Herpe zoster virus

Case 2 was a year-old male healthcare professional with a medical history of ulcerative colitis, for which he had been using infliximab and, for 4 years without infectious complications.

He had chicken pox as a child, but never HZ. He received his first dose of tozinameran on January 12, , with no adverse reactions over the following days. On January 25, he noticed painful and swollen inguinal lymph nodes, after which he saw a rash on his right leg.

Blood analysis was normal. He was prescribed valacyclovir, 1 gram thrice daily, for 10 days, and recovered completely. On February 2, he received the second dose of the vaccine without any complications. The average duration of the rash ranges from 7 to 10 days, and is a self-limiting condition Van Oorschot, Although usually a limited disease, it can progress to disseminated cutaneous eruptions, encephalomyelitis, and pneumonia, especially in immunocompromised individuals Gershon At the time of writing, the European EudraVigilance database had reported cases of HZ after receiving tozinameran, accounting for 1.

For mRNA the Moderna vaccine , 0. S the Janssen vaccine 59 cases 0. The Dutch pharmacovigilance center Lareb reported cases 0. Whether these numbers are disproportionate or not requires further analysis. However, combined with the case reports describing HZ simultaneously with COVID infection, the vaccination data do suggest a possible relationship.

HZ is caused by reactivation of VZV, which tends to remain in a latent state in the dorsal root ganglia of cutaneous nerve endings following a primary episode of chicken pox Wei, ; Gershon, Reactivation occurs when the immunological mechanisms that suppress VZV replication fail to contain the virus Wei, Classic risk factors include advanced age, use of immunosuppressant medication, immunocompromising conditions e.

HIV, autoimmune disease , and psychological stress Gershon, ; Marra, Both cases presented here had chicken pox in childhood, yet never suffered from HZ. While subject 2 had other risk factors for HZ use of immunosuppressive agents , subject 1 did not. Both subjects received the vaccination as healthcare professionals, and were completely free of any symptoms at the time of vaccination. The occurrence of HZ after vaccination could be a simple coincidence. However, recent reports have described similar cases, mostly involving known risk factors for HZ reactivation Bostan, ; Furer, ; Arora, ; Tessas, ; Eid, Rodriguez et al.

This led to the hypothesis that illness, with physical and psychological stress, might trigger HZ. Since cell-mediated immunity is considered to be of great importance in protection against herpes zoster reactivation, such a functional impairment of T-lymphocytes could reactivate VZV Brambilla, ; Wang, ; Wei With the dosage now used worldwide, which is 30 micrograms, These decreases were transient, with lymphocyte levels returning to normal 6—8 days after vaccination.

Although a full discussion regarding the role of T-regulatory cells is beyond the scope of this report, Sahin et al. This would cause rolling and adhesion of lymphocytes to the endothelium, and consequently fewer T-cells available to be measured in blood samples Kamphuis, However, functionality would not be decreased, and type 1 interferons would normally inhibit varicella zoster replication Kamphuis, ; Ku, The lesions initially start as macules and quickly transform into painful vesicles.

The vesicles often rupture, ulcerate and eventually crust over. Patients are most infectious in this stage until the lesion dry out. Pain is severe during this phase and often unresponsive to traditional pain medications.

The phase may last weeks but the pain may continue. Chronic infection is characterized by recurrent pain that lasts more than 4 weeks. Besides the pain, patients experience paresthesias, shock-like sensations, and dysesthesias.

The pain is disabling and may last 12 months or longer. Disseminated zoster is defined as more than twenty skin lesions developing outside the primarily affected area or dermatomes directly adjacent to it. Besides the skin, other organs may also be affected, causing hepatitis or encephalitis making this condition potentially lethal. Post-herpetic neuralgia is the persistence of pain after a month of onset of herpes zoster.

It is the commonest side effect seen in elderly patients with involvement of the ophthalmic division of trigeminal nerve. Complications like cranial neuropathies, polyneuritis, myelitis, aseptic meningitis, or partial facial paralysis occur due to the involvement of the nervous system. Evaluation Herpes zoster is clinically diagnosed with burning pain, characteristic morphology, and typical distribution. Varicella-zoster virus-specific IgM antibody in blood is detected during the active infection of chickenpox or shingles but not when the virus is dormant.

Direct fluorescent antibody testing of vesicular fluid or corneal fluid can be done when there is eye involvement. PCR testing of vesicular fluid, a corneal lesion, or blood in a case with eye involvement or disseminated infection. Differential Diagnosis Cellulitis. Enhancing Healthcare Team Outcomes Shingles is a common infectious disorder in the elderly with significant morbidity.

Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure Herpes Zoster. Contributed by DermNetNZ. Figure Herpes zoster or Shingles. Image courtesy S bhimji MD.

Figure Follicular conjunctivitis may be seen with viral infections like herpes zoster, Epstein-Barr virus infection, infectious mononucleosis , chlamydial infections, and in reaction of topical medications and molluscum contagiosum. Figure Conditions that can cause epiphora: A. Figure Herpes Zoster Ophthalmicus with Hutchinson sign. Figure Herpes zoster.

Contributed by Sunil Munakomi, MD. References 1. Understanding the immunology of Shingrix, a recombinant glycoprotein E adjuvanted herpes zoster vaccine.

Curr Opin Immunol. Watanabe D. Brain Nerve. Segmental zoster abdominal paresis mimicking an abdominal hernia: A case report and literature review. Medicine Baltimore. Herpes zoster vaccination efficacy in the long-term care facility population: a qualitative systematic review.

Curr Med Res Opin. Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis.

Sci Rep. Davis AR, Sheppard J. Herpes Zoster Ophthalmicus Review and Prevention. Eye Contact Lens. A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation.

J Am Acad Dermatol. J Am Psychiatr Nurses Assoc. Front Microbiol. Primary care physicians' experience with zoster vaccine live ZVL and awareness and attitudes regarding the new recombinant zoster vaccine RZV. Syed YY. Drugs Aging. Mospan CM, Colvin N. What are the new vaccination recommendations for herpes zoster? J Acquir Immune Defic Syndr. Herpes Zoster. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed. This virus can reactivate years later, causing shingles.

Recombinant zoster vaccine RZV, Shingrix is the recommended vaccine to prevent shingles in adults 50 and older.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Shingles Herpes Zoster. Section Navigation. Facebook Twitter LinkedIn Syndicate.