Herpes zoster duration of treatment, vaginal herpes discharge - Plans Download

Significant scarring may result from cutaneous herpes zoster and this is most problematic with facial involvement. In most circumstances, the diagnosis of cutaneous herpes zoster is made on clinical grounds. The following treatment recommended for varicella and zoster are based on the 2009 document Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adolescents and Adults[4]. The recommendations regarding the use of the varicella vaccine (Varivax) and zoster vaccine (Zostavax) are discussed in the in Case 4 (Appropriate Vaccinations) in the section Initial Evaluation. These extensive zoster lesions on the buttock and posterior leg have crusted and show no sign of secondary bacterial infection. Given the widespread prevalence of varicella-zoster virus (VZV) infection in adults, most HIV-infected adults are at risk of developing VZV reactivation and herpes zoster.
The factors governing the maintenance of latency or the progression to viral replication remain poorly understood, but the increased incidence of zoster among immunocompromised persons suggests that cell-mediated immunity probably plays a critical role. Reactivation of herpes zoster in the trigeminal ganglia may lead to the development of herpes zoster ophthalmicus, a condition that includes a number of inflammatory manifestations in the eye, such as conjunctivitis, episcleritis, keratitis, and iritis.
All patients with an acute episode of varicella or zoster should promptly receive antiviral treatment[4]. In contrast, HIV-infected persons with complicated primary varicella infection, including involvement of visceral organs, retina, or the central nervous system, should receive treatment with intravenous acyclovir and undergo hospitalization for observation (Figure 7). The recommended antiviral treatment options (Figure 8) for localized dermatomal zoster in HIV-infected persons consist of valacyclovir (Valtrex), famciclovir (Famvir), or acyclovir (Zovirax)[4].

The duration of therapy, frequency of intravitreal injections, and number of intravitreal injections will depend on the patient's clinical course and should be determined by the ophthalmology expert.
In the rare instance when an HIV-infected person who is non-immune to VZV has significant exposure to a patient with active varicella or zoster, varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure (preferably within 48 hours). Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. The incidence of zoster among HIV-infected adults is more than 15-fold higher than age-matched VZV-infected immunocompetent persons, with nearly 30 cases per year observed for every 1,000 HIV-infected adults[2]. Patients with herpes zoster often present with dysesthesias of the skin several days prior to the onset of cutaneous lesions.
Post-herpetic neuralgia (defined as pain that persists longer than 30 days after the onset of the rash) is a significant problem associated with herpes zoster infection, but, after adjusting for age, the risk of post-herpetic neuralgia does not differ significantly among HIV-infected persons compared with immunocompetent persons[7]. The direct fluorescent antibody (FA) assessment of a cellular rich sample from the base of the lesion offers the most sensitive, specific, and rapid diagnosis for herpes zoster.
Note these antiviral medications are administered at doses higher than those commonly used for the treatment of uncomplicated herpes simplex virus infections. One report described 18 HIV-infected patients with advanced immunosuppression and acyclovir-resistant VZV-related skin lesions that failed to heal despite treatment with acyclovir[15]; most of these patients had an excellent respond to treatment with foscarnet (Foscavir). The diagnosis of herpes zoster should prompt the clinician to consider HIV testing, particularly in persons with known HIV risk factors, those younger than 50 years of age, or those who develop multi-dermatomal herpes zoster.
Post-herpetic neuralgia manifests as chronic (more than 30 days after the onset of lesions) severe skin pain along the distribution of the initial zoster outbreak[8].


In these cases of complicated varicella, if the patient responds well to intravenous acyclovir, they can typically switch to oral antiviral therapy to finish their treatment course[4]. In addition, the incidence of zoster increases within the first 4 months after initiating highly active antiretroviral therapy (mean 5 weeks), probably related to immune reconstitution[6].
Although herpes zoster can occur anywhere on the body, the skin of the thorax is the most frequently involved region.
Bacterial superinfection of vesicles can also complicate cutaneous herpes zoster (Figure 6). In immunocompetent persons, the use of corticosteroids in conjunction with acyclovir reduces the duration of active lesions and pain during an initial outbreak[14], but has not been well evaluated in HIV-infected persons. Accordingly, the use of corticosteroids as part of the treatment for herpes zoster in HIV-infected persons is not recommended[4]. Although other infections, such as herpes simplex virus and smallpox, may cause similar appearing vesicular lesions, the characteristic dermatomal distribution of herpes zoster helps to distinguish herpes zoster from these other disorders. Treating acute zoster-associated neuropathic pain or post-herpetic neuralgia is an important component of the management of patients with VZV infection.

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