International Journal of Clinical Case Reports 2017, Vol.7, No.3, 9-14
14
cell culture of human fibroblasts is still the best diagnostic modality which reveals multinucleated epithelial cells,
although, it takes 24 hours for the concluding statement and does not distinguish between herpes simplex virus
(HSV) and varicella zoster virus (VZV). The other methods with higher sensitivity and rapid diagnosis are direct
immuno-fluorescence antibody detection against varicella zoster virus (VZV). This technique gives positive
results in upto 80% of the cases. Polymerase chain reaction (PCR) detects viral antigen (Neville et al., 2009;
Wadhawan et al., 2015). In recurrent cases, increased IgM levels are detectable in serum ten days after the
appearance of the vesicles and increased IgG and IgA four days after the vesicles. The treatment of acute herpes
zoster infections (HZIs) in younger, healthy patients is generally limited to symptomatic therapy. However, in
elderly or, immuno-compromised patients, an early, aggressive therapy is indicated (Katz et al., 1989). There are
non-invasive approaches that include the use of anti-viral agents, systemic steroids, analgesics, anti-depressants
and topical treatment modalities (Katz et al., 1989). Acyclovir, valacyclovir, famciclovir or, brivudin are the
agents administered systemically (Katz et al., 1989; Johnson and Dworkin, 2003; Wadhawan et al., 2015).
Systemic steroids, also, have been reported to decrease the incidence as well as the severity of pain during the first
few weeks of treatment (Katz et al., 1989). There are no promising evidences, although, regarding the reduction in
risk of developing post-herpetic neuralgias (PHNs) as one of the most dreaded complication with either anti-viral
agents and/or, systemic steroids (Johnson and Dworkin, 2003; Opstelten et al., 2008).
3 Conclusion
Post-herpetic neuralgia (PHN) is the most dreaded complication of herpes zoster infections (HZIs). The incidence
of HZIs and PHN increases with increasing age of the patients. An early diagnosis of HZIs, thus, becomes
mandatory in decreasing the risk of PHN as well as decreasing the duration and severity and in early resolution of
the lesions.
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