ISSN 0973 - 9289

Herpes Zoster Infection

HIV Topics

Viral Infections

Herpes zoster occurs in children previously exposed to varicella zoster virus. It is reactivation of varicella.

Clinical features

In immunocompetent adults, vesicular lesions usually occur in the region of a dermatome unilaterally and are associated with pain and fever. Herpes zoster is rare in immunocompetent children and if it occurs in a child, then HIV infection should be suspected. In HIV infected children usually vesicles occur in multiple dermatomes and can occur bilaterally. Patients may have associated retinitis, pneumonitis, hepatitis and even encephalitis.

Diagnosis

Clinical presentation leads to the diagnosis. Laboratory tests in form of viral isolation or detection of viral antigens in the skin lesions is confirmatory.

Treatment

Acyclovir is the treatment of choice in herpes zoster. IV Acyclovir (10 mg/kg/do IV tds) for 7-14 days may be given in children with severe immunosuppression, trigeminal nerve involvement, multidermatomal zoster. Oral acyclovir (20 mg/kg/do PO tds) for 7 days should be given for mild disease. Patients who fail to respond to acyclovir may be treated with foscarnet (120 mg/kg/day IV in 3 divided doses).

Prophylaxis

Primary prophylaxis : HIV infected children who have no history of chickenpox or herpes zoster or are seronegative for varicella antibodies should be vaccinated with varicella vaccine provided they are not immunosuppressed (have a CD4% more than 25%). Varicella vaccine is a live alternated vaccine and can be given after 12-15 months of age. It should not be given in immunosuppressed children because of rise of disseminated viral infection.

Secondary prophylaxis : No suppressive treatment is required post therapy.