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PwintPhyu 03/09/2012

Zoster sine herpete

Zoster sine herpete is a condition in which nerves are affected without the usual rash associated with shingles. Patients may experience pain and weakness in a dermatomal distribution but have no visible signs of shingles. This usually occurs in elderly patients. An accurate early diagnosis of shingles in such cases is often difficult. It is demonstrated in 8-25% of patients with acute peripheral facial palsy without cutaneous vesicles.

Symptoms 1. Unilateral segmental pain or muscular paresis on one side of the body 2. Unilateral ophthalmic neuralgia with involvement of the eyeball, or with paresis of ocular muscles, or both; 3. Unilateral ear pain without evidence of middle-ear disease and associated with facial palsy, hyperacusis, or loss of taste sensation on the anterior two-thirds of the tongue; 4. An acute labyrinthitis, or Menieres syndrome, with evidence of involvement of adjacent nerves, particularly CN 7 5. Unilateral paralysis of soft palate, pharyngeal muscles, or vocal cord of obscure origin, especially when associated with ear pain or with an inflammatory reaction in, or around, the entrance to the larynx. 6. Fever, other flu like symptoms, tingling, and numbness on one side of the body

Diagnosis VZV DNA may be detected by PCR from oropharyngeal swabs in patients with zoster peripheral facial palsy, by finding VZV DNA in cerebrospinal fluid or in blood mononuclear cells, or the presence of anti-VZV IgG antibody or anti-VZV IgM antibody in CSF or serum.

Treatment Acylovir (Zovirax) therapy appears to produce a moderate reduction in the development of postherpetic neuralgia. Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir. Acyclovir, the prototype antiviral drug, is a DNA polymerase inhibitor. Intravenously administered acyclovir is generally used only in patients who are severely immunocompromised or who are unable to take medications orally. Valacyclovir, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia. Famciclovir is also a DNA polymerase inhibitor. The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir. The most common adverse effects are nausea, headache, vomiting, dizziness and abdominal pain. There are drugs that can reduce for pain are Gabapentin, pregabalin, skin patches with lidocaine, and steroids.