Varicella zoster virus

Question 1

Zoster is caused by

Answer 1

reactivation of VZV

Question 2

dermatoses most comm affected

Answer 2

TCLs

Thoracic 55
Cranial 20 (single most common nerve involved- trigeminal nerve most inv)
Lumbar 15
Sacral 5

Question 3

total duration if eruption

Answer 3

2-3 wks younger

>6 weeks elderly - scarring

Question 4

Disseminated herpes zoster. how many lesions

Answer 4

more than 20 lesions outside the affected dermatome.

Question 5

tx disseminated zoster

Answer 5

IV acyclovir may be changed to oral antibiral ones visceral involvement has been excluded and atleast 2-3 days of IV tx.

Question 6

ophthalmic zoster what cranial nerve?

Answer 6

ophthalmic division ir 5th cranial nerve.

Question 7

if external division of the nasocicialry branch is affexted what sign is seen

Answer 7

Vesicles in tge side and tip of the nose ( Hutchinson sign) tge eye is involved 76% if time compared w 34% when not incolved

Question 8

ocular involvement in zoster is in what form

Answer 8

uveitis (92) abs keratitis 50

Question 9

results frkm inv if facial and auditory nerves by VZV.

Answer 9

Ramsay hunt sundrome (herpes zoster oticus)

Question 10

tx zoster

Answer 10

antiviral tx cornerstone if tx.
l

Vala 1000mg and famciclov 500 ng 3x a day.

Acyclovir 800 mg 5x a day

Question 11

tx for disseminated, opthalmic zoster or ramsay hunt- those failing iral tx shiudl recieve

Answer 11

IV ACYCLOVIR 10 mg/kg 3x a day adj for renal func

Question 12

mortality rate in pxs w zoster who have undergone bmt

Answer 12

5%

Vzv igg serostatus is determined before transplant.

Question 13

zoster test of choice

Answer 13

PCR

Question 14

H:

Answer 14

vesicles are intraepidermal
sides of vesicles are large swollen cells called balloon cells.
acidophilic inclusion bodies
multinucleated kerstinocytes
nuclear molding
peripheral condensation of the nucleoplasm are characteristic and confirmatory.
inflammatory and degenerative changes are noted on posterior root ganglia and dorsal nerve root of affected nerve.

Question 15

differentiate herpes simplex and herpes zoster diagnostic modality

Answer 15

DFA

Question 16

pxs taking antiviral meds must stop taking it for ho many days before and after immunization

Answer 16

stop 24 hrs before immunizatioj and not take then 14 days agter immunization

Question 17

preferred vaccine for shjngles

Answer 17

Shingrix. for 50 yo and above

Question 18

drug that sloghtly inc risk of zoster

Answer 18

Statin

Question 19

lifetime risk of dev zoster is .. for more than 80 yo.

Answer 19

under 45 yo- annual incidence less than 1 in 1000z
older than 75- more than 4x greater.
white persons older than 80- 10-30%

women have higher risk

Question 20

in HIV pxs/ annual risk for vzv

Answer 20

3%

high risk also immunosuppressed and hema malignancy.

Question 21

mortality rate in pxs w zoster who have undergone BMT is

Answer 21

5%

VZV IGG serostatus is determined before transplant. and all seropositice pxs recieve prophylaxis with either acyclovir 800mg 2x a day or Valacyclovir 500mg 2x a day for 1 year or longer if the px is recieving immunosupp tx.

Question 22

Dx.

Answer 22

same used in varicella.
clinical appearanc eis pften adequate.
In office tzanck smear - rapidly confirm.

PCR or DFA testing is preferred to viral culture. bec it is rapid. types the virus and has a higher yield than culture.

PCR- Test of choice. 97% positive.

Question 23

H

Answer 23

as w herpes simplex the vesicles in zoster are intraepidermal.
sides of the vesicles are large swollen cells called BALLOON CELLS( degenerated cells of the spinous layer)
ACIDOPHILIC INCLUSION BODIES.
MULTINUCLEATED KERATINOCYTES
NUCLEAR MOLDING
PERIPHERAL CONDENSATION OF NUCLEOPLASM

Inflammatory and Degenerative changes are also noted in the posterior root ganglia in the dorsal nerve roots of the affected nerve.

CONFIRMAtory with either HSV OR VZV.

Question 24

vaccine

Answer 24

Zostavax.
persons taking antiviral meds must stope them 24 hrs before immunization and not take them for 14 days after immunization.

shingrix- preferred vaccine for shingles.