Clinical Manifestations:
- Any part of the trunk may be affected but the thoracic segment is commonly involved.
- Other area that may be affected are the extremities and branches of the 5th and 7th cranial nerves.
- The virus affects the ganglion of the posterior nerve roots or the extramedullary cranial nerve ganglion.
1. An erythematosus base of the skin lesion appears first but is followed within 24 hours by the appearance of the vesicles.
2. Cluster of vesicles appear to form patches, which coalesce to form an irregular band-like distribution along the course of involved dermatomes. Eruptions are unilateral and never cross the midline of the body. The vesicles become pustular, break down and form crusts. Lesions may last for 1 -2 weeks.
3. Pain of varying intensity is a presenting symptom in about two thirds of the patients.
4. Pain occurs from one to five days prior to the development of rash and is neuralgic and paroxysmal in type. It may be described as burning or stabbing.
5. Patient may complain of pruritus. The pain is usually worse at night and in intensified by movement.
6. Fever, malaise, anorexia, and headache occur in one or more days.
7. Regional lymph nodes are involved early in the disease.
8. When ophthalmic or the 5th cranial nerve is affected, corneal anesthesia may occur, it is known as Gasserian ganglionitis.
9. Paralysis of the facial nerve and vesicles in the external auditory canal affecting the 7th cranial nerve. The condition is called Ramsay Hunt Syndrome.
Diagnostic Exam
1. Characteristic skin rash may be diagnostic
2. Tissue culture technique – the virus may be isolated from fluid taken from newly developing vesicles.
3. Smear of vesicle fluid
4. microscopy
Complications
1. Encephalitis
2. Paralytic ileus, bladder paralysis
3. Ophthalmic herpes which may lead to blindness
Modalities of Treatment
• Symptomatic
• Antiviral drugs
• Analgesics to control pain
• Anti-inflammatory