Varicella-Zoster Virus

Clinical presentations include Varicella (chicken pox) and Herpes Zoster (shingles)
Varicella is marked by diffuse vesicular rash with lesions in various stages of healing
Once aquired, vzv resides in the dorsal root ganglion
Reactivation of vzv leads to herpes zoster: painful, unilateral, dermatomal vesicular eruption
Note that immunocompromised patients may have diffuse rather than dermatomal reactivation
Greatest risk for Herpes Zoster is age (>50 y)

Complications of Herpes Zoster include:
* Acute Neuritis described as burning, throbbing, stabbing and may have pruritis and allodynia
* Postherpetic neuralgia (PHN)— 7.9 percent
* Bacterial skin infection — 2.3 percent
* Ocular complications including uveitis and keratitis — 1.6 percent
* Motor neuropathy — 0.9 percent
* Meningitis — 0.5 percent
* Herpes zoster oticus — 0.2 percent

Know these patterns:

Hutchinson's Sign: vesicular lesions on the nose associated with herpes zoster ophthalmicus due to nasociliary branch involvement of the trigeminal nerve, which also innervates the globe

Ramsey Hunt Syndrome: herpes zoster oticus and facial n. palsy
CN VIII involvement results in auditory and vestibular disorders ie) vertigo

(Ellen Eaton MD, 11/18/10)