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On our Youtube channel, you’ll find a limited
selection of pathology and patient videos. With Osmosis Prime, you’ll get access to over
700 videos including complete coverage of pathology and physiology and a growing collection
of pharmacology and clinical reasoning topics. Try it free today. Varicella zoster virus is one of the herpesviruses
and it causes two diseases – varicella or chickenpox, and herpes zoster also known as
shingles. Zoster actually refers to a type of belt used
by ancient Greek warriors because of the belt like appearance of shingles. Now, let’s first talk a bit about the nervous
system – it consists of two parts. The central nervous system which includes
the brain and the spinal cord, and the peripheral nervous system includes the nerves that fan
out from the central nervous system to reach the skin, muscles, and organs. Peripheral nerves that originate from the
brain are called cranial nerves, and they’re in charge of motor and sensory innervation
of the head and neck. A specific cranial nerve, cranial nerve V,
is the trigeminal nerve and it’s responsible for the sensation in the face. Its sensory neurons create a nerve cell cluster
called trigeminal ganglion, located in the bones on the side of the face between the
eyes and ears. The peripheral nerves originating from the
spinal cord are called the spinal nerves. Each nerve is formed by a dorsal and a ventral
root. Ventral roots contains neurons that carry
motor innervation from the spinal cord to the muscles. Sensory information, like touch, temperature,
pain, and pressure from the skin and other tissues travel through 1st order sensory neurons,
in the dorsal root ganglion near the spinal cord, then through the dorsal root, and into
the spinal cord, where it synapses with the 2nd order neurons. Now, each spinal nerve is in charge of the
sensation of a specific area of the skin, called a dermatome. For example, if you step on a lego, the pain
would be carried by the S1 nerve, but if you hit your big toe on a table leg, the pain
would be carried by the L5 nerve. Varicella zoster virus is a double-stranded
DNA virus, protected by a protein coat called capsid, which is enveloped in a lipid membrane. The virus initially enters respiratory epithelial
cells – but eventually spreads to numerous cell types. It gets into all of these cells by fusing
its membrane with the cell membrane and releasing the capsid inside the cell. The capsid binds to the nucleus and injects
it with viral DNA, where it’s copied. The viral genes are transcribed into RNA and
go over to the ribosomes, where they are translated into capsid proteins. The capsid and viral DNA fuse together. They go through the Golgi complex, a cell
organelle in charge of packing proteins, to get their lipid membrane and finally the newly
formed viruses leave the cell. Leaving behind a dead cell. When an infected person sneezes or coughs,
the viruses leaves the lungs and get released into the air. The virus can also be transmitted through
contact with the oral or skin lesions of the infected person. When the virus comes in contact with the respiratory
mucosa or the skin of a new person, it starts replicating in the epithelial cells. It soon gets picked up by nearby immune cells
and gets transported to a nearby lymph node. The virus now causes primary infection called
varicella or chickenpox, and it has two stages – primary viremia and secondary viremia. In primary viremia the virus infects a part
of immune system in the liver and spleen called the reticuloendothelial system, which is made
of phagocytic cells. About two weeks after entering the body, the
virus starts infecting immune cells themselves – specifically T cells – and that is considered
the secondary viremia. Infected T cells start expressing proteins
that bind to receptors on the skin cells. It’s a bit like the virus is hitching a
ride in the T cell to get to the skin. Once the T cells reach the skin, they release
the viruses, which start infecting keratinocytes. The infection spreads through the skin, going
directly from cell to cell. Sometimes the infected keratinocytes start
to fuse together and create giant multinucleated cells called Tzanck cells. Uninfected cells start secreting interferons
alpha and beta, which inhibits viral protein synthesis and protects those cells from getting
infected. As a result, we get tiny lesions on the skin
separated by normal areas of skin. In addition to infecting keratinocytes, the
virus also infects sensory neurons in the skin, and in those neurons it travels retrogradely,
meaning backward through the neuron to the dorsal root ganglia or if it’s on the face,
the trigeminal ganglion. Over time, when the adaptive immune reaction
kicks in, most of the viruses in the body are eliminated, but the ones in the ganglions
are spared and can remain dormant for many years. Most commonly, the virus establishes a latent
state within the trigeminal ganglia and the dorsal ganglia. Later on, if the immune system weakens, due
to aging, stress, or immunosuppressive therapy, the virus can be reactivated. It can then travel back up through the sensory
nerve, anterogradely to the skin and cause an infection in the innervated dermatome – that’s
called herpes zoster or shingles. With both chickenpox and shingles, the most
common complication is a secondary bacterial infection of the skin lesions. So, if the liver becomes infected, hepatitis
can occur. If the virus spreads to the lungs we get pneumonia. If the brain or its protective membrane, called
the meninges, become inflamed, encephalomeningitis could occur. Symptoms of chickenpox begin about 2 weeks
after it enters the body. The infection usually causes a fever, headache
and overall weakness. After a couple days, skin lesions start to
appear on the scalp, face, and trunk. At first, there are flat, red, itchy spots
called macules. Over time, they become elevated and develop
into papules, and then into small fluid-filled vesicles. Within 1 to 2 days the vesicles begin to crust
over and form scabs. After about 5 days the scabs fall off, usually
without leaving a scar. New crops of lesions are continuously forming
in different places on the body every 3 to 5 days, so it’s possible to see lesions
in different phases at the same time. In addition to the itchy lesions, painful
sores can appear on mucosal surfaces like inside the mouth. In shingles there’s typically pain, itching,
or tingling in the area where the rash will develop. The rash itself is usually in a single stripe
of vesicles around either the left or the right side of the body or on one side of the
face. It usually takes 4 weeks for the rash to disappear,
but there can be pain in the affected dermatome which lasts for more than 90 days called postherpetic
neuralgia. Chickenpox and shingles are usually diagnosed
based on the way that the skin lesions appear, but the diagnosis can be confirmed by using
the Tzanck test to look for multinucleated giant cells in the fluid of the vesicles. More commonly, blood test for varicella zoster
antibodies or PCR can be done to look for viral DNA. Chickenpox treatment mainly includes the use
of topical antipruritic medications to help reduce the itching. Also, analgesics and anti-inflammatory medications
can help reduce the fever, but aspirin shouldn’t be used in someone with chickenpox, because
it can trigger Reye syndrome. In Reye syndrome, the liver gets affected
by both varicella zoster virus and aspirin and it leads to a buildup of ammonia in the
body. In immunocompromised individuals, antivirals
like acyclovir, famciclovir, and valacyclovir can be used. In some situations, varicella-zoster immune
globulin or VZIG which are anti-varicella antibodies can be given to treat immunocompromised
or pregnant individuals. Finally, varicella vaccine can be used to
prevent chickenpox by helping the body mount protective immunity against a weakened form
of the virus. Similarly, zoster vaccine can be used to reduce
zoster – which is more common in adults. All right, as a quick recap varicella zoster
virus is a herpesviruses that causes primary infection in the lymph nodes and secondary
infection in the keratinocytes and neurons in the skin. From the neurons in the skin, it travels retrogradely
to the nerve ganglia, where it remains dormant. Chickenpox is characterized by a rash on the
scalp, face, and trunk that contains macules, papules, vesicles and scabs at the same time. Herpes zoster or shingles is caused by the
reactivation of the virus, with vesicles located along one dermatome. Treatment is usually symptomatic, and in some
cases includes antiviral drugs.

21 thoughts on “Varicella zoster virus – causes, symptoms, diagnosis, treatment, pathology

  1. This is a great video but come on the Cranial nerves are from the CNS not PNS. They come from the brainstem at different levels and 1, 2 and 5 in particular are from the cerebrum.

  2. I AM FURIOUS AT THE PRESENT DAY MEDICAL PROFESSION. Sick x 2 weeks with severe flank pain to back, right abdomen, extreme nausea & fatigue. Awakened from hard sleep with more severe pain to lower back in ribcage area so presented to Baptist East Medical Center ER, Montgomery, Al. After 5 hour wait and many unnecessary test sent home with instructions to have another more expensive gallbladder test alrhough ultrasound in ER showed no stones. All kinda produces and unnecessary test done. All normal…cardiac enzymes normal. Botton line is if one, JUST ONE, nurse or doctor had bothered to do a thorough assessment, put me in a HOSPITAL GOWN and had taken a look at my back, the herpes zoster could have been detected. 36 hrs after ER visit, pain worse with rash spreading to front of abdomen. Since I DO NOT have eyes in the back if my head I couldn't see lesions until my daughter visited 36 hrs too late. Each and every nurse sat on their butts, even during triage and admission and never, ever laid a hand on me to gather good baseline information. My nurse pushed a COMPUTER around the entire time I was there, talked in a cell ohine and the extent of her care was to give me a percocet and zofran. She never touched me or assessed me at ALL. The ER doc listen to my lungs and that's the extent of her hands on care. When my daughter approached my nurse about a test result the nurse stated, "I'll have to get her NURSE." My daughter replied "You ARE her nurse." It appeared the nurse maybe had 2 patients. Unbelievable. Perhaps if I had gotten diagnosed properly and given the right medication, this could have been less severe. I expressed my concerns/complaints to ER charge nurse 2 days after I FIGURED OUT WHAT WAS WRONG….he basically said I was lying and a complete head to toe assessment WAS done. BULL! Hats off to old school nurses who care for the patients and not computer documentation. I'm thinking acupuncture and a holistic approach might be out best option these days.
    P.S. I had the vaccine 5 years ago…didn't work.

  3. I thought host cells released interferons but in this video it says that uninfected cells do. I guess the first one is a generalization?

  4. Appreciate Video! Excuse me for the intrusion, I would appreciate your opinion. Have you considered – Taparton Incredible Cure Takeover (do a search on google)? It is an awesome one off guide for Curing Shingles without the hard work. Ive heard some incredible things about it and my friend Sam at last got amazing results with it.

  5. Kudos for the video content! Excuse me for butting in, I would appreciate your opinion. Have you considered – Taparton Incredible Cure Takeover (search on google)? It is an awesome one off product for Curing Shingles without the normal expense. Ive heard some great things about it and my buddy after a lifetime of fighting got great success with it.

  6. Great Video! Sorry for butting in, I would appreciate your thoughts. Have you heard the talk about – Taparton Incredible Cure Takeover (do a search on google)? It is a good one of a kind guide for Curing Shingles without the hard work. Ive heard some amazing things about it and my GF finally got excellent results with it.

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  8. I'm having herpes zoster right now, I'm only 23 and I believe the trigger factor which has reactivated the virus could possibly be the extraction of the wisdom tooth wich I had surgically removed, the operation went surprisingly well, the post operation either, but 2 days after I felt like a paresthesia on my right arm, I belived it was a consequence of the antibiotic i took (amoxicillin) but after a few days, little round bubbles started to form in my arm and the rest is obvious..
    I've always been in good shape, my blood tests are good, my diet is excellent, I hadn't a flu or even a cold since 3 or 4 years, I'm not stressed at all, I can't be considered an immunodepressed subject, so I still don't know why such a terrible situation occurred. So my question is, could the extraction of a tooth trigger herpes zoster, or could it be local anaesthesia or even the administation of amoxicillin?
    Thank you for your patience!

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