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AT A GLANCE

AT A GLANCE VARICELLA

  • Varicella (chickenpox) and herpes zoster (shingles) are distinct clinical entities caused by a single member of the herpesvirus family, varicella-zoster virus (VZV).

  • Varicella, a highly contagious exanthem that occurs most often in childhood, is the result of primary VZV infection of a susceptible individual.

  • The rash of varicella usually begins on the face and scalp and spreads rapidly to the trunk, with relative sparing of the extremities. Lesions are scattered, rather than clustered, reflecting viremic spread to the skin, and they progress sequentially from rose-colored macules to papules, vesicles, pustules, and crusts. Lesions in all stages are usually present at the same time.

  • In immunocompetent children, systemic symptoms are usually mild and serious complications are rare. In adults and immunocompromised persons of any age, varicella is more likely to be severe and can be associated with life-threatening complications.

  • Varicella results in lifelong latent VZV infection of sensory and autonomic neurons, and host immunity to VZV.

  • Live attenuated Oka VZV varicella vaccines have virtually eliminated varicella in countries where they have been deployed.

HERPES ZOSTER
  • Herpes zoster is characterized by unilateral dermatomal pain and rash that results from reactivation and multiplication of latent VZV that persisted within neurons following varicella.

  • The erythematous maculopapular and vesicular lesions of herpes zoster are clustered within a single dermatome, because VZV reaches the skin via the sensory nerve from the single ganglion in which latent VZV reactivates, and not by viremia.

  • Herpes zoster is most common in older adults and in immunocompromised individuals.

  • Pain is an important manifestation of herpes zoster. The most common debilitating complication is chronic neuropathic pain that persists long after the rash resolves, a complication known as postherpetic neuralgia (PHN).

  • Antiviral therapy and analgesics reduce the acute pain of herpes zoster. Lidocaine patch (5%), high-dose capsaicin patch, gabapentin, pregabalin, opioids, and tricyclic antidepressants may reduce the pain of PHN.

  • A live attenuated Oka/Merck strain VZV herpes zoster vaccine (ZVL; Zostavax®) reduces the incidence of herpes zoster by one-half and the incidence of PHN by two-thirds. An adjuvanted recombinant glycoprotein E subunit herpes zoster vaccine (RZV; Shingrix®) has substantially greater efficacy for herpes zoster and PHN, but it requires 2 doses and is more reactogenic.

INTRODUCTION

Varicella (chickenpox) and herpes zoster (shingles, zoster) are distinct clinical entities caused by a single member of the herpesvirus family, varicella-zoster virus (VZV). The different clinical manifestations of these 2 diseases are the result of differences in the host immune response and in the pathogenesis of the VZV infection, and not due to differences in the etiologic agent. Varicella, a highly contagious vesicular exanthem that occurs most often in childhood, is the result of exogenous primary infection of a susceptible individual. In contrast, herpes zoster results from reactivation of endogenous virus that persists in latent form within ganglionic neurons following an earlier attack of varicella. Herpes zoster is a localized dermatomal ...

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