Herpes Zoster, commonly known as shingles, is a viral infection caused by the varicella-zoster virus and causes chickenpox. Most cases of Herpes Zoster are localized. They typically affect older adults or those with weakened immune systems. In rare cases, it can affect both sides of the body simultaneously. This is called bilateral herpes zoster. It is a rare condition but presents a challenge for healthcare providers. The infection can lead to serious complications. Recently, a 74-year-old patient was treated for bilateral herpes zoster at Manipal Hospitals. This case offers valuable insights into managing the disease. It also highlights the hospital’s comprehensive treatment approach.
We will explore the clinical significance of bilateral herpes zoster, the symptoms, diagnosis, and treatment options, and highlight the exceptional care provided by Manipal Hospitals in this particular case.
Understanding Herpes Zoster and Its Rare Bilateral Form
What is Herpes Zoster?
Herpes Zoster occurs when the varicella-zoster virus reactivates in a person who has previously been infected with chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve cells, typically in the spinal cord or brain. Over time, the virus can reactivate due to aging, stress, or a weakened immune system. This reactivation leads to the painful rash and blisters typical of shingles.
What is Bilateral Herpes Zoster?
Bilateral herpes zoster is a rare manifestation of the condition. In most cases, shingles affect only one side of the body, typically appearing as a rash or blisters along a single dermatome (a region of the skin served by sensory nerves from a single spinal root). In bilateral herpes zoster, the infection affects both sides of the body, which can be more complicated to diagnose and treat due to the increased severity of the symptoms and the involvement of multiple nerve roots.
Risk Factors for Bilateral Herpes Zoster
The risk factors for developing bilateral herpes zoster include age, immune suppression, chronic stress or trauma, and prior history of chickenpox. Older adults, particularly those over 60, are at a higher risk due to the decline in immune function with age. People with compromised immune systems, whether due to medical conditions like HIV, cancer, organ transplants, or treatments like chemotherapy, are more susceptible. Physical or emotional stress can trigger the reactivation of the varicella-zoster virus, and anyone who has had chickenpox in the past can potentially develop herpes zoster later in life.
Case Study: A 74-Year-Old Patient at Manipal Hospitals
The Patient’s Condition
The 74-year-old patient arrived at Manipal Hospital with symptoms indicative of herpes zoster. The patient first had a painful, blistering rash on one side of the body. Soon, lesions appeared on the opposite side as well. This indicated the rare bilateral form of the disease. Upon examination, the rash was affecting multiple dermatomes.
Dermatomes are skin areas controlled by the spinal cord’s nerve roots. The pain from herpes zoster is often intense, burning, or stabbing, and it can significantly impact the patient’s quality of life. The case was unique due to the patient’s bilateral involvement and age. The patient’s underlying health conditions required a comprehensive treatment plan.
Diagnosis and Medical Investigation
The diagnosis of bilateral herpes zoster was confirmed through a thorough medical evaluation, which included a physical examination, medical history review, and laboratory tests. The doctor carefully examined the rash and blisters, noting the involvement of both sides of the body. The patient’s age, medical history, and underlying immune conditions were assessed. The patient had no previous history of immunocompromised conditions, which made this case even rarer. A polymerase chain reaction (PCR) test was conducted to confirm the presence of varicella-zoster virus DNA in the lesions, which confirmed herpes zoster.
This diagnostic approach ensured that the correct diagnosis was made and the treatment could be tailored to address the unique nature of bilateral herpes zoster.
Treatment Approach at Manipal Hospitals
1. Antiviral Therapy
Antiviral medication is the cornerstone of herpes zoster treatment. Drugs such as acyclovir, valacyclovir, and famciclovir are commonly used to reduce the severity and duration of the outbreak. The patient at Manipal Hospital was immediately started on a course of antiviral treatment to target the varicella-zoster virus and prevent further complications.
The timely administration of antivirals is crucial, especially in older patients; it can reduce the severity of symptoms, the risk of postherpetic neuralgia (a common complication in which pain persists after the rash has healed), and other potential complications.
2. Pain Management
Managing pain is crucial in treating herpes zoster. This is especially important in bilateral infections, which cause more severe discomfort. In this case, the patient was prescribed pain relief medications. Acetaminophen and NSAIDs were used to control mild to moderate pain. For more severe pain, opioid medications were considered and prescribed cautiously.
In addition, the patient was prescribed topical analgesics to help alleviate localized pain from the rashes. Medications like lidocaine patches or capsaicin cream can provide relief from the burning or stabbing pain.
3. Preventing Postherpetic Neuralgia
Postherpetic neuralgia (PHN) is a concerning complication of herpes zoster, especially in older adults. PHN is persistent nerve pain after the rash heals. It can be debilitating and complex to treat. Early antiviral treatment was started at Manipal Hospitals to reduce the risk of PHN.
This treatment helps lower the chance of developing PHN. The patient was monitored closely for signs of PHN. If PHN developed, neuropathic pain medications like gabapentin or pregabalin were prescribed. These medications help reduce nerve pain.
4. Skin Care and Wound Management
If not properly managed, the skin lesions associated with herpes zoster can lead to secondary bacterial infections. The patient received guidance on proper wound care to prevent diseases, including keeping the blisters clean and dry and applying topical ointments when necessary.
The team at Manipal Hospitals also discussed the importance of moisturizing the skin to reduce irritation and promote healing. This aspect of care is essential for elderly patients whose skin may be more fragile.
5. Psychological Support and Counseling
Living with herpes zoster can be a challenging experience, especially for older patients who may already face physical or emotional stressors. At Manipal Hospitals, the patient was provided with psychological support and counseling to help manage the mental toll of the condition. The emotional aspect of herpes zoster is often overlooked, but addressing mental health is an integral part of holistic care.
The hospital’s multidisciplinary team includes psychologists and counsellors who work closely with patients to provide support, reduce anxiety, and improve overall well-being.
Outlook and Recovery
The recovery process for bilateral herpes zoster can be prolonged, especially in elderly patients. However, with prompt and effective treatment, the patient at Manipal Hospital showed significant improvement within a few weeks. The antiviral medications were well-tolerated, and pain management strategies effectively relieved the rash. The severity of the rash was significantly reduced, and the patient could return to daily activities.
The healthcare team continued to monitor the patient’s progress, adjusting treatments as necessary to ensure the best possible outcomes. Follow-up visits were scheduled to assess the healing of the lesions and monitor for any potential complications, such as postherpetic neuralgia.
Conclusion
The 74-year-old patient at Manipal Hospital was treated for a rare bilateral herpes zoster. Managing such infections in older adults is complex. The hospital’s treatment approach was comprehensive. It included antiviral therapy, pain management, wound care, and psychological support. These factors were crucial for the patient’s recovery. Advancements in medical treatments help manage herpes zoster more effectively. A holistic care focus further supports the treatment process. However, the rare and more severe bilateral form of the disease highlights the importance of early diagnosis and timely intervention. This helps prevent complications and promotes better outcomes.
Manipal Hospitals continues to provide exceptional care to patients dealing with complex conditions like herpes zoster. The hospital ensures patients receive the comprehensive support needed for a full recovery.
Reference: 74-year-old treated for rare bilateral Herpes Zoster at Manipal Hospitals
