Herpes virus infections are reponsible for morbidity and mortality among immuno-suppressed patients. When it occurs, it causes vesicular lesions clustered unilaterally in the dermatomal distribution of one or more adjacent sensory nerves, which are preceded or accompanied by localized pain, hyperesthesias, pruritus, and low-grade fever. Similarly, herpes zoster is associated with much greater morbidity in patients with impaired cell-mediated immune responses. lymphoma, leukemia) HIV patients cell-mediated immune disorders organ or bone marrow transplantation immunosuppressive medications Clinical Manifestations in Immunocompromised hosts disseminated zoster: vesicular rash affecting several distinct dermatomes that cross midline may be delayed atypical with hemorrhage, nodular lesions or chronic crusting of skin increased likelihood of prolonged duration, recurrence, and severity visceral organ involvement pneumonia, hepatitis, encephalitis may occur in absence of rash Bone Marrow Transplant Recipients VZV dissemination most frequent late infection reactivated VZV occurs in 35% of BMT recipients at 1 year 50% develop VZV dissemination select BMT recipients presented with acute abdominal pain w/o antecedent rash delayed rash (up to 10-14 days later) delay prompt dx –> poor outcome Stephanie Yen, MS3 chickenpox latent infection reactivation later in life shingles enveloped, linear dsDNA lab tests useful in immunocompromised since often present atypically viral culture (30-70% sensitive, 100% specific) PCR (most sensitive and specific) DFA – antigen detection serology consider HIV testing in young adults if present with herpes zoster suspect immunodeficiency if new lesions present >1 week after presentation post-herpetic neuralgia Diagnosis resolves in 2-4 weeks HIV-infected Patients Zoster Vaccine (Zostavax) live, attenuated vaccine reduces shingles risk by 50% reduces severity and duration reduces PHN incidence effective for at least 6 years 16x more potent than Varivax When should low-dose acyclovir be used to prevent HZ? Search terms related to HZ, autoimmune diseases and IMS were used. יירשם ע”י רופא מומחה למחלות זיהומיות או רופא מומחה שהורשה ע”י הנהלת המחוז. Mean (± SD) Cmax values for acyclovir following oral valacyclovir were 18.8 ± 7 uM with a total exposure of 4106 ± 1519 uM•min.