The herpes surrounding
Shingles has the second name – the surrounding herpes as the activator is the herpes virus. The disease affects nervous system and integuments, and therefore treatment is carried out both by neurologists, and dermatologists, depending on what clinical manifestations are most expressed. Shingles, and chicken pox have the general etiology and pathogenesis. Shingles is characterized by the elements evolving from a stage of a spot and formation of a vesicle to a residual hyperpegmentation. Etiotropny treatment of a disease is carried out by an acyclovir, viroleksy, zovirax. It is followed by symptomatic therapy, processing of affected areas brilliant green and dermatolovy ointment, local physiotherapy.
The herpes surrounding
Shingles has the second name – the surrounding herpes as the activator is the herpes virus. The disease affects nervous system and integuments, and therefore treatment is carried out both by neurologists, and dermatologists, depending on what clinical manifestations are most expressed. Shingles, and chicken pox have the general etiology and pathogenesis.
The modern medicine carries diseases which are caused by a herpes virus to infectious as they have the virus nature; patients and virus carriers have high contageousness; the symptomatology, typical for infectious diseases, which consists of a classical triad is brightly expressed: the general symptoms of infectious diseases, skin manifestations in the form of characteristic of the surrounding herpes ekzanty and manifestations from the central and peripheral nervous system.
The causative agent of the surrounding herpes and chicken pox is the Herpesviridae family virus. It, as well as all viruses of this family is unstable in the external environment and quickly perishes under the influence of the sunshine disinfecting and the cleaning substances, and also when heating. But in the conditions of low temperatures it is capable to remain a long time and is very steady against repeated freezing.
Despite high contageousness, the surrounding herpes meets only in the form of sporadic cases, the peak of incidence falls on cold season, on each hundred thousand of the population about 12-15 cases of incidence. People of the advanced and middle age who had chicken pox earlier enter into risk group. And only the insignificant percent had herpes of this form does not gain resistant immunity owing to what perhaps repeated infection at a meeting with a virus of the surrounding herpes. High contageousness of a disease is confirmed by cases when the children contacting to patients with the surrounding herpes got sick with chicken pox. In 1888, doctors noticed this regularity, as was confirmation of the theory on a similar etiology and pathogenesis of both diseases.
The surrounding herpes is a secondary infection of an endogenous origin at the persons who earlier had chicken pox in a clinical or latent form. After chicken pox the virus is capable is long to persistirovat in an organism and most likely is localized in spinal gangliya and in gangliya of cranial nerves, and under the influence of provocative factors there is its reactivation. Laboratory diagnostics and features of pathogenesis of latent forms of a disease are yet not rather studied, but reactivation of a virus and its clinical manifestations in the form of the surrounding herpes happen when easing cellular immunity.
Stressful states, injuries, overcoolings, somatic and infectious diseases can also make active a virus. The percent of incidence is higher at those persons who have oncological diseases, diseases of blood or accepts hormonal and himiopreparata, with age probability to ache also considerably increases.
The pathological anatomy of a disease in a classical look represents inflammatory changes in spinal gangliya and on adjacent sites of integuments, sometimes back and forward horns of gray substance and backs of a spinal cord, and also soft brain covers are involved in process.
Clinic of the surrounding herpes
The disease begins gradually, with the general prodromalny symptoms: headache, dispepsichesky frustration, small rise in temperature, fever and indisposition. Further pain and an itch on the course of peripheral nervous trunks join, the itch and burning of skin on the place of future rashes are possible. These signs are subjective, and intensity of manifestations at each patient can vary. Duration of an initial stage no more than 4 days, but at children this period is slightly shorter, than at adults.
After the short prodromalny period sharp rise in temperature to febrilny and intoxication symptoms is noted (head and muscular pains, appetite loss). Along with it on the course of one or several spinal there is painful skin rash in the form of the pink spots not inclined to merge, with a diameter of 2-5 mm. But within a day against the background of ekzanty tesnosgruppirovanny vesicles with serous contents appear. Edges of vesicles uneven, basis edematous and hyperemic. Depending on a condition of immune system and from weight of a course of the surrounding herpes to be noted increase and morbidity of regionarny lymph nodes. At children catarrhal inflammations of the top airways (pharyngitis, laryngitis, rhinitis) are possible that complicates a course of disease.
Ekzantema are localized in places of a projection of a nervous trunk, both unilateral, and bilateral defeat nervous is diagnosed. Unilateral defeat which is localized on the course of intercostal nerves, a trigeminal facial nerve meets more often. Cases when nervous trunks of extremities with development of neuritis are surprised, are quite rare; ekzantema in inguinal area are sometimes observed.
At the surrounding herpes as well as at chicken pox, it is at the same time possible to see rashes of various stages, beginning from a spot and finishing with sites of a hyperpegmentation after permission of vesicles. In several days puffiness around vesicles begins to fall down, and together with it and hyperaemia, contents of vesicles grows turbid, gradually they dry up, on their place serous crusts after which falling away small pigmentation of skin is noted are formed. Together with it temperature, intensity of syndromes of intoxication decreases, and by the end of thirds of week there occurs recovery.
Generalized form. Sometimes the generalized form of the surrounding herpes is confused to the joined chicken pox as rashes are noted not only on the course of nervous trunks, but also on other sites of skin, and also on mucous membranes. If the generalized herpetic infection is diagnosed or the disease proceeds more than 3 weeks, then it is necessary to examine patients on existence of immunodeficiencies and on presence of oncological processes.
Abortive form. If the surrounding herpes proceeds on abortive type, then eritematozny rash on the course of nervous trunks which quickly disappears without transformation to vesicles is characteristic. The general condition of the patient at the same time does not suffer.
Bullous form. Such form of the surrounding herpes is characterized by larger vesicles which merge in large bubbles with serous contents. If at the same time blood vessels are injured, then contents become hemorrhagic, and at accession of an infection – purulent. In hard cases, bubbles merge in continuous tapes which when drying can be also infected, and further form a dark necrotic scab. Weight of a current of this form depends on localization ekzanty: if facial nerves are surprised, then sharp neuralgic pains, defeat a century and corneas join.
Disease duration in a sharp form – 2-3 weeks; at abortive – several days; and at the complicated or long current – more than a month. Pains are burning, have pristupoobrazny character, and their intensity increases at night. Local paresteziya and violation of sensitivity of skin are also the most characteristic symptoms of the surrounding herpes.
Cases of damage of glazodvigatelny nerves, belly muscles and sphincter of a bladder are noted. If serous meningitis develops, then extent of changes at a likvor research not always corresponds to expressiveness of meningialny symptoms. In a sharp phase encephalitis and an encephalomeningitis is possible; the poliradikulonevropatiya and a sharp miyelopatiya meet in incidental cases.
After treatment permanent remission is observed, and a recurrence happens in several percent of cases. At timely complex therapy of the residual phenomena it is not observed, but at some patients neuralgic pains remain within several years.
In the prodromalny period the surrounding herpes should be differentiated from pleurisy, neuralgia of a trigeminal nerve and from a syndrome of a sharp stomach (appendicitis, renal colic, cholelithiasis). If rashes are located not on the course of nervous trunks, then differential diagnostics with simple herpes, chicken pox is carried out, and the bullous form needs to be differentiated from an erysipelatous inflammation and from defeats of integuments at immunodeficiencies and diabetes.
Treatment of the surrounding herpes
Etiotropny therapy consists in use of selective inhibitors of synthesis of virus DNA – an acyclovir. Such therapy is effective in initial stages of a disease. The acyclovir is appointed intravenously kapelno, a daily dose in 15-30 mg/kg which is divided into three introductions from intervals at 8 o'clock. The single dose is parted in 150 ml of isotonic solution. At application of the tableted acyclovir forms the single dose for adults makes 800 mg, reception of medicine to five times a day, the general course of therapy – 5 days.
Pathogenetic therapy consists in reception of a dipiridamol which slows down aggregation of platelets, a course from 5 to 7 days. For dehydration appoint furosemide. For activation of immunogenesis intramuscular introduction of homologous immunoglobulin which is entered by 2-3 times a day on 1-2 dose daily or every other day is shown.
Symptomatic therapy of the surrounding herpes is appointed individually, depending on weight of a current. Analgetics, the febrifugal and all-strengthening medicines are applied, at frustration of a dream – sedative and somnolent medicines, reception of antidepressants is in some cases shown. If symptoms of intoxication are brightly expressed, then dezintoksikatsionny therapy with the forced diuresis is carried out.
Locally vesicles process solution of diamond greens, and crusts grease 5% with dermatolovy ointment. The Reparant on the basis of dialyzate from blood of calfs, metatsilovy ointment is applied at slow forms of the surrounding herpes. Locally, on sites of skin with rashes of the surrounding herpes, appoint Ural federal district, quartz and laser therapy. At accession of a secondary infection conduct an antibiotic treatment course.