herpes zoster oticus


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herpes

 [her´pēz] any inflammatory skin disease caused by a herpesvirus and characterized by formation of small vesicles in clusters. When used alone the term may refer to either herpes simplex or herpes zoster.herpes cor´neae herpetic inflammation involving the cornea.herpes febri´lis a variety of herpes simplex usually found on or around the lips and nostrils but occasionally on other mucoid tissues. It is generally caused by human herpesvirus 1, although occasionally it may be caused by human herpesvirus 2. It is usually a concomitant of fever, but may also develop in situations of other stresses without fever or prior illness. The virus is carried by most people but usually lies quiescent. There is no cure for the condition, but some medications increase comfort. Antiviral medications used in this way include acyclovir and valacyclovir. Called also fever blisters and cold sores.genital herpes (herpes genita´lis) herpes simplex" >herpes simplex of the genitals, a common sexually transmitted disease, usually caused by human herpesvirus 2 but occasionally by human herpesvirus 1. If it is present at term in the pregnant female, it may lead to infection of the neonate (see herpes" >maternal herpes).
The incidence of active genital herpes is difficult to determine precisely because many cases present mild symptoms, are self-limiting, and are not called to the attention of health care personnel. However, it is clear that the disease has reached epidemic proportions in the United States. It is highly contagious and is transmitted by direct person-to-person contact (not limited to sexual contact). Autoinoculation via the hands is possible; for example, from a lip ulcer to the genital area or from the lip or genitals to the eye. Once the virus gains access to the body it enters the nervous system and invades nerve cells located near the site of infection, such as in the sacral ganglia. The virus lies dormant in nerve cells and can remain there indefinitely, predisposing the person to recurrent outbreaks. Factors contributing to recurrent genital herpes are not well understood. Some infected persons experience no recurrences while others have frequent and severe outbreaks. Many patients are aware of a correlation between the appearance of lesions and precipitating factors such as exposure to sunlight, local trauma, fever, or emotional stress. Hormonal changes preceding menses have been associated with recurrences in women.Diagnosis and Symptomatology. Diagnosis is most often based on the patient's history and symptoms, which are easily recognized by an experienced clinician. Clinical and serological findings help establish whether the patient's complaints are manifestations of a primary infection or an initial phase of a recurrent episode. At the primary or first exposure to the virus, the typical cutaneous lesions may or may not be present and no antibodies to the virus are found in the patient's serum. The presence of such antibodies at the time of an initial episode indicates a previous herpes infection. Since the virus dwells in the lesions and nerve cells and not in the blood, antibody titers, smears, and cultures taken from the lesions can be helpful in identifying the stage of the disease.
Typically, recurrent episodes become milder and less frequent; however, some patients may experience weekly or monthly outbreaks that are severe and painful. Those with recurrent herpes usually have high antibody titers. Paradoxically, it has been noted that the higher the antibody titer the more severe the symptoms and the more frequent the recurrences. Thus, it is apparent that the body's immune system is not effective in providing protection against herpes infection or in mitigating its effects.
A genital rash and mild itching usually are the earliest signs of infection. Eventually vesicles on the surface of the skin form, and then enlarge, break open, and ulcerate. The lesions are painful, especially during coitus, and can cause intense itching, and, if the urethra is involved, painful urination. The disease affects both sexes. In the male, vesicles are found principally on the glans penis, shaft of the penis, and prepuce, and may extend to the scrotum and inner thighs. In the female, vesicular eruptions usually involve the vulva, vagina, and cervix, and may extend to the perineum, inner thighs, and buttocks. Lesions of the cervix can vary from small superficial ulcers with diffuse inflammation to a single, large, necrotic ulcer. Other symptoms include malaise, fever, and anorexia. There also can be involvement of neural structures and the manifestation of neurologic symptoms. The characteristic lesions usually last from one to three weeks in either the initial stage or during periodic outbreaks.Treatment. At the present time there is no cure for genital herpes. (A vaccine to prevent the development of herpes is under active development.) Antivirals such as acyclovir and valacyclovir help shorten episodes during the initial phase of infection, but do not cure it. Palliative treatment consists of measures to keep lesions clean and dry, to control pain with an analgesic, to promote healing with frequent sitz baths, and to prevent secondary bacterial infections.Complications and Sequelae. A primary herpetic infection usually is self-limiting, and, barring secondary infection and neurologic damage, immediate complications are rare. In some instances the infection may be complicated by urethral stricture, meningoencephalitis, labial fusion, or lymphatic suppuration. Although there is no conclusive evidence that herpesvirus infection actually leads to cervical cancer, women with genital herpes are eight times more likely to develop carcinoma in situ than are those whose serum lacks antibodies to the virus.Patient Care. Probably the greatest needs of patients with herpes are accurate information and support and counseling to help them cope with the emotional impact and fears about the disease and its effects. The palliative treatments presented above can provide symptomatic relief. In addition, the patient should be told to try to keep the lesions clean and dry. Loose cotton clothing avoids trapping moisture in the genital area. The person should not use perfumed soaps or sprays, and women should not use feminine deodorants or douches. Management of stress can be important in controlling symptoms; ineffective or harmful coping mechanisms can aggravate the condition and delay healing. The emotional impact of genital herpes often is overwhelming to persons who learn they have the disease. Since there currently is no cure, preventive medication, or vaccine and the infection can be transmitted by intimate contact, patients often feel anger, guilt, fear, or anxiety.
Support groups can provide patients opportunities to ventilate their anger and talk about their guilt. In a group of persons with similar problems, they can learn that there are others who have had much the same feelings and have managed to work through them and develop a more positive attitude. The American Social Health Association (ASHA) sponsors self-help groups and provides educational materials; their address is P.O. Box 13827, Research Triangle Park, NC 27709.
Fear of cancer is very real in these patients; females are encouraged to have a Pap smear every six months. Early detection is almost guaranteed with such frequent examinations, and the cure rate in these cases is 100 per cent. Another source of anxiety for female patients is the effect of herpes on fertility and the welfare of infants born of mothers with herpes (see herpes" >maternal herpes).herpes labia´lis herpes febrilis affecting the vermilion boder of the lips.maternal herpes active herpes" >genital herpes during pregnancy and the perinatal period. Herpes infection during early pregnancy can result in a viral septicemia and abortion" >spontaneous abortion. Infants born of mothers with active herpes during which there is shedding of the virus at the time of delivery are likely to become infected during a vaginal delivery. Of those who contract herpes from their mothers, about 50 per cent will not survive. Of the ones who do survive, half will suffer from permanent neurological or visual damage.
Protective measures such as cesarean section for delivery improve the chances of avoiding infection in the newborn. During the last trimester it is best if the woman abstains from sexual intercourse if there is any history of either partner having herpes. When there is such a history, it is recommended that frequent cervical viral cultures be done to determine whether vaginal delivery is safe.
With early diagnosis and cesarean section many infants can be protected from infection, but only if the membranes are intact or have been ruptured no more than 4 to 6 hours before the operation. After that length of time it is assumed that an ascending infection has reached the fetus. Mothers who have no active lesions at the time of birth and two negative cervical smears for the virus within a week of delivery can safely deliver their newborns vaginally.
Wound and skin precautions are followed in the care of the mother if she has recurrent herpes (see above). An isolation nursery and wound/skin precautions are recommended for newborns delivered (whether vaginally or by cesarean section) to women with active genital herpes. Some authorities recommend isolation precautions the entire time the newborn is in the hospital and until the incubation period of 21 days has passed.progenital herpes (herpes progenita´lis) herpes genitalis.herpes sim´plex an acute viral disease caused by a herpesvirus and marked by groups of vesicles on the skin, each about 3 to 6 mm in diameter. Type 1 herpes simplex, or herpes labialis, is usually found on the borders of the lips or nostrils and has been nicknamed “kissing herpes.” It may accompany fever (herpes febrilis or fever blisters), although there may also be other precipitating factors, such as the common cold, sunburn, skin abrasions, and emotional disturbances. Type 2 herpes simplex, or herpes" >genital herpes, is usually found on or around the genital area. Infection of the newborn from a mother with the condition (see herpes" >maternal herpes) has a fatality rate of 50 per cent and many survivors have significant neurological or ocular sequelae. traumatic herpes (wrestler's herpes) a self-limiting cutaneous herpesvirus infection following trauma, the virus entering through burns or other wounds; the temperature rises moderately, and vesicles appear around the wound.herpes zos´ter an acute viral disease caused by a herpesvirus (the same virus that causes chickenpox); characteristics include inflammation of spinal ganglia and a vesicular eruption along the area of distribution of a sensory nerve. Called also shingles and zoster. It may appear in persons who have been exposed to chickenpox, and it sometimes accompanies other diseases such as pneumonia, tuberculosis, and lymphoma or is triggered by trauma or injection of certain drugs. In some cases it appears without any apparent reason for activation.
Treatment is symptomatic and is aimed at relieving the pain and itching of the blisters. Local applications of calamine lotion or other lotions to dry the blisters may help. Herpes zoster is a very exhausting disease, especially for elderly people, because the constant itching and pain are difficult to control, even with systemic analgesics in some cases.
Herpes zoster affecting the eye causes severe conjunctivitis and possible ulceration and scarring of the cornea if not treated successfully.
Herpes zoster is a communicable disease and therefore requires some type of isolation, the specific precautions depending on whether the disease is localized or disseminated and also on the condition of the patient. Localized lesions in immunocompromised patients often become disseminated. Persons susceptible to varicella-zoster (chickenpox) should stay out of the patient's room. This includes hospital personnel as well as other patients. If there is any question as to the proper procedures for prevention of the spread of herpes zoster, the CDC Guidelines for Infection Control in Hospital Personnel should be consulted.herpes zos´ter auricula´ris (herpes zos´ter o´ticus) Ramsay Hunt syndrome.

her·pes zos'·ter o'ti·cus

a painful varicella virus infection presenting with a vesicular eruption on the pinna, with or without facial nerve paralysis. Synonym(s): geniculate zoster, Ramsay Hunt syndrome (2)

herpes zoster oticus

n. See Ramsay Hunt syndrome.

her·pes zos·ter oti·cus

(hĕr'pēz zos'tĕr ō'ti-kŭs) A painful varicella virus infection presenting with a vesicular eruption on the pinna, with or without facial nerve paralysis.
Synonym(s): Ramsay Hunt syndrome (2) .

herpes

(her'pez? ) [Gr. herpes, creeping] Vesicular eruption caused by a virus, esp. herpes simplex virus or herpes zoster.

herpes corneae

Inflammation of the cornea caused by herpesvirus.

herpes facialis

A form of herpes simplex that occurs on the face.

herpes febrilis

Herpes simplex of the lips and nasal mucosa. GENITAL HERPESGENITAL HERPES

genital herpes

A persistent, recurring eruption of the genital or anorectal skin or mucous membranes, caused by herpes simplex virus (usually herpes simplex virus type II). It usually affects adolescents and young adults, is spread by intimate contact, and is classified as a sexually transmitted disease. Worldwide about 85 to 90 million people are infected. See: illustration

Symptoms

Patients often experience local pain, itching, burning, dysuria, or other uncomfortable sensations that sometimes begin before a rash or lesion(s) appears on the skin. The skin lesion consists of a reddened patch or small blisters (vesicles) or pustules that ulcerate before healing. These typically take about 10 days to heal. Regional lymph nodes often enlarge and become tender. Systemic symptoms (e.g., fever and malaise) sometimes accompany the initial outbreak or recurrences. However, asymptomatic shedding of the virus is common and may represent the most common way in which the virus is transmitted from person to person.

Potential Complications

Genital herpes may be transmitted to the newborn during childbirth and may cause serious complications, including respiratory illnesses, retinal infection, liver infection, encephalitis, mental retardation, blindness, deafness, seizures, microcephaly, and diabetes insipidus. Cesarean delivery or maternal suppression of the virus with acyclovir are two methods used to prevent newborn infection. Poor hand hygiene may transmit the virus to the eye(s), resulting in herpetic keratoconjunctivitis.

Treatment

Oral acyclovir or its derivatives can treat both the initial outbreak and subsequent recurrences and diminish asymptomatic viral shedding.

CAUTION!

Herpetic lesions are contagious, and those caring for the patient must avoid contact with the exudates. Wearing gloves when in contact with mucous membranes, followed by good hand hygiene helps health care professionals prevent herpetic whitlow (finger infections).

Patient care

The patient should be taught to avoid all skin-to-skin contact when lesions are present and to practice safe sex. Patients should not share towels or other personal care items. Patients with genital herpes often experience anger, self-doubt, fear, or guilt, esp. at the time of initial diagnosis or during recurrences. Counseling and support may help the patient address these issues. Patient education improves understanding of the prevalence of the disease in the general population, the recurring nature of the eruption, safe sexual practices, medication use, and psychosocial and relationship issues.

illustration

herpes gestationis

An autoimmune rash usually occurring in pregnancy or trophoblastic disease, characterized by red, itchy, blistering, or papular lesions. The lesions stain positive for the third component of complement on immunofluorescent microscopy. HERPES LABIALIS

herpes labialis

A form of herpes simplex that occurs on the lips. See: cold sore; fever blister; illustrationillustration

herpes menstrualis

Herpetic lesions appearing at the time of the menstrual period.

ocular herpes

Herpes of the eye.

herpes simplex

An acute infection caused by herpes simplex viruses 1 and 2. The infections are categorized by the site of infection, e.g., herpes corneae, herpes facialis, genital herpes, etc. See: herpes simplex virus under virus.

traumatic herpes

Herpes at a wound site.HERPES ZOSTERHERPES ZOSTER

herpes zoster

Reactivation of varicella virus years after the initial infection with chickenpox. It is marked by inflammation of the posterior root ganglia of only a few segments of the spinal or cranial peripheral nerves. A painful vesicular eruption occurs along the course of the nerve (called a dermatome) and almost always is unilateral. The trunk is the region most often affected, but the face, the groin, or the limbs may also be affected. The virus may cause meningitis or affect the optic nerve or hearing. Chickenpox (varicella zoster) virus incorporates itself into nerve cells and lies dormant there after patients recover from the initial infection. Normally, immunity is boosted by exposure to infected children; as more children are vaccinated against chickenpox, adult immunity against herpes zoster is decreased.

The incubation period is from 7 to 21 days. The total duration of the disease from onset to complete recovery varies from 10 days to 5 weeks. If all the vesicles appear within 24 hr, the total duration is usually short. In general, the disease lasts longer in adults than in children. It is estimated that about 50% of people who live to age 80 will have an attack of herpes zoster. This infection is more common in persons with a compromised immune system: older adults, those with AIDS or illnesses such as Hodgkin's disease and diabetes, those taking corticosteroids, or those undergoing cancer chemotherapy.

Pain often develops along affected skin and persists for months after resolution of the rash. This discomfort, which may be severe in patients older than 50, is known as postherpetic neuralgia. It may intensify at night or worsen when clothes rub against the skin. Synonym: shinglesillustration; herpes zoster ophthalmicus;

Diagnosis

Diagnosis is usually made based on clinical assessment. If further studies are required, the CDC recommends direct fluorescent antibody testing of specimens collected by rubbing a swab on the base of an open lesion.

Treatment

In healthy adults, acyclovir, famciclovir, and valacyclovir are effective in reducing viral shedding and nerve pain damage if administered within 3 days of onset of the rash. Corticosteroids, gabapentin, pregabalin, nonsteroidal anti-inflammatory drugs, some antidepressants, and narcotics may decrease the pain of postherpetic neuralgia. Itching may be reduced with colloidal oatmeal or other topical treatments. Capsaicin cream (an extract of hot chili peppers) may be applied topically for pain relief, but this should be done only after active lesions have subsided.

Patient care

The prescribed antiviral agent is administered and explained to the patient, along with information about desired and adverse effects. Skin lesions are inspected daily for signs of healing or secondary infection; the patient's response to treatment is evaluated regularly, and he is monitored for associated complications. Prescribed analgesics are given on a schedule to minimize neuralgic pain. Patients experiencing neuralgia following the acute stage of the disease should be referred for ongoing therapy. He is reassured that HSV pain will subside eventually, that the prognosis for complete recovery is good, and that the infection seldom recurs.

prevention

Reactivation of varicella zoster virus (VZV) may be prevented with a vaccine. VZV vaccination is approved for use in the U.S. in adults at age 60.

illustrationHERPES ZOSTER OPHTHALMICUS

herpes zoster ophthalmicus

Herpes zoster affecting the first division of the fifth cranial nerve. The area of the face, eye, and nose supplied by this nerve is affected. Ocular complications may threaten sight. It is important that the eye be treated early with antiviral agents and that therapy be supervised by an ophthalmologist. illustration

herpes zoster oticus

Ramsay Hunt syndrome.

Hunt,

James Ramsay, U.S. neurologist, 1872-1937. Hunt atrophy - obsolete term for atrophy of the small muscles of the hand, without sensory disturbances.Hunt neuralgia - a severe paroxysmal lancinating pain deep in the ear. Synonym(s): geniculate neuralgiaHunt paradoxical phenomenon - in torsion dystonia, extension of the foot in response to passive flexion and flexion in response to attempted passive extension.Hunt syndrome - (1) an intention tremor beginning in one extremity and subsequently involving other parts of the body. Synonym(s): progressive cerebellar tremor; - (2) facial paralysis, otalgia, and herpes zoster resulting from viral infection of the seventh cranial nerve and geniculate ganglion. Synonym(s): herpes zoster oticus; - (3) a form of juvenile paralysis agitans associated with primary atrophy of the pallidal system. Synonym(s): paleostriatal syndrome; pallidal syndrome; Ramsay Hunt syndromeRamsay Hunt syndrome - Synonym(s): Hunt syndrome