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You will receive an email whenever this article is corrected, updated, or cited in the literature. In the present article, the natural history and incidence of varicella zoster (ie, primary VZV infection) and herpes zoster are discussed. The child or young adult becomes infectious approximately 48 hours before the onset of vesicle eruption and may remain infectious for 4 to 5 days after vesicle eruption.
The Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention revised the criteria for evidence of VZV immunity in 2006.2 The criteria for evidence of immunity now include documentation of age-appropriate administration of the live attenuated VZV vaccine, which should be given in one dose to children aged 12 months to 12 years, and in two doses to adolescents and adults. An estimated 1 million new cases of herpes zoster occur each year in the United States,5 resulting in 50,000 to 60,000 hospitalizations.
The increased risk of herpes zoster associated with advancing age is at least partly caused by immunosenescence, the gradual deterioration of the immune system that is part of the natural aging process. In addition to the role played by advancing age, immunosuppression increases the risk for development of herpes zoster. As previously mentioned, herpes zoster is the consequence of the primary VZV infection reactivating after a period of dormancy in the dorsal root ganglia. The rash may be accompanied by unbearable itching, altered sensitivity to touch, or allodynia (ie, pain at the site provoked by innocuous stimuli).
A diagnosis of herpes zoster is often made based on the localization and morphologic characteristics of the rash. The varicella-zoster virus can be collected from lesions and identified using tissue culture, but this is a time-consuming process, and false-negative results may occur because viable virus is difficult to obtain from cutaneous lesions.
Direct fluorescent antibody staining of VZV-infected cells obtained by scraping the base of the lesion is a rapid and sensitive method for diagnosis of herpes zoster.
When the symptoms of allodynia, pain, burning, and itching manifest without the rash, herpes zoster is especially difficult to diagnose.
Results of recent studies15,16 suggest that PCR can be used to positively identify VZV DNA in patients' blood before symptoms manifest. Postherpetic neuralgia is a common and potentially debilitating complication of herpes zoster that is difficult to manage. The severity of pain in PHN ranges from mild to excruciating, and it can be constant, intermittent, or triggered by such stimuli as clothes touching the skin. In addition to PHN, other neurologic complications that can result from herpes zoster include chronic sensory loss at the site of the rash, limb weakness, and autonomic dysfunction related to the site of the rash (eg, bladder dysfunction if the rash has sacral dermatomal distribution). Herpes zoster ophthalmicus, which is prevalent in 10% to 25% of patients with herpes zoster, can occur when reactivation of latent VZV involves the first division of the trigeminal nerve.4 Ophthalmic herpes zoster is a severe complication that is difficult to manage.
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Download anatomical drawings of human central and peripheral nervous system (CNS and PNS), brain and cranial nerves, spinal cord, autonomic (ANS) reflexes, neuron, synapse structure and function, membrane potential, neurological disorders, and more. Please note: Free downloads are intended to facilitate healthcare education for people in need in low income countries and can be used for educational purposes only.


This entry was posted in Brain and nervous system, Browse Images and tagged anatomy, brain, central nervous system, CNS, conditions, diagrams, diseases, disorders, drawing, galleries, gallery, health, human, illustration, images, Medical, nerves, nervous system, neurology, organs, peripheral nervous system, pics, pictures, PNS, science, spinal cord on August 2, 2013 by Alila Medical Media. Find us on YoutubeSubscribe FREE to our Youtube channel to watch new educational videos uploaded weekly. DisclaimerMedical information on this website is for educational purposes only and is NOT intended to be medical advice in any cases. Primary VZV is transmitted from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions, or infected respiratory tract secretions that are aerosolized. Herpes zoster is characterized by a unilateral vesicular eruption in a dermatomal distribution, with thoracic and cranial and cervical distributions being the most common.
In the initial stage of herpes zoster infection, known as the prodromal phase, patients may report such symptoms as headache, pain, malaise, and acute photophobia before the rash appears. However, the rash associated with herpes zoster is sometimes confused with that of herpes simplex virus (HSV). Polymerase chain reaction (PCR) can be used to detect the DNA of VZV from collected lesion material.
Although allodynia affects 45% to 55% of patients with herpes zoster, it may affect as many as 90% of those with PHN.18 The pain associated with herpes zoster or PHN may last for a few minutes or occur as chronic pain. Affected patients require admission to the hospital and administration of intravenous acyclovir and, in some cases, intravenous immunoglobulin.
It typically results in a rash with a unilateral dermatomal distribution, which usually resolves within 2 to 4 weeks. If you can afford it or if you plan to use the images for commercial purposes, please consider buying instead. Cross section of the spinal cord diagram showing spinal nerve and ganglion, and neurons of a reflex. Herpes zoster infection results later in life from reactivation of VZV in the dorsal root ganglia. However, VZV infection persists for the infected individual's lifetime, and viral latency subsequently develops along the spinal cord in dorsal root ganglia. In a typical household, there is an 85% risk of transmission of chickenpox to a susceptible sibling.2 The infection is characterized by fever, malaise, and the typical diffuse rash.
Zoster lesions contain high concentrations of VZV, which can be spread to susceptible individuals by direct contact with the lesions. In some cases, patients experience the allodynia, pain, itching, and burning without a rash ever developing—a condition known as zoster sine herpete.
Physicians should keep in mind that a rash that is recurrent in the same dermatome is most likely HSV. The duration of PHN has been found to be inconsistent, ranging from 30 days to 6 months or longer after rash onset. In the initial stage of herpes zoster (ie, prodromal phase), patients may experience headache, pain, malaise, and acute photophobia before the rash appears.


Bacterial “superinfection,” particularly with methicillin-resistant Staphylococcus aureus, can also occur.
Even after aggressive management, patients may have long-term sequelae, including vision loss and pain related to the location of the rash, stemming from herpes zoster ophthalmicus. You can find a larger image collection at higher resolutions for sale at affordable prices on Alila Medical Media website. Herpes zoster characteristically results in a rash with a unilateral dermatomal distribution, which usually resolves within 2 to 4 weeks.
Localized herpes zoster is contagious from the time of rash eruption until the time of lesion crusting. After the prodromal phase, the acute phase is characterized by the dermatomal rash, as well as by pain, unbearable itching, and altered sensitivity to touch. If the infection does not resolve after its acute phase, long-term complications, such as postherpetic neuralgia, may develop. The author discusses the natural history and incidence of primary VZV infection and herpes zoster and details the epidemiology, clinical manifestation, diagnosis, and complications of this disease.
If the infection does not resolve after the acute phase, complications, such as postherpetic neuralgia, may develop.
Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). Regulation of blood pressure through baroreflex, labeled version.Anatomy of a nerve, unlabeled. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction [published correction appears in Mayo Clin Proc. Anatomy of a spinal nerve, labeledThe trigeminal nerve, labeled diagram.The trigeminal nerve, Cranial nerve V and branches.
Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). Later in life, the virus reactivates—usually in a dermatomal distribution—causing the secondary infection known as herpes zoster (ie, shingles). Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy [review].
The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Incidence and risk factors for herpes zoster among patients with inflammatory bowel disease. Rapid quantitative PCR assays for the simultaneous detection of herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, and human herpesvirus 6 DNA in blood and other clinical specimens [published correction appears in J Med Virol.



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