Chickenpox Holistic Treatment
To address these issues, we have recently examined the effect of major depression on varicella zoster virus (VZV)-specific cellular immunity (Irwin, Costlow, Williams, Artin, Levin, Hayward, & Oxman, 1998). The frequency of cells in the peripheral blood capable of proliferating in response to VZV antigen (VZV-responder cell frequency, VZV-RCF) was determined in patients with major depression and in age-and gender-matched normal controls. In addition, we evaluated VZV-RCF in a group of older adults to determine whether the decline in VZV-RCF observed in major depression was comparable in magnitude to that typically found in older persons who are known to be at increased risk of developing HZ.
Herpes zoster (HZ), also known as shingles, results from reactivation of varicella zoster virus (VZV), an a herpes virus, which has been persistent in a clinically latent state in spinal and cranial sensory ganglia since primary infection with varicella (chickenpox), often several decades earlier. Varicella is usually a childhood disease in temperate climates, but more often affects adolescents and adults in tropical areas. Latency is maintained by competent VZV-specific cell-mediated immunity (CMI), which declines as a normal function of aging
Most of the salicylic acid drugs (commonly referred to as the salicylates) are either marketed as salts of salicylic acid (sodium, magnesium, bismuth, choline, or triethanolamine) or as ester or amide derivatives (aspirin, salsalate, salicy-lamide). (Fig. 24.17) Children, between the ages of 3 and 12, who are recovering from flu or chicken pox, should not be taking aspirin or any salicylates because of the perceived risks of a rare disease known as Reye syndrome.159
The cause of PHN is an infection of herpes zoster (HZ), commonly called shingles. There are an estimated 1 million episodes annually in the United States. The varicella zoster virus (chickenpox) that causes HZ can lay dormant on the dorsal root ganglia nerve endings for years and become activated much later in life or when the patient's immune system becomes compromised. The syndrome affects those patients older than 50 years when the varicella virus becomes reactivated in a specific dermatome, where a unilateral localized vesicular rash appears on only one side of the body. The rash can last for 7 10 days, and a thoracic presentation is common. There is no gender preference, but it does occur less frequently in patients with darker skin. Although it is rare, HZ can occur without any rash at all, and patients will present with a localized severe pain in the area of the affected dermatome.
A rare but potentially fatal syndrome targeting the liver and brain changes in behavior and cognitive state can be seen as a result of encephalopathy and chemical alterations in the blood derived from liver damage. Other symptoms include vomiting, seizures, hyperventilating and coma. It primarily presents in children and adolescents as the result of consuming acetylsalicylic acid during a viral infection such as chickenpox or influenza.
VZV causes chickenpox (varicella), becomes latent in cranial and dorsal root ganglia, and may reactivate decades later to produce shingles (zoster). Reactivation occurs most commonly in elderly and immuno-compromised individuals. Although zoster rash is usually temporally associated with neurological disease, all of the above conditions, most notably meningoencephalitis, cranial neuropathies and myelitis, may occur without antecedent rash.14
Acute retinal necrosis and progressive outer retinal necrosis, most often caused by varicella zoster virus, can be treated by various combinations of oral, intravenous, intravitreal injection, and intravitreal implantation of antiviral medications.
Postherpetic neuralgia (PHN) is a syndrome of persistent ( six months after acute zoster) pain and dysesthesia in the dermatomal topography of the original zoster outbreak. There is a definite predilection for the dormant varicella zoster virus to reoccur in the aged and immu-nocompromised patients (e.g. lymphoma patients). The pain of PHN is variously described as constant, aching, sharp, or shooting. Patients often have severe allodynia, dysesthesia, or hypoesthesia, and may not be able to tolerate even their own clothing touching the area involved. Pharmacologic therapies have been the mainstays of treatment, although various sympathetic and somatic blocks, epidural and intrathecal corticosteroid injections, TENS, and topical treatments are advocated by some. Pharmaceutical agents generally are utilized, such as ion channel modulating anticonvulsant class agents, non-selective reuptake inhibition by tricyclic antidepressants and newer agents, opioids, topical local anesthetics, or...
Although the classic combination of unilateral dermato-mal rash and pain often leads to prompt and correct diagnosis, studies have shown significant incorrect clinical diagnosis rates in up to 20 percent of cases. The most common confusing diagnoses are herpes simplex type 1 (labial), type 2 (genital), or allergy. Pain accompanies acute HZ in over 90 percent of cases. Antiviral drugs (acyclovir, valaciclovir, famciclovir, and brivudin) control viral DNA replication and significantly reduce acute pain, hasten rash healing, and shorten the period of viral shedding (infectivity).45'46 I The effectiveness of analgesic drugs has not been well studied with regard to whether paracetamol, paracetamol with opioid, or non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice. Some patients require strong opioid medication. The place of drugs more commonly associated with PHN management is unproven but there is expert consensus that they have a place in the management of acute pain....
Although successful programs have been initiated to vaccinate children against chickenpox and elderly people against HZ, we are far from globally eradicating the virus and in all likelihood will be treating patients with PHN during the next few decades. Much research will be needed to establish how effectively PHN can be prevented through immunization. Interventions during HZ to prevent PHN are too little researched, partially due to limited understanding of the pathophysiology of prolonged pain. A better understanding of the transition of HZ to PHN may reveal a new target for preventive treatment. Whereas highly invasive interventions possibly have a potential to lessen the development of PHN 44, 45 , they are not practical in the clinic, and lesser interventions are not helpful 43 . We need studies to establish whether substantial pain relief per se (irrespective of
Ataxia, nystagmus and nausea with movement may be associated with acute chickenpox and develop either before44 or after45 rash. In one subject,44 the EEG showed bilateral slowing with sharp bursts of theta waves and lack of sleep spindles. Brain imaging does not usually reveal lesions in the cerebellum or brainstem, and the CSF is normal. Symptoms and signs usually resolve spontaneously. No antiviral treatment appears to be necessary.
Figure 49-1 provides a schematic diagram of the replicative cycle of a DNA virus (A) and an RNA virus (B). DNA viruses include poxviruses (smallpox), herpesviruses (chickenpox, shingles, oral and genital herpes), adenoviruses (conjunctivitis, sore throat), hepadnaviruses (hepatitis B virus HBV ), and papillomaviruses (warts). Typically, DNA viruses enter the host cell nucleus, where the viral DNA is transcribed into messenger RNA (mRNA) by host cell polymerase and mRNA is translated into virus-specific proteins.
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