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In some cases, it is difficult to distinguish between Bell's palsy and Ramsay Hunt syndrome, particularly in the early stages. Ramsay Hunt syndrome tends to be more severe than Bell's palsy. Although evidence is weak on treating facial involvement of herpes zoster, some experts recommend oral prednisone (a corticosteroid) and an antiviral agent within seven days of symptom onset. Even though nearly all cases of Bell's palsy and the majority of Ramsay Hunt syndrome resolve without problems, the possibility of residual symptoms with Ramsay Hunt and the early resemblance between the two syndromes warrants this treatment.
Effects on the Brain. Inflammation of the membrane around the brain (meningitis) or in the brain itself (encephalitis) is a rare complication in people with herpes zoster. The encephalitis is generally mild and resolves in a short period. In rare cases, particularly in patients with impaired immune systems, it can be severe and even life-threatening.
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Click the icon to see an image of the meninges of the brain. |
Effects in the Urinary Tract. In rare situations, herpes zoster can infect the urinary tract and cause difficult in urination. The condition is temporary but may require a catheter to eliminate urine in some patients who have prolonged difficulty in urinating.
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Click the icon to see an image of the male urinary tract. |
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Infections in the Eye. If shingles occurs in the face, the eyes are at risk, particularly if the path of the infection follows the side of the nose. If the eyes become involved (called herpes zoster ophthalmicus), a severe infection can occur that is difficult to treat and can threaten vision. AIDS patients may be at particular risk for a chronic infection in the cornea of the eye.
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Click the icon to see an image of the eye. |
Herpes zoster can also cause a devastating infection in the retina called imminent acute retinal necrosis syndrome. In such cases, visual changes develop within weeks or months after herpes zoster outbreak has resolved. It should be noted that this complication does not always follow a herpes outbreak in the face but can occur after an outbreak in any part of the body. Prompt treatment with acyclovir can often halt its progress, at least in people with healthy immune systems. Acyclovir or valacyclovir, a similar agent, may prevent other eye complications, such as conjunctivitis (pink-eye), inflammation of the cornea, and pain.
Disseminated Herpes Zoster. As with disseminated chickenpox, disseminated herpes zoster, which spreads to other organs, can be serious to life-threatening, particularly if it affects the lungs. People with compromised immune systems are at greatest danger, with risk of 5% to 25%. It is very rare in people with healthy immune systems.
In very rare cases, herpes zoster has been associated with Stevens-Johnson syndrome, an extensive and serious condition in which widespread blisters cover mucous membranes and large areas of the body.
High-Risk Candidates for Complications of Chickenpox, Shingles, or Both
Elderly people. The older the patient the higher the risk for complications from either chickenpox or shingles. Adults who smoke are at particularly higher risk for pneumonia from chickenpox. In England, where chickenpox vaccinations have not been recommended, adults account for 81% of all deaths from chickenpox.
Patients with Compromised Immune Systems. People with suppressed immune systems from diseases, such as AIDS, leukemia, or those who take immunosuppressive drugs, are at the highest risk for severe and even unusual forms of VZV. Examples include chronic chickenpox with persistent sores, or disseminated varicella-zoster (in which the infection spreads to internal organs).
Patients with Serious Illnesses. People with serious illnesses may be at risk for complications of the varicella-zoster virus. Of note, patients with diseases, such as Hodgkin's disease, who receive bone marrow or stem cell transplants are at higher risk for herpes zoster and its complications. An inactivated vaccine given before the procedure may be helpful.
Pregnant Women. Pregnant women who become infected with the varicella-zoster virus, whether in the form of chickenpox or shingles, are at increased risk for serious pneumonia.
- The risk for the infant is lower or higher depending on when the mother became infected.
- Chickenpox in the mother during early pregnancy poses a slightly increased risk for birth defects in the infant, but it is not usually viewed as grounds for terminating a pregnancy.
- The highest risk for birth defects is about 2%, which usually occurs if the mother has chickenpox between the 13th and 20th week. Even in such cases, birth defects may only result in minor skin abnormalities. More serious defects include a smaller than normal head, eye problems, low birth weight, and mental retardation.
- If women develop chickenpox (not shingles) within five days before and two days after delivery, their newborns are at risk for life-threatening varicella.
Newborns and Infants. Chickenpox in newborns is a life-threatening condition. Although chickenpox can still be very dangerous in older infants, most are protected by antibodies in breast milk from mothers who have had chickenpox. Nevertheless, children under age one who develop chickenpox are at still higher risk for childhood shingles. All infants should have as little exposure to people with chickenpox as possible.
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