{
"topic": "Herpes Zoster",
"slug": "herpes-zoster",
"category_id": 15809,
"passage_count": 14,
"source_chars": 11967,
"enough_material": true,
"references": [
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
2007,
2011
]
},
{
"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
"author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
"pages": [
1240,
1271
]
},
{
"title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online",
"author": null,
"pages": [
497,
814
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
5040
]
},
{
"title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)",
"author": "Lissauer, Tom,Carroll, Will",
"pages": [
282
]
},
{
"title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
"author": null,
"pages": [
790
]
},
{
"title": "Red Book Atlas of Pediatric Infectious Diseases",
"author": "American Academy of Pediatrics,Carol J. Baker, MD, FAAP",
"pages": [
719,
824
]
},
{
"title": "Diagnostic Imaging: Pediatrics",
"author": "A. Carlson Merrow Jr. MD",
"pages": [
1126
]
}
],
"passages": [
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2007",
"text": "**Herpes zoster** is caused by the reactivation of latent VZV. It is not common in childhood and shows no seasonal variation in incidence. Zoster is not caused by exposure to a patient with varicella; in fact, exposures to varicella boost the cell- mediated immune response to VZV in individuals with prior infection, decreasing the likelihood of reactivation of latent virus. The lifetime risk for herpes zoster for individuals with a history of varicella is at least 30%, with 75% of cases occurring after 45 years of age. Herpes zoster is unusual in healthy children younger than 10 years of age, with the exception of those infected with VZV in utero or in the first year of life, who have an increased risk for development of zoster in the first few years of life. Herpes zoster in otherwise healthy children tends to be milder than herpes zoster in adults, is less frequently associated with acute pain, and is generally not associated with postherpetic neuralgia. In children receiving immunosuppressive therapy for"
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1240",
"text": "**2. Herpes zoster (shingles)\u2014** This eruption involves a single dermatome (thus unilateral and does not cross the midline), usually truncal or cranial; occasionally a contiguous dermatome is involved. Especially in older children this is preceded by neuropathic pain or itching in the same area (designated the \u201cprodrome\u201d). Ophthalmic zoster may be associated with corneal involvement. The closely grouped vesicles, which resemble a localized version of varicella or herpes simplex, often coalesce. Crusting occurs in 7\u201310 days. Postherpetic neuralgia is rare in children. Herpes zoster is a common problem in HIV-infected or other immunocompromised children, and is also common in children who had varicella in early infancy (< 1\u20132 years old) or whose mothers had varicella during pregnancy. Herpes zoster can occur infrequently in children who received the varicella vaccine. ## **B. Laboratory Findings**"
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 814",
"text": "## **Herpes Zoster (Shingles)** Herpes zoster results from reactivation of the varicella-zoster virus and inflammation of a dorsal root or extramedullary cranial nerve ganglion. Although the disease is seen in otherwise healthy children, it is more likely to occur in the severely debilitated or immunosuppressed child. The patient exhibits a prodrome of malaise, fever, headache, and tenderness along the affected dermatome that may last 3 days or more. This is followed by the extraoral formation of painful, grouped vesicular lesions that rupture to form ulcerations. The oral cavity also may be affected with erosions when maxillary and mandibular divisions of the trigeminal nerve are involved (Fig. 20-45). ## **Recurrent Aphthous Ulcers (Canker Sores)**"
},
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 1271",
"text": "Adapted with permission from WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-related disease in Adults and Children. \u00a9 World Health Organization 2007. **1239** **HUMAN IMMUNODEFICIENCY VIRUS INFECTION** Herpes zoster (shingles) occurs 10 times more frequently among untreated HIV-infected children compared with agematched healthy children."
},
{
"source": "Cover, p. 5040",
"text": "Herpes zoster, or shingles, represents reactivation of VZV that has remained dormant in the sensory root ganglia following acute infection. The incidence is low in immunocompetent children, although the risk seems to be greater in those who had either intrauterine exposure to VZV or acute varicella early in life. Herpes zoster presents with grouped vesicles on an erythematous base that are distributed within 1 to 3 sensory dermatomes ( **Fig. 362-7** ); this may be preceded by pain or paresthesias in the affected areas. The most common dermatomes to be affected are the ophthalmic (V1) branch of the trigeminal nerve and the thoracic dermatomes. Ophthalmologic examination should be performed in all patients with involvement of the V1 dermatome given the possibility of associated eye involvement. Lesions of herpes zoster may be more generalized in immunosuppressed patients, and visceral involvement may be present. Postherpetic neuralgia, a persistent pain syndrome involving the affected dermatomes, is more"
},
{
"source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 282",
"text": "268  Figure 15.15 Herpes zoster (shingles) in a child. Distribution is along the S1 dermatome. (Courtesy of Dr Sam Walters.) - Recurrent or multidermatomal shingles suggests a primary or secondary T-cell immune defect ## Summary ## **Chickenpox** - Clinical features \u2013 fever and itchy, vesicular rash, which crops for up to 7 days. - Complications \u2013 secondary bacterial infection, encephalitis; disseminated disease in the immunocompromised. - Human varicella zoster immunoglobulin \u2013 if immunocompromised and in contact with chickenpox or if there is maternal chickenpox shortly before or after delivery. - Treatment is mainly supportive; intravenous aciclovir for severe chickenpox and for immunocompromised children. ## **Epstein\u2013Barr virus: infectious mononucleosis (glandular fever)**"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 790",
"text": "to varicella and has a history of exposure must be kept in a negative-pressure isolation room with airborne and contact precautions during the incubation period\u2014 specifically from days 8-21 after exposure. Remember: Individuals who receive varicella-zoster IG may have a longer incubation period\u2014up to 28 days. In the hospital setting, a child with varicella is considered infectious and remains in isolation until all lesions are crusted over or at least a minimum of 5 days if crusting occurs earlier. Herpes Zoster (Shingles) Herpes zoster is caused by reactivation of VZV. Varicella vaccine (a live attenuated virus vaccine) can also cause herpes zoster in children with immunocompetence; how- ever, it is usually mild. Most commonly, herpes zoster affects 1 or 2 adjacent dermatomes, with thoracic, cranial nerve, and lumbosacral areas most frequently involved. The lesions increase in number over 3-5 days and crust over by 2 weeks. A Tzanck smear (now of only historical value) shows"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2011",
"text": "herpes zoster typically begins with burning pain or itching followed by clusters of skin lesions in a dermatomal pattern. Almost half of the elderly with herpes zoster experience complications; the most frequent complication is postherpetic neuralgia, a painful condition that affects the nerves despite resolution of the skin lesions. Approximately 4% of patients suffer a second episode of herpes zoster; three or more episodes are rare. Unlike herpes zoster in adults, zoster in children is infrequently associated with localized pain, hyperesthesia, pruritus, low- grade fever, or complications. In children, the rash is mild, with new lesions appearing for a few days (Fig. 300.4); symptoms of acute neuritis are minimal; and complete resolution usually occurs within 1- 2 weeks. Unlike in adults, postherpetic neuralgia is unusual in children. An increased risk for herpes zoster early in childhood has been described in children who acquire infection with VZV in utero or in the first year of life."
},
{
"source": "Red Book Atlas of Pediatric Infectious Diseases, p. 719",
"text": " Image 151.19 varicella zoster in a 7-year-old girl. The patient had an erythematous vesicular skin rash on the face on first examination. The dermatologic distribution suggested the diagnosis of herpes zoster. This image was taken 3 days after acyclovir therapy was initiated. The lesions were crusting. The child had no prior history of recurring infections and was growing well. Copyright Barbara Jantausch, mD, FAAP.   Image 151.18 Herpes zoster in an otherwise healthy child.  Image 151.20 Herpes zoster. Trigeminal nerve involvement. There may be significant pain associated with lesions in the trigeminal nerve distribution. Courtesy of David Ascher, mD/Howard Johnson, mD. Image 151.21 Herpes zoster (shingles). Courtesy of C. W. Leung. 712 CHOLErA 152 ## **Vibrio** _**Infections**_ ## Cholera **(** _**Vibrio cholerae**_ **)**"
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 497",
"text": " **----- Start of picture text -----**
B
**----- End of picture text -----**
 **----- Start of picture text -----**
D
**----- End of picture text -----**
**Figure 12-5** Herpes zoster (shingles). Dermatomal distribution of lesions is a hallmark of herpes zoster. **A,** Initially discrete thin-walled vesicles on an erythematous base are seen. **B,** Vesicles coalesce over a few days, and lesions then evolve to a crusted stage **(C)** . **D,** Involvement of the ophthalmic branch of the trigeminal nerve produces lesions involving the forehead, eyelids, and nose. _(_ _**B,** Courtesy Michael Sherlock, MD, Lutherville, Md.)_ **474** Zitelli and Davis\u2019 Atlas of Pediatric Physical Diagnosis"
},
{
"source": "Diagnostic Imaging: Pediatrics, p. 1126",
"text": "- Zoster: Immunocompetent patient with CN & peripheral nerve palsies in dermatomes involved by skin lesions - \u25cbEnterovirus encephalitis (EV 71) - Hand, foot, & mouth disease: Fever, vesicles on hands, feet, elbows, knees, lips ## **Demographics** - Epidemiology - \u25cbHerpes: Most common cause of sporadic (nonepidemic) viral encephalitis - \u25cbJapanese encephalitis: Most common endemic encephalitis in Asia - \u25cbCNS involvement in EBV uncommon (< 10% of cases) ## **Natural History & Prognosis** - Rapid diagnosis & early treatment with antiviral or antibacterial agents can \u2193 mortality, may improve outcome ## **SELECTED REFERENCES** 1. Bajaj M et al: Clinical and neuroimaging findings in neonatal herpes simplex virus infection. J Pediatr. 165(2):404-407.e1, 2014 2. To TM et al: Insights into pediatric herpes simplex encephalitis from a cohort of 21 children from the California Encephalitis Project, 1998-2011. Pediatr Infect Dis J. 33(12):1287-8, 2014"
},
{
"source": "Red Book Atlas of Pediatric Infectious Diseases, p. 824",
"text": "Varicella-Zoster Virus infections   **Image 161.24** Bullous varicella (uncomplicated) in a 1-year-old. courtesy of George nankervis, MD. **Image 161.23** Herpes zoster (shingles). courtesy of c. W. leung.  **Image 161.25**"
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 219",
"text": "hemorrhagic lesions, coagulopathy and visceral organ involvement including hepatitis, pneumonia and encephalitis; mortality rates are high despite therapy. Chickenpox in pregnancy is associated with increased tisk of severe disease in the mother. Congenital varicella syndrome may occur following infection in the first and second trimester at a frequency of 0.4-2% and is characterized by skin scarring, malformed extremities, cataracts and brain abnormalities (e.g. aplasia, calcifications). Finally, if the disease occurs in the mother 5 days before and 2 days after delivery, severe and often fatal neonatal disease may result. Herpes zoster in children is characterized by a mild Vesicular rash with dermatomal distribution; unlike adults Pain is less and post-herpetic neuralgia unusual. The risk of herpes zoster is more in children who acquire chicken- Pox in infancy, those whose mothers developed varicella in the third trimester and in the immunocompromised. Diagnosis"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2007",
"text": "Varicella- zoster virus (VZV) causes primary, latent, and reactivation infections. The primary infection manifests as varicella (chickenpox) and results in establishment of a lifelong latent infection of sensory ganglionic neurons. Reactivation of the latent infection causes herpes zoster (shingles). Although often a mild illness of childhood, varicella can cause substantial morbidity and mortality in otherwise healthy children. Morbidity and mortality are higher in immunocompetent infants, adolescents, and adults, as well as in immunocompromised persons. Varicella predisposes to severe group A streptococcus and staphylococcus infections. Primary clinical disease can be prevented by immunization with live- attenuated varicella vaccine. A clinically modified disease can occur among vaccinated persons (breakthrough varicella), usually with milder presentation. Varicella and herpes zoster can be treated with antiviral drugs. Vaccines are also available to prevent herpes zoster in older adults."
}
]
}