Prognosis + Complications of Herpes Zoster

PROGNOSIS

• most healthy people who receive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks
  
• The blisters often leave no scars.
  
• a serious threat in immunocompromised individuals
  

COMPLICATIONS

Herpes Zoster Opthalmicus

• Occurs when one of the nerves that go into the eye (known as the ophthalmic nerve) is involved with the shingles infection.
  
• Most common problem is known as anterior uveitis, which is inflammation that normally includes the iris
  
• may cause
  
  • Redness of the eye
    
  • Pain
    
  • Blurred vision.
    
• Up to 70% people with this complication will develop some sort of temporary or permanent eye problem.
  
• May also lead to temporary or permanent blindness.
  

Ramsay Hunt Syndrome

• Occurs when herpes zoster causes facial paralysis and rash on the ear (herpes zoster oticus) or in the mouth.
  
• Symptoms
  
  • Severe ear pain
    
  • Hearing loss
    
    • Varies from partial to total
      
    • May be permanent
      
  • Ringing in the ear
    
  • Loss of taste
    
  • Nausea
    
  • Vomiting
    
  • Dizziness
    
    • May last for a few days or even for weeks
      
    • Usually resolves
      
• May also cause a mild inflammation in the brain
  

Bell's palsy

• Partial paralysis of the face.
  
• May suggest a reactivation of herpes zoster, even if no rash appears.
  

Postherpetic Neuralgia

• Most common severe complication (10%-70%)
  
• Risk factor:
  
  • Age
    
  • Gender
    
  • Severe/ complicated shingles
    
• Pain that persists for longer than a month, sometimes years after the onset of herpes (commonly resolves within 3 months)
  
• Mechanism :
  
  
  • Occurs from damage to the nerve fibers, caused by the varicella zoster virus
    
  • The herpes zoster virus appears to produce persistent inflammation in the spinal cord that causes long-term damage, including nerve scarring.
    
  • Nerves that are injured in the initial attack may regrow abnormally and provoke an exaggerated response in the brain that signals intense sensitivity or pain.
    
• Skin is so sensitive that clothing or even a passing breeze cannot be tolerated on the affected area.
  
• The pain is described as agonizing, excruciating, and burning.
  
• last longer
  
• Difficult to treat
  
• Can result in an inability to perform daily tasks of living. This can lead to loss of independence and, ultimately, depression and isolation.
  

Sacral Zoster

• When the shingles virus affects the nerves that control bladder function
  
• Symptoms can include
  
  • Being unable to urinate
    
  • Feeling the urge to urinate but not being able to
    
  • Having a dribbling urinary stream.
    

Secondary Infection In The Blisters

• If the blistered area is not kept clean and free from irritation
  
• May become infected with Streptococcus A or Staphylococcus bacteria
  
• If the infection is severe, scarring can occur.
  

Disseminated Herpes Zoster

• Spreads to other organs
  
• Can be life-threatening, particularly if it affects the lungs
  
• Immunocompromised person are at greatest danger, with risk of 5 - 25%.
  
• Very rare in people with healthy immune systems.
  

Encephalitis / Meningitis

• A rare complication
  
• Generally mild
  
• Resolves in short period
  
• Can be severe and even life-threatening in immunocompromised person
  

Imminent acute retinal necrosis syndrome

• A devastating infection in the retina
  
• Visual changes develop within weeks or months after the herpes zoster outbreak has resolved
  
• Usually follows a herpes outbreak in the face
  
• Can also occur after an outbreak in any part of the body
  
• Symptoms
  
  • Conjunctivitis
    
  • Inflammation of the cornea
    
  • Pain