Shingles ( herpes) - a viral disease, which is characterized by damage to the nervous system, mucous membranes of the mouth and skin.Manifested blisters neuralgia, and in certain segments of skin innervated by sensory nerves.
Shingles (herpes) is a disease that causes the same virus as chickenpox.
After chickenpox disease, which usually occurs in childhood, the virus does not die, but rather slept in the nerve cells of the spinal cord or brain.After a few years and can revive virus migrate to the nerve along the surface of the skin, causing a rash painful blisters.In general, it is not dangerous disease, but it can be extremely painful and often causes aching nerve pain (postherpetic neuralgia) for months or even years after the rash pass.
most often herpes zoster occurs in the spring and autumn periods.Ill mostly men aged 40-70 years, with men slightly more than women.In older patients with more severe disease and is often complicated by postherpetic neuralgia.How to use folk remedies in this il
etiology. causative agent - the herpes virus type 3 (varicella-zoster virus - VZV).The infectious nature of herpes zoster is installed I. Bokay (1888).The identity of the causative agents of varicella and herpes zoster proved T. Weller, N. Witton (1958).
Epidemiology. Shingles (herpes zoster) is the most common viral infections of man.Every year shingles carry 0.2-2% of people.Patients with a history of herpes zoster to have an indication of the previously transferred chickenpox.In his absence indication transferred vertyanuyu smallpox can not exclude latent congenital varicella, as well as mild or subclinical form of the disease in the postnatal period, which was not detected in a timely manner.
VZV reactivation occurs in a CID.risk groups are patients with malignant tumors, oncohematological disorders, HIV infection, diabetes, transplant recipients, and others.
Epidemic risk of herpes zoster patients is low.
pathogenesis.After undergoing chickenpox VZV life persists in the spinal ganglia and ganglia of the cranial nerves.Persistence VZV periodically replaced by periods of reactivation and replication of the virus.However, in the intact immune system function stops the reproduction of the virus.With the development of systemic and local CID nerve axons on virus enters the skin, where it is breeding.
Pathomorphological with herpes zoster reveal a sharp gangliitis with necrosis of neurons, inflammatory response and hemorrhages.Inflammatory changes are also noted in the dorsal root and underlying spinal cord segments, the brain stem, the peripheral nerves.Pathomorphosis exanthema with herpes zoster is similar to chicken pox.
Clinic. Disease begins acutely, accompanied by an increase in body temperature (optional sign) and the emergence of pain in the area of skin innervated by a segmental nerve.The general condition suffers slightly.After 1-2 days (possibly lengthening prodrome to 5 days) appears skin seal, and then groups of red papules that are close to each other.In their place will soon emerge bubbles with clear content that quickly becomes cloudy.Multiple vesicles, are located close to each other, resemble a bunch of grapes, may merge.Eruptions are located in one or two adjacent segments along the sensory nerves, reminiscent of times (from the Greek zoster -. Times).New rash appears within 2-4 days.Bubbles gradually dry out and in their place formed a crust.The entire cycle of changes takes 5-10 days.
fever, pain and induration in the lesions usually persist for the entire period of disease progression.Increased regional lymph nodes.The rash disappears in 1-2 weeks, leaving a light pigmentation.
The most common lesions are located along the intercostal nerves (rib gangliitis).Less developed lumbar (localized rash on the skin of the lumbar region, buttocks, lower limbs) and traumatic brain ganglionitis.
With the defeat gasserova node lesions are localized along the branches of the trigeminal nerve - the mucous membranes soft and hard palate, eyes, nose, on the skin.The disease process often affects the cornea, iris, sclera, which can lead to permanent visual impairment.The disease may last several weeks, accompanied by fever, pain, severe intoxication.
With the defeat of the crankshaft of the ganglion of the facial nerve (Hunt syndrome), rashes appear on the ear and ear canal.paresis of facial muscles often develop in the field of ear pain, loss of taste sensitivity in the anterior two thirds of the tongue, hearing impairment (hyper- and Gipoakuzija), dizziness.
Generalized forms of herpes zoster can occur in children at risk.Repeated diseases occur with a frequency of less than 1%.
with herpes zoster may develop the following complications - keratitis, uveitis, serous meningitis, meningoencephalitis, ganglioradikulopleksity, a bacterial infection, laryngotracheitis, obstructive bronchitis.
Diagnostics. Diagnostics carried out on the basis of epidemiological history, clinical symptoms and laboratory tests.
Methods of laboratory diagnostics of herpes zoster include.
In the study of immune status detect T-cell immune deficiency disorders of the B-cell level, interferon status, functional activity of neutrophils, macrophages, increased the CEC.
Differential diagnosis.According to a leading syndrome "vesicular rash" differential diagnosis of herpes zoster is carried out with infectious diseases - varicella, herpes simplex infection, enterovirus infection (hand, foot), rickettsialpox, monkeypox, pseudocowpox;Noncommunicable diseases - exudative erythema multiforme, Stevens-Johnson syndrome, insect bites, urticaria, dyshydrosis.differential diagnosis algorithm is presented in section "herpes simplex infection."
Treatment includes a set of measures.Hospitalization is performed as clinically indicated (severe and complicated forms), age indications (children of the first three years of life, at risk) and socio-epidemiological indications (children from dysfunctional families, from closed groups).Patients hospitalized in meltserovskie boxes.Patients are prescribed bed rest for a period of severity of the condition followed by its extension.Recommend milk-vegetable diet rich in vitamins and trace elements.An important measure for the prevention of complications is a thorough skin care.Eruptions on the skin is treated with 1-2% aqueous or alcoholic solution of brilliant green, methylene blue, gentian violet, and others. In the period of formation of crusts used 5% dermatolovuyu ointment solkoseril, cold cream and others.
Causal treatment involves a combination of virucidaldrugs (acyclovir, Valtrex, famvir, inosine pranobex) with interferon (viferon, Genferon light, kipferon, IFN-EU lipint, IFN, intron a, Roferon a) or interferon inducers (tsikloferon, neovir, amiksin, anaferon).Schemes similar to those in the treatment of chicken pox.According to the testimony used immunoglobulins (varitekt, immunovenin, Intraglobin, intratekt, pentaglobin et al.) And antibiotics (protected aminopenicillin, cephalosporins 3-4-generation macrolides, carbapenems).
Pathogenetic therapy comprises administering to detoxification: the mild and moderate forms - plentiful drink;in severe and complicated forms - intravenous drip infusion glyukozosolevyh solutions.Cytokine preparations (leukinferon, roncoleukin) and immunomodulators (timalin, taktivin, timogen, immunofan, polyoxidonium, likopid, imunoriks, derinat sodium nukleinat, IRS-19, ribomunil, bronhomunal, immunomaks et al.) Is prescribed under the control immunogram.Recommend taking a multivitamin, vitamin-mineral complexes, drugs metabolic therapy (Riboxinum, kokarboksilaza, cytochrome C, Elkar), probiotics.When pain syndrome using non-steroidal anti-inflammatory drugs (ibuprofen, indomethacin, naproxen, and others.) And procaine blockade, under expressed pain syndrome - ganglioplegic (gangleron).According to the testimony prescribed protease inhibitors (contrycal, gordoks, trasilol), antiplatelet agents (cavinton, pentoxifylline, cinnarizine, aktovegin), oxygen therapy, antihistamines.Use physiotherapy (UFO, electrophoresis with novocaine) and acupuncture.
Symptomatic therapy includes the administration on the testimony of antipyretic drugs and cardiac glycosides.
Rehabilitation. Clinical supervision includes inspection pediatrician and infectious disease 1 time in 3 months, according to testimony - consultations of specialists (neurologist, immunologist).Conduct laboratory study markers of VZV ELISA and PCR immunogram.Rehabilitation therapy is to appoint a protective regime for 2 weeks, viferona the maintenance dose for 2-6 months interferon inducers (tsikloferon, neovir, amiksin, anaferon) for prolonged schemes, multivitamins, herbal adaptogens, immunomodulators controlled immunogram.Patients underwent physical therapy, massage, physiotherapy, acupuncture, spa treatment.
Prevention. abroad studying the possibility of herpes zoster vaccination in the elderly with use of live attenuated vaccines "Varilriks" (Glaxo-SmithKline), "Varivax" (Merck, Sharp & Dohme).
isolation of the patient often carried out in the home, at least - in a hospital in meltserovskom box.The patient is isolated for 5 days from the date of the last eruption.Final disinfection is not carried out, after the patient is necessary aeration and wet cleaning.Contact before the age of 3 years of life, without a history of varicella, is isolated for the period from 11 th to 21 th day from the moment of contact with the patient.