous membranes of the genital tract).Also, during breastfeeding there is a transfer of the virus.
Symptoms of herpes zoster in the newborn can be detected one week after transmission.When herpes zoster in children perinatal bubbles rash occurs on the skin and mucous membranes.Very often, the virus infects the conjunctiva eye without causing rashes on the skin and mucous surfaces, but persistiruya in the body of the child.The disease severe enough for the baby and lasts about 10 days.
If a child is born prematurely, the viral infection in the form of herpes zoster will flow much more difficult, affecting the brain (encephalitis herpes).The prognosis of herpes zoster in preterm infants is poor.About 70% are premature death.
But the treatment of herpes zoster in the newborn group of antiviral drugs reduce perinatal mortality in half.Treatment of a virus is detected in a newborn is assigned immediately.
treatment of herpes zoster newborns using antivirals reduce child mortality by almost 50%.
herpes infections are the most common infectious diseases in pregnant women, which may complicate pregnancy.But shingles during pregnancy is not so frequently, unlike simplex virus.
number of pregnant women who are carriers of the herpes simplex virus is growing at a faster pace (about 30% of all pregnant women).They also increasing the incidence of herpes zoster during pregnancy.In the case of primary infection of this type of virus can occur: Fetus in a variety of malformations, chromosomal abnormalities, or intrauterine fetal death.
During pregnancy, herpes zoster can lead to long nepersistiruyuschego herpes 1.2 species, or combine them both.What the pregnant woman will be painful and unbearable itching, with accompanying fever and general malaise.
Pregnancy itself is a cause of immunodeficiency.Under other conditions, ie at elevated immunity, pregnancy would be impossible.Nature intended physiological decrease immunity throughout pregnancy for a successful gestation.Shingles "wakes up" due to lower immunity, and that, not in the early stages of its reduction, and for chronic immunosuppression, which can be observed during pregnancy.
As is clear from the above, the reason for the development of lesions or herpes zoster may seem immune deficiency, which can occur in various diseases and conditions, at any age.
symptoms in herpes zoster begins with general prodromal symptoms: dyspepsia, headache, slight fever, chills, and a pronounced malaise.In the following may join itching and pain along the nerve fibers of the peripheral.Characteristic considered itching and burning of the skin at the site of future bubbles.Such signs are recognized very subjective, and the intensity of herpes symptoms can be different for each patient.The duration for an initial period not exceeding 5 days, but in children this period is even shorter than in adult patients.
After a short period of prodromal phase there may be a considerable rise in body temperature to subfebrile digits, with the accession of intoxication symptoms (myalgia, headache, anorexia).Along with this, in the course of several spinal ganglia skin rash may appear as pink spots from severe pain that is usually not coalesce and form a diameter of 5 mm.
After a few hours, amid exanthema begin to appear tightly grouped vesicles with serous contents of color.The edges of these vesicles are usually uneven, and their base bloodshot and swollen.Depending on the state of immunity and to the degree of severity of herpes zoster can join pain and increase in regional (local) lymph nodes.Children may be pharyngitis, laryngitis and rhinitis, which greatly complicates the course of the disease.
rash determined in the projection of the nerve trunk.Frequently encountered unilateral damage nerve ganglia, which is projected along the intercostal nerve, the facial trigeminal nerve.There are cases when the process of destruction involved nerve trunks of extremities with subsequent development of neuritis.Fortunately, such cases are very rare.Most occur in the groin exanthema.
with herpes zoster rash can simultaneously identify at various stages, ranging from redness and finishing areas of hyperpigmentation after healing vesicles.About a week later flushing of the skin around the vesicles decreases and with it the swelling, cloudy liquid inside the vesicles, they begin to dry out and their location on the site of the crust formed after the passage of which there may be a slight pigmentation of the skin.As a result, after 2-3 weeks from the onset of the disease occurs recovery.
However, shingles can be generalized form manifestations.
sometimes form generalized rash with herpes zoster compared with joined chickenpox, because the localization of lesions is observed not only in the nerve ganglia, but also in other areas of the skin and mucous membranes.If there is a generalized herpes zoster or clinical manifestations of his last more than 21 days, it is necessary to examine the patient to determine the nature of the immune deficiency and the presence of cancer.
Shingles may also be abortive form, which is characterized by erythematous rash along the nerve ganglia, which disappear soon enough after the appearance of vesicles.Thus the general condition of the patient does not suffer too much.
bullous form with herpes zoster is characterized by large vesicles, merging into large bubbles with serous content.If the damage of the blood vessels of the serous content is converted into hemorrhagic, and in the event of secondary infection - in purulent.In serious cases, these bubbles can coalesce into continuous ribbons during desiccation which can occur as a secondary infection with the formation of dark necrotic scab.The degree of severity of such a form of herpes zoster depends on the location of exanthema.For example, with the defeat of the facial nerve join sharp neuralgic pain, damage the cornea and eyelids.
duration of herpes zoster in the acute form of 2-3 weeks;when abortive form about a week;and in a complicated form or during the protracted nature - more than a month.Pain with herpes zoster are burning, paroxysmal in nature, with greater intensity during the night.Violation of the sensitivity of the skin and local paresthesia are the most recognized symptoms of herpes zoster.
are cases of oculomotor nerve damage, bladder sphincter and pelvic muscles.If you begin to develop aseptic meningitis, changes in the study of CSF sometimes do not match the severity of the symptoms of meningitis.In the acute form of herpes opoyasyvayushego may develop encephalitis and meningoencephalitis.
When a ophthalmic herpes zoster may occur violations such as failure ophthalmic branch of the trigeminal nerve.When symptom Ramsey-Hunt holds a one-sided facial paralysis with a lesion of the peripheral muscles and facial rash in the ear canal, or on the mucous membranes of the mouth and throat.It is also noted the intense pain in the ear canal, dizziness, and later, complete or partial deafness.
with herpes zoster motor nature can be observed slight muscle weakness, loss myotome with a dermatome, are amazed herpes rash.In herpes zoster can be of varying intensity clinical manifestations, especially in people with weakened immune systems.These patients may develop encephalitis, spinal cord lesion.May be affected artery, causing hemiplegia.
neuralgic pain in herpes zoster sometimes last up to six months.Rarely herpes zoster is quick and painless, although such cases are, due to a good level of immunity.
Shingles can cause complications in the form of transverse myelitis, which eventually turns into a motor paralysis.Herpes zoster in HIV-infected combining other immunodeficiency states proceeds much harder.The duration of the latent period before the appearance of the rash is about a week.The greatest risk are manifestations of herpes zoster patients with lymphoma or Hodgkin's disease.About 50% of them have cold sores, which are spread all over the body.