PANRE Review Topic: Varicella

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CME4LIFE “Let’s Be Clear Series”

PANRE Review: Varicella (chickenpox) and Herpes Zoster (shingles)

 

In your PANRE reivew, remember the varicella zoster (VC) virus causes two diseases, Chickenpox and Shingles. Remember Shingles is reactivation of the latent varicella zoster virus that we got as kids. Well, usually.

 

Shingles is also know as herpes zoster, but we don’t call it that in front of patients. Just like the term “anorexia” or “abortion,” “herpes” doesn’t man the same thing to patients as it does to providers.

Chickenpox is highly contagious. It’s spread through the respiratory track. 98% of adults are immune to this either through getting Chickenpox as a child or through the vaccine (which is pretty effective.) All medical providers must show immunity to the VC virus. So remember when answering PANRE review questions, chickenpox requires air born isolation.

 

Localized HZ is not highly contagious. HZ in a dermatome requires standard precautions only. BUT, if it’s disseminated HZ then that’s a different story. Disseminated HZ is diagnosed by greater than 20 lesions outside the primary dermatome or greater than three dermatomes involved. It’s uncommon. So, when answering PANRE review questions, shingles requires contact isolation.

 

PA CME

Herpes Zoster

 

Hutchingson’s sign is HZ on the tip of the nose. This requires ophthalmology referral due to “herpes zoster ophthalmicus.” This is bad.

Antivirals are recommended for all patients with Shingles if within 72 hours.

 

Per UpToDate, “There is no clear role for the use of glucocorticoids or tricyclic antidepressants since clinical benefit has not been demonstrated and there are significant risks associated with these medications.”

 

So, that’s CME4LIFE’s “Let’s Be Clear Series” talk on Varicella (chickenpox) and Herpes Zoster (shingles.) Now go teach this to someone else or re-post it or you will have bad karma!

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John Bielinski, Jr., MS PAC is a practicing emergency medicine clinician, and has been lecturing nationally for more than ten years, teaching the tactics that have proven invaluable in his career as a medical professional.
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