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Shingles Quiz - How much do you know? Second Nature Care

[fa icon="calendar'] Mar 23, 2015 9:00:00 AM / by Dr. Isadora Guggenheim

We have safe and effective treatment for shingles.  Second Nature Care.

Shingles has been coming up with my patients asking questions about preventing shingles and treating shingles. There are Naturopathic treatments for shingles. Shingles is one expression of a broken immune system which a vaccine will not correct. Let's see what you know about shingles with this quiz. 

Herpes zoster, also referred to as shingles, is an acute, cutaneous viral infection caused by the reactivation of the varicella-zoster virus (VZV), the herpesvirus that causes chickenpox. Herpes zoster is an acute neurologic disease that warrants immediate evaluation. Many individuals continue to suffer pain after the virus resolves, a condition known as postherpetic neuralgia (PHN). Do you know which symptoms to watch for, which tests to obtain, and what treatment to initiate? Test your knowledge with this quick quiz.  Quiz: How Much Do You Know About Shingles? Medscape. Mar 03, 2015.

Which of the following is not a characteristic of the pre-eruptive phase of herpes zoster infection?
Sensory phenomena along one or more skin dermatomes, lasting 1-10 days
Pain that simulates headache, iritis, brachial neuritis, pleurisy, cardiac pain, appendicitis or other intra-abdominal disease, or sciatica
Patchy erythema, vesicular involution, and regional lymphadenopathy
Malaise, myalgia, and photophobia

The clinical manifestations of herpes zoster can be divided into the following three phases:

  • Pre-eruptive phase (preherpetic neuralgia)

  • Acute eruptive phase

  • Chronic phase (PHN)

The pre-eruptive phase is characterized by the following:

  • Sensory phenomena along one or more skin dermatomes, lasting 1-10 days (average, 48 hours)

  • Phenomena usually are noted as pain or, less commonly, itching or paresthesias

  • Pain may simulate headache, iritis, pleurisy, brachial neuritis, cardiac pain, appendicitis or other intra-abdominal disease, or sciatica

  • Other symptoms, such as malaise, myalgia, headache, photophobia, and, uncommonly, fever

The acute eruptive phase is marked by the following:

  • Patchy erythema, occasionally accompanied by induration, in the dermatomal area of involvement

  • Regional lymphadenopathy, either at this stage or subsequently

  • Grouped herpetiform vesicles developing on the erythematous base (the classic finding)

  • Cutaneous findings that typically appear unilaterally, stopping abruptly at the midline of the limit of sensory coverage of the involved dermatome

  • Vesicular involution: Vesicles initially are clear but eventually cloud, rupture, crust, and involute

  • After vesicular involution, slow resolution of the remaining erythe

    • After vesicular involution, slow resolution of the remaining erythematous plaques, typically without visible sequelae

    • Scarring can occur if deeper epidermal and dermal layers have been compromised by excoriation, secondary infection, or other complications

    • Almost all adults experience pain, typically severe

    • A few experience severe pain without a vesicular eruption (ie, zoster sine herpete)

    • Symptoms tend to resolve over 10-15 days

    • Complete healing of lesions may require up to a month

    PHN is characterized by the following:

    • Persistent or recurring pain lasting 30 or more days after the acute infection or after all lesions have crusted (9%-45% of all cases)

    • Pain usually is confined to the area of original dermatomal involvement

    • The pain can be severe and incapacitating

    • Pain can persist for weeks, months, or years

    • Slow resolution of pain is especially common in the elderly

    • PHN is observed more frequently after cases of herpes zoster ophthalmicus and in instances of upper-body dermatomal involvement

    • Less common postherpetic sequelae include hyperesthesia or, more rarely, hypoesthesia or anesthesia in the area of involvement

    • Which of the following is a recognized risk factor for herpes zoster?
      Type 2 diabetes mellitus
      Bulimia nervosa
      Budd-Chiari syndrome
      Inflammatory bowel disease
    • Research indicates that patients with IBD are at significantly increased risk for herpes zoster. In an analysis of more than 108,000 IBD patients and 430,000 matched controls, the overall annual incidence of herpes zoster per 100,000 person-years was 734 among IBD patients, compared with 437 in non-IBD patients. The elevated risk in IBD patients remained after adjustment for comorbidities and other factors. Treatment with thiopurines, corticosteroids, and biologic antitumor necrosis factor-alpha (anti-TNF) agents was independently associated with an increased risk for herpes zoster.
    • Which of the following dermatomes is most commonly affected in herpes zoster?
      The trigemenial dermatome
      A thoracic dermatome
      The ulnar dermatome
      A lower-limb dermatome
    • Classic physical findings of herpes zoster include painful grouped herpetiform vesicles on an erythematous base confined to the cutaneous surface innervated by a sensory nerve. Typically the condition affects a single dermatome, most commonly a thoracic dermatome, on one side of the body. Regional lymphadenopathy may be present.

      Which of the following tests is preferred for acute diagnostic confirmation of herpes zoster?

      The Tzanck smear
      Viral culture
      Skin biopsy
      Polymerase chain reaction (PCR) assay

      Although VZV can be cultured, its growth rate is usually too slow for culturing to make a timely contribution to diagnosis. One of the least expensive and simplest laboratory diagnostic methods for VZV and other herpesviruses is the Tzanck smear. The Tzanck smear is performed by obtaining a scraping from the base of a fresh vesicular lesion after it has been unroofed, spreading and drying the collected material on a glass slide, staining the result with Giemsa, and examining the material with a microscope for the characteristic presence of multinucleated giant cells.

      The Tzanck smear confirms that the lesion is herpetic, but it cannot differentiate between VZV and other herpesviruses. Furthermore, this test has limited sensitivity compared with other diagnostic methods, such as PCR assay. Thus, when acute diagnostic confirmation is desired, modern tests, such as direct fluorescent antibody (DFA) testing or PCR (if available), are preferred to the Tzanck smear.

      Which of the following is an indication for inpatient treatment of a patient with herpes zoster?

      Ophthalmic involvement
      Grouped herpetiform vesicles on the erythematous base
      Erythema with induration
      Slow resolution of erythematous plaques

      Uncomplicated zoster does not require inpatient care. Hospital admission should be considered for patients with any of the following:

      • Severe symptoms

      • Immunosuppression

      • Atypical presentations (eg, myelitis)

      • Involvement of more than two dermatomes

      • Significant facial bacterial superinfection

      • Disseminated herpes zoster

      • Ophthalmic involvement

      • Meningoencephalopathic involvement

      • Second Nature Care Shingles Prevention and Treatment

        How did you do on the quiz?  We offer safe and effective shingles vaccines without harmful adjuvuncts. We offer I.V. ozone and topical ozone treatments to the affected areas. Ozone kills viruses safely and effectively. Book your ozone treatment. Book Now
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Topics: Ozone and Prolozone therapies

Isadora Guggenheim, ND, RN, MS, CNS LMT, owner of Second Nature Naturopathic Care, LLC
For all appointments: Tel: 845 358-8385 Fax: 845 358-2963