Recurrent shingles

Introduction Herpes zoster is an acute skin disease caused by varicella-zoster virus, herpes simplex virus type 1 and type 2, but is the patient most concerned about recurrent episodes of herpes zoster? The problem, experts believe that herpes zoster and varicella are the same virus, in which the primary infection is varicella, then the virus may enter the spinal ganglia or the sensory ganglia of the cranial nerve and lurk in the spinal cord, but lurking The virus can no longer cause symptoms, or it can be reactivated several years later to cause herpes zoster. In addition, when the immune system is reduced due to some other diseases, or when an immunosuppressive product is used, it may cause the virus to recur.

Cause

Herpes zoster is the same virus as varicella. The primary infection is varicella. The virus may then enter the root ganglia of the spinal cord or the sensory ganglia of the cranial nerve and lurk in it, but the latent virus can no longer be used. Causes symptoms, or is reactivated several years later to cause herpes zoster. In addition, when the immune system is reduced due to some other diseases, or when an immunosuppressive product is used, it may cause the virus to recur.

an examination

Related inspection

Cholinesterase Cochet and Bonnet's Corneal Sensory Meter

It is generally not difficult to diagnose a detailed medical history with a detailed medical history.

Like the blood of patients with chickenpox, the total number of granulocytes and the proportion of neutrophils in normal herpes zoster patients are normal.

The main changes in histopathology are found in the nerves and skin. Like herpes simplex, it is mainly cell degeneration. The neurological damage of the disease begins in one or several adjacent dorsal root ganglia or cerebral ganglia by severe inflammatory infiltration, extending to the corresponding sensory spinal or cranial nerves. The destruction. The affected ganglion in this disease was examined by light microscopy and electron microscopy or cultured with monkey kidney cells to prove the inclusion of intranuclear eosin inclusion bodies.

Changes in degeneration can extend from the affected ganglia along the sensory nerve to the skin. Chickenpox is located in the deep part of the epidermis. It is multi-atrial and contains a transparent slurry. The old ones have red blood cells and neutrophils. Inflated balloon-like cells can be found in chickenpox and at its edges, due to degeneration of spine cells. The edema around the blisters is obvious, the dermal papilla is swollen, and the capillaries are dilated. Polymorphonuclear leukocytes, lymphocytes or plasma cells infiltrate around blood vessels, hair follicles and nerves. Eosinophilic intranuclear inclusion bodies (Lipchuetz bodies) can be found in vesicular epithelial cells or denatured nuclei, especially in balloon-like nuclei.

In systemic varicella or herpes zoster, focal necrotic areas containing nucleus eosin inclusion bodies can be found in different organs, especially in the liver, kidneys, lungs and adrenal glands. Intranuclear eosin inclusion bodies seen in the vascular endothelium can be used as evidence of hematogenous dissemination. Unlike varicella, varicella has no nucleus eosin inclusion bodies in the dorsal root ganglia. In the lethal case of herpes zoster pneumonia, autopsy showed inclusion bodies of intranuclear eosin in epithelial cells and alveolar cells of the bronchi.

Staining with acetylcholinesterase demonstrated that the dermal neural network appeared to be significantly reduced in the skin stage of herpes zoster infection, which can be considered to be due to the presence of the virus, because in the dermis under the blister, small nerves Inclusion bodies of eosinophils have been confirmed in neuromembrane cells; in addition, electron-microscopic examination of viral mature particles and severe destruction of unmyelinated nerve fibers have been observed in axons of unmyelinated dermal nerves.

Differential diagnosis

1, herpes zoster on the tip of the nose or nose: herpes zoster ophthalmicus can be associated with orbital inflammation, conjunctivitis, keratitis, scleritis, uveitis, retinopathy (acute retinal necrosis), optic neuritis, eye Muscle paralysis and so on. 60% of them can develop herpes zoster keratitis, which causes corneal scars and seriously affects vision. There has been a tendency to increase gradually in recent times and it is worthy of vigilance. The occurrence of keratitis occurs mostly after the appearance of rash, especially the presence of herpes zoster on the tip of the nose or the nose, which is a sign of invasion of the nasal ciliary nerve, followed by keratitis and iritis.

2, herpes zoster-like appearance: herpes zoster-like appearance, its main feature is clustered blisters, distributed along a side of the surrounding nerves clustered, with obvious neuralgia. The first infection is characterized by chickenpox. After the virus can be lurking in the posterior root ganglia of the spinal cord for a long time, the immune function can be weakened to induce the varicella zoster virus to re-activate, grow and reproduce, and spread herpes along the peripheral nerves and the skin. Patients with herpes zoster generally receive lifelong immunity to the virus. However, there have been repeated authors.

3, herpes labialis: herpes labialis (face herpes) is the most common type of herpes simplex. The cause is infection with herpes simplex virus. It appears that there are hot, itching and flushing in the beginning, and then there are dense integrated groups or groups of needle-sized blisters, which are smaller and more clustered than the original blister, ruptured and eroded, exudate, and gradually dry. Hey, after about 1 to 2 weeks, the local pigmentation can be left behind. The damage occurs at the junction of the skin and mucous membranes, such as the corners of the mouth, the lips and the nostrils, and also occurs in the face and lips. Herpes labialis (face herpes) is the most common type.

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