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Chickenpox and Shingles or VaricellaZoster Infections:
Varicella-Zoster virus is one of the herpes viruses that is pathogenic for humans. The primary infection for the disease in seronegative individuals is know as varicella or chickenpox. The secondary disease is caused by reactivation of a latent varicella-zoster virus is known as herpes zoster or more commonly as shingles. The virus remains inactive in sensory ganglia for indefinite periods after a primary infection. Transmission of varicella is believed to be caused mainly through inspiration of contaminated droplets. Direct contact is a much less common way of acquiring the disease. The incubation period lasts for two weeks during which the virus proliferates within macrophages. Viremia and dissemination to skin occurs subsequently. With viremia overwhelming the host defenses, systemic signs and symptoms develop. In a normal healthy host, the immune response is able to limit and halt the replication of the virus allowing for recovery in two to three weeks. During the disease process the varicella-zoster virus may progress along the sensory nerves to the sensory ganglia, where it can reside in a latent form indefinitely. Varicella-zoster virus infections affect mucosa and skin in a similar fashion. Both primary (varicella) and secondary (zoster) infections begin as vesicles and ultimately ulcerate and crust. The most commonly affected site is the trunk, followed by the head and neck and then the lumbosacral region. Often a unilateral rash develops along the distribution of one of the three branches of the trigeminal nerve affecting the skin of the face. Shingles is a self-limiting condition, and heals with some scarring after 2-3 weeks. Pain is a frequent complication during and after clinical healing. Zoster infections may signal the presence of a lymphoma or an immunocompromising condition.
Treatment: Acyclovir and its derivatives are not as effective against Varicella-Zoster virus as they are against Herpes Simplex virus. However, with higher doses, acyclovir provides adequate control. Even though systemic corticosteroids are generally contraindicated in infectious disease, they have been used in Varicella-Zoster virus infections to help control postzoster neuralgia. |
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References: Regezi JA, Sciubba JJ. Common Skin Lesions. Oral Pathology: Clinical Pathologic Correlations 3rd ed 17:506-507, 1999. Dagg j, Felix D, Lowe G, Scully C, Wray D. Oral Mucosal Infections. Textbook of General and Oral Medicine 22:261-262, 1999. |
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