TBL/CBL Herpes Zoster

Conjunctivitis

inflammation of the conjunctiva

keratitis

inflammation of the cornea

What are risk factors for shingles?

older age previous infection with varicella suppressed immune system

What is the clinical presentation of otitis media?

pediatric population upper respiratory tract infection or exacerbation of seasonal allergic rhinitis otalgia (ear pain) decreased or muffled hearing tinnitis

Long Term Sequelae of Herpes Zoster Infections

postherpetic neuraliga/pain If not treated on time or left untreated, ophthalmic shingles can cause serious complications conjunctivitis (pink eye) uveitis (inflammation of the middle layer of your eye) keratitis (inflammation of the top layer of your eye known as the cornea) glaucoma (condition that damages your optic nerve) blindness in the affected eye

What medications can be given for PHN (post herpetic neuralgia)

pregabalin tricyclic antidepressant

What type of nerve fiber is responsible for taste?

special visceral afferent = taste/smell

Bell's Palsy

temporary paralysis of the seventh cranial nerve (facial nerve) that causes paralysis only on the affected side of the face Pathophysiology: idiopathic trauma of facial nerve VII theories hypothesize that this is due to reactivation of HSV within the geniculate ganglion leading facial paralysis caused by inflammation and demyelination of peripheral nerves another theory = nerve entrapment Clinical Presentation: New onset unilateral facial paralysis unable to close the eye (orbicularis oculis) facial droop on one half of the face sagging eyebrow (frontalis) drooping corner of the mouth/one sided smile (zygomaticus) loss of taste on the anterior 2/3 of the tongue

Why does keratitis develop in patients with herpes zoster opththalmicus?

the cornea is supplied by sensory fibers derived from the V1 branch of the opthalmic nerve the nerves are responsible for maintaining the integrity of the corneal tisse due to their role in the blink reflex and tear production

What medications can be given for keratitis caused by herpes zoster?

topical dexamethasone for corneal inflammation Note: Corticosteroids are used as first line treatment for many ocular inflammatory conditions antiviral viroptic (topical trifluridine) also prescribe: oral valacyclovir and oral prednisone for two months

What pharmacologic therapy is available for acute herpes zoster?

Antivirals Acyclovir Famciclovir Valacyclovir Adjunctive Therapy Corticosteroids Analgesics Acetaminophen

postherpetic neuralgia

Pain that lasts longer than a month after a shingles infection and is caused by damage to the nerve; the pain may last for months or years. occurs in the same distribution as the initial rash can be burning, pruritic (itchy), sharp, stabbing, constant or intermittent 90% of patients with PHN also have allodynia sensation of pain evoked by normally nonpainful stimuli such as light touch typically involves as specific nerve and typically localized to a dermatome

How does acyclovir work?

blocks nucleic acid synthesis by incorporating a "wrong base" into the DNA of a virus inhibits viral DNA polymerase by acting as an analog to dGTP incorporation of acyclovir into the DNA results in chain termination since the absence of the 3' hydroxyl group prevents attachment of addition nucleosides

What muscles are innervated by the facial nerve?

facial expression muscles frontalis orbicularis oris orbicularis oculis nasalis zygomaticus platysma buccinator

What nerves provide sensory innervation to the tongue?

facial nerve (VII) - anterior 2/3 of the tongue glossopharyngeal nerve (IX) - posterior 1/3 of the tongue

Ramsay Hunt Syndrome

herpes zoster oticus The two main signs and symptoms of Ramsay Hunt syndrome are: A painful red rash with fluid-filled blisters on, in and around one ear Facial weakness or paralysis on the same side as the affected ear

Hutchinson's Sign

Trigeminal eruptions of zoster that include the tip of the nose and risk corneal involvement herpes zoster ophthalmicus Ophthalmic shingles occurs when the varicella-zoster virus reactivates in your trigeminal nerve, specifically at its ophthalmic branch

Geniculate ganglion

The geniculate ganglion is a sensory ganglion of the facial nerve (CN VII). It contains the cell bodies of the fibers responsible for conducting taste sensation from the anterior two-thirds of the tongue

What is the prevention for acute herpes zoster infection?

vaccination - shingrix