Tag Archives: Varicella zoster virus

Straight, No Chaser: Shingles – Return of the Chickenpox

Skin/Dermatology, , , , , , , , , , , , , , , , ,

shingles

It’s another interesting night in the ER.  My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is.  They’re so good that they rarely get stumped, and they get excited when they are.  The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster.  Unknown to them, their problem with this patient is she’s African-American.  Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.

I wonder if any of you haven’t had chickenpox.  That’s a question that never would have been asked a few decades ago.  Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.).  Repeat infections or reactivation of the virus that went dormant inside of you causes shingles.  When I was younger, no one ever got shingles because no one got chickenpox twice.  Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it.  The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).

Then an odd thing happened.  A chickenpox vaccine came out.  Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age.  Then shingles started being seen more often.

shingles

The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes.  Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears.  The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks).  Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.

Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful.  If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half.  Please discuss this with your physician.  If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.

shinglescommon

Quick Tips:

  • If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
  • If you have shingles, avoid close contact with people until after the rash blisters heal.
  • Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories.  For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer.  Who’s this famous manager pictured here with shingles?

larussashingles
 
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Straight, No Chaser: 10 Questions You Want Answered About Genital Herpes

Genital/Urinary, Infectious Disease, Obstetrics and Gynecology, Public Health, , , , , , , , , , ,

Herp_leg1 herpes_2
If you’re in a room, look around. Look to your left, then to your right. Look behind and in front of you. Then look deep inside yourself. Statistically, one of the people you’ve just viewed has genital herpes. Different studies suggest between 16-25% of us between ages 14-49 are infected.

Questions You Want Answered Regarding Genital Herpes

1. How common is it? That’s actually a question with two answers. One of five or six individuals have herpes (well over 50 million Americans if you’re keeping count), but it’s estimated that just short of 800,000 new cases occur every year.
2. How do you get it? Herpes is transmitted sexually (genital, oral and/or anal contact) via someone already infected.
3. Can you really get it from a cold sore? Possibly and theoretically yes, but usually not. The Herpes Simplex Virus-1 (HSV-1) is usually found in oral blisters (i.e. ‘cold sores’ or ‘fever blisters’), and its family member HSV-2 is usually found on or near the genitalia, but both can be found in either. Although the Center for Disease Control and Prevention states that “Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection,” many (if not most) emergency physicians have diagnosed herpes based on transmission from oral as well as genital sex.
4. What are the symptoms? Most have no symptoms or symptoms that may be mistaken for the flu (fever, body aches and swollen and tender lymph nodes). The prototypical symptoms are a cluster of blisters (around your genitalia, mouth, fingers or rectum) or painful ulcers.
5. Does it really stay around forever? Yes. Fortunately, the frequency and severity of outbreaks decrease as you age (assuming your immunity is good). If you are immunocompromised, HSV infections can be devastating.
6. If I catch chickenpox or shingles, does that mean I’ll have genital herpes? No. There are many different herpesviruses. HSV-2 is the virus that causes genital herpes. Varicella zoster virus (VZV) is the virus that causes chickenpox and shingles. Varicella zoster does not cause genital herpes.
7. Is it true you can catch herpes in the eye? Yes. Wash your hands. Or else…
Herpes Simplex KeratitisHerpeticWhitlow

8. What was that last picture? That wasn’t an just eye, there was also a finger! Well, how did you get it got from the genitals to the eye (Please don’t answer in the comments section…)? That’s called herpetic whitlow. Notice the common theme of grouped clusters of small blisters (vesicles) again. Regarding that eye infection (herpes keratitis), it can cause blindness.

9. Is it true that women get it more often? Some estimates suggest that 25% of American women and 20% of men have genital herpes. Transmission from males to females is easier than from females to males, but guys, I wouldn’t take any chances.
10. What about the babies? 80-90% of general herpes infections to newborns are transmitted during childbirth as the newborn passes through the birth canal. C-section is recommended for all women in labor with active symptoms or lesions of herpes.
11. How do you treat this anyway? Antiviral medications are used at first sign of outbreaks. These medications don’t cure you of herpes, but they do shorten the frequency and severity of outbreaks. Plus, you’ve got to let your sexual partner know about this. It’s criminal not to.
Overall, my best advice to you is prevention, knowledge about your status, recognition of symptoms and prompt treatment. It is very important to emphasize that many people live quite normal lives with herpes. That still doesn’t mean you should be cavalier or irresponsible about it.
I welcome your questions or comments.
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Straight, No Chaser: Can You Get Chicken Pox Twice? Emergency Room Adventures: Introducing Shingles

Health Prevention, Medical Treatment, , , , , , , , , , , , ,

shingles
It’s another interesting night in the ER.  My nurses are hounding me because there’s a patient with a rash, and they don’t know what it is.  They’re so good that they rarely get stumped, and they get excited when they are.  The patient had a pretty impressive cluster of little blisters called vesicles (see the picture above) under one eye with significant reddening of the skin under the cluster.  Unknown to them, their problem with this patient is she’s African-American.  Many healthcare professionals have difficulty identifying common rashes in dark-skinned individuals.
I wonder if any of you haven’t had chickenpox.  That’s a question that never would have been asked a few decades ago.  Chickenpox is caused by the Varicella Zoster virus, which is one of the Herpes viruses (No not that one; we’ll discuss that next week.).  Repeat infections or reactivation of the virus that went dormant inside of you causes shingles.  When I was younger, no one ever got shingles because no one got chickenpox twice.  Chickenpox was something you got as a child, and when you contracted it, everyone in the neighborhood would bring the kids by so everyone could get it and be done with it.  The first case of shingles I actually remember seeing was during residency in a HIV+ patient who actually died from it (Herpes Zoster pneumonia; I was told it happened to the elderly or patients with lowered immunity).
Then an odd thing happened.  A chickenpox vaccine came out.  Chickenpox started being seen in older individuals, because all the kids were immunized, and the loss of the ‘herd immunity’ phenomenon allowed some individuals to sneak by without getting chickenpox as a child, only to develop it at an older age.  Then shingles started being seen more often.
The shingles rash is classically a group of lesions stretched around a single dermatome (an area of skin corresponding to the distribution a specific nerve root), usually in the abdomen or back, but seen with some frequency on the face and involving the nose and around the eyes.  Infection begins with general nonspecific symptoms like headache, light sensitivity, pain, itching and burning in the area a few days before the rash appears.  The pain should be emphasized, as it can last for a year after the rash (which typically lasts for 2-4 weeks).  Amazingly 30 out of 100 Americans will now develop this illness at some point in their lives.
Anyone who has had chickenpox may get shingles. However, you can now get a shingles vaccine, which serves two purposes: it may prevent shingles, but if it doesn’t it can make the episode less painful.  If you’re 50, you can get vaccinated, and it can cut the risk of contracting shingles in half.  Please discuss this with your physician.  If you’re eligible, you’ll thank me; if you don’t get vaccinated and contract shingles, you’ll wish you had.
Quick Tips:

  • If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from blisters in both conditions is contagious and can cause chickenpox in these groups.
  • If you have shingles, avoid close contact with people until after the rash blisters heal.
  • Certain people are at heightened risk from chickenpox and shingles, including anyone pregnant, elderly, ill or with a diminished immune system.

I welcome your questions, comments or stories.  For the sports fans out there, this pictorial trivia question shouldn’t be hard to answer?  Who’s this famous manager pictured here with shingles?
larussashingles