Herpes zoster
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Herpes zoster mjehurići na vratu i ramenu
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ReferencesHerpes zoster, uzrokovan reaktivacijom virusa varicella zoster koji je odgovoran za vodene kozice, pogađa oko milijun ljudi godišnje u Sjedinjenim Državama, a doživotni rizik iznosi 30 %. Osobe s oslabljenim imunološkim sustavom znatno su sklonije razvoju šindre, s simptomima koji obično počinju malaksalošću, glavoboljom i blagom vrućicom, a nakon toga slijede neobični osjećaji na koži nekoliko dana prije pojave osipa. Ovaj osip, koji se obično pojavljuje na određenom području tijela, napreduje od prozirnih mjehurića do ranica s krastama tijekom tjedna do deset dana. Presudno je započeti brzo liječenje antivirusnim lijekovima (acyclovir, valacyclovir, famciclovir) unutar 72 sata od pojave osipa. Postherpetička neuralgija, uobičajena komplikacija koju karakterizira dugotrajna bol u zahvaćenom području, pogađa otprilike jednog od pet pacijenata i zahtijeva kontinuirano liječenje lijekovima poput gabapentina, pregabalina ili određenih antidepresiva, uz lokalne pripravke poput lidokaina ili kapsaicina. Cijepljenje protiv virusa varicella zoster preporučuje se odraslim osobama od 50 i više godina kako bi se smanjio rizik od herpesa.
Shingles, caused by the reactivation of the varicella zoster virus responsible for chickenpox, affects around 1 million people annually in the United States, with a lifetime risk of 30%. Those with weakened immune systems are significantly more prone to developing shingles, with symptoms typically starting with malaise, headache, and a mild fever, followed by unusual skin sensations a few days before the appearance of a rash. This rash, usually appearing in a specific area of the body, progresses from clear blisters to crusted sores over a week to ten days. Prompt treatment with antiviral medications (acyclovir, valacyclovir, or famciclovir) within 72 hours of rash onset is crucial. Postherpetic neuralgia, a common complication characterized by prolonged pain in the affected area, affects about one in five patients and requires ongoing management with medications such as gabapentin, pregabalin, or certain antidepressants, along with topical agents like lidocaine or capsaicin. Vaccination against the varicella zoster virus is recommended for adults aged 50 and above to reduce the risk of shingles.
Shingles, caused by the reactivation of the varicella zoster virus responsible for chickenpox, affects around 1 million people annually in the United States, with a lifetime risk of 30%. Those with weakened immune systems are significantly more prone to developing shingles, with symptoms typically starting with malaise, headache, and a mild fever, followed by unusual skin sensations a few days before the appearance of a rash. This rash, usually appearing in a specific area of the body, progresses from clear blisters to crusted sores over a week to ten days. Prompt treatment with antiviral medications (acyclovir, valacyclovir, or famciclovir) within 72 hours of rash onset is crucial. Postherpetic neuralgia, a common complication characterized by prolonged pain in the affected area, affects about one in five patients and requires ongoing management with medications such as gabapentin, pregabalin, or certain antidepressants, along with topical agents like lidocaine or capsaicin. Vaccination against the varicella zoster virus is recommended for adults aged 50 and above to reduce the risk of shingles.
Herpes zoster češće javlja kod osoba starijih od 50 godina, onih s oslabljenim imunološkim sustavom i onih koji uzimaju lijekove za supresiju imuniteta. Pokreće ga reaktivacija virusa varicella‑zoster, istog virusa koji uzrokuje vodene kozice. Simptomi poput vrućice, boli i svrbeža obično prethode pojavi karakterističnog osipa. Najčešća komplikacija je postherpetička neuralgija – stalna bol u živcima nakon nestanka osipa. Čimbenici rizika i komplikacije povezane s herpes zosterom variraju ovisno o dobi, imunološkom stanju i vremenu početka liječenja. Pokazalo se da cijepljenje osoba starijih od 60 godina značajno smanjuje pojavu herpes zoster‑a i postherpetičke neuralgije. Uzimanje antivirusnih lijekova i analgetika unutar 72 sata od pojave osipa može smanjiti težinu bolesti i komplikacije herpes zoster‑a te postherpetičke neuralgije.
Herpes zoster tends to occur more frequently in people aged 50 and older, those with weakened immune systems, and those taking immunosuppressant medications. It's triggered by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Symptoms like fever, pain, and itching commonly precede the appearance of the characteristic rash. The most common complication is post-herpetic neuralgia, which is persistent nerve pain after the rash clears up. The risk factors and complications associated with herpes zoster vary depending on age, immune health, and timing of treatment initiation. Vaccination for individuals aged 60 and above has been shown to significantly reduce the occurrence of herpes zoster and post-herpetic neuralgia. Starting antiviral medications and pain relievers within 72 hours of rash onset can lessen the severity and complications of herpes zoster and post-herpetic neuralgia.
Herpes zoster tends to occur more frequently in people aged 50 and older, those with weakened immune systems, and those taking immunosuppressant medications. It's triggered by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Symptoms like fever, pain, and itching commonly precede the appearance of the characteristic rash. The most common complication is post-herpetic neuralgia, which is persistent nerve pain after the rash clears up. The risk factors and complications associated with herpes zoster vary depending on age, immune health, and timing of treatment initiation. Vaccination for individuals aged 60 and above has been shown to significantly reduce the occurrence of herpes zoster and post-herpetic neuralgia. Starting antiviral medications and pain relievers within 72 hours of rash onset can lessen the severity and complications of herpes zoster and post-herpetic neuralgia.
Klinička ispitivanja prije odobrenja pokazuju da živo cjepivo protiv zostera djeluje u rasponu od 50 % do 70 %, dok rekombinantno cjepivo postiže bolje rezultate – od 90 % do 97 %. Studije u stvarnom svijetu potvrđuju ove nalaze, pokazujući da je živo cjepivo djelotvorno oko 46 %, dok je rekombinantno oko 85 %.
The pre-licensure clinical trials show the efficacy of the live zoster vaccine to be between 50 and 70% and for the recombinant vaccine to be higher at 90 to 97%. Real-world effectiveness studies, with a follow-up of approximately 10 years, were reviewed in this article. These data corroborated the efficacy studies, with vaccine effectiveness being 46% and 85% for the live and recombinant vaccines, respectively.
The pre-licensure clinical trials show the efficacy of the live zoster vaccine to be between 50 and 70% and for the recombinant vaccine to be higher at 90 to 97%. Real-world effectiveness studies, with a follow-up of approximately 10 years, were reviewed in this article. These data corroborated the efficacy studies, with vaccine effectiveness being 46% and 85% for the live and recombinant vaccines, respectively.
Vodene kozice, koje se nazivaju i varičela, rezultat su početne infekcije virusom, koja se obično javlja tijekom djetinjstva ili adolescencije. Nakon što se vodene kozice izliječe, virus može ostati neaktivan (uspavan) u ljudskim živčanim stanicama godinama ili desetljećima, a potom se ponovno aktivirati. Herpes zoster nastaje kada se uspavani virus varičele ponovno aktivira. Virus tada putuje duž živčanih tijela do živčanih završetaka u koži, stvarajući mjehuriće. Tijekom izbijanja herpes zoster, izloženost virusu varicella koji se nalazi u herpes zoster mjehurićima može uzrokovati vodene kozice kod osobe koja još nije imala vodene kozice.
Čimbenici rizika za reaktivaciju uspavanog virusa uključuju stariju dob, lošu imunološku funkciju i oboljevanje od vodenih kozica prije 18 mjeseci života. Varicella‑zoster virus nije isto što i herpes simplex virus, iako oba pripadaju istoj obitelji herpesvirusa.
Herpes zoster cjepiva smanjuju rizik od herpes zoster za 50 % do 90 %. Također smanjuju stopu postherpetičke neuralgije i, ako se bolest pojavi, njenu težinu. Ako se razvije herpes zoster, antivirusni lijekovi kao što je aciklovir mogu smanjiti težinu i trajanje bolesti ako se započnu unutar 72 sata od pojave osipa.
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