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Herpes zoster is a viral infection that is prevalent among 20-30% of
people. Though it is unclear, the underlying pathophysiology can be attributed
to cellular immunity dysfunction. Potential risk factors may involve routine
procedures like biopsies and teeth extraction. Herpes zoster usually follows a
very benign course that is most commonly complicated with post herpetic
neuralgia; however, serious systemic complications including heart block and
cerebral angiitis are frequently reported in immunocompromised cases. This
article reviews publications on this topic and aims to highlight the potential
risk factors and documented complications.
Herpes zoster is a reactivation of varicella-zoster virus, a member of
the Herpesviridae that remains dormant within the dorsal root or cerebral nerve
ganglion after a primary varicella infection. (Herpes) and (Zoster) are Greek
words mean Creeping Girdle. This article aims to review publications on herpes
zoster, with a special focus on potential risk factors and reported
complications.
Herpes zoster typically presents as a vesicular eruption proceeded by
pain, erythema, local edema or abnormal sensation. Pain might be burning,
shooting, stapping, itching or aching. It usually follows a ganglion distribution,
typically on the thoracic region; however, immunocompromised patients might
have disseminated herpes zoster. Young patients usually present with an
erythematous form, whereas elderly or ill patients present with hemorrhagic or
necrotic forms. EPIDEMIOLOGY Herpes zoster is incident among one million, or 4
per 1000 population, per year in the United States and twenty to thirty percent
of people will get herpes zoster in their life. It dominates in old age; and
rarely, it reactivates during infancy with primary foetal/early infantile
infection or during childhood. It is still controversial whether it has a
sporadic reactivation or it is a seasonal disease. RISK FACTORS Exact risk
factors of reactivation are not well-known; yet, cellular immunity is thought
to have a key role.
This role is well illustrated in old age due to normal age-related
decline in cellular immunity; Plasmodium/malaria infection due to transient
depression of cellular immunity and immune suppression in cases of immune
deficiencies, human immunodeficiency infection or HIV disease and
immunosuppressants. The role of genetics and family history is still
controversial.
Risk of rheumatoid and connective tissue diseases is debateable. It is
difficult to attribute the risk of reactivation to the disease per sae;
especially that patients are frequently on immunosuppressant medications. Some
publications suggest luck of association between herpes zoster and the disease
and/or the medication, whereas other researchers propose a possible
relationship. Other co-existing diseases are diabetes mellitus, essential
hypertension, dyslipidaemia, chronic venous diseases, other skin diseases, and
malignancies including breast cancer, lung cancer, prostate cancer, lymphoma,
lymphatic leukaemia, multiple myeloma and Hodgkin’s disease with bone marrow
transplant. COMPLICATIONS Though it usually follows a benign course, herpes
zoster is most commonly complicated by post herpetic neuralgia. It is proposed
that different organopathies are due to either direct infiltration of the virus
or indirect hematogenous infection.
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