Is Shingles Dangerous?

Decades ago, conventional wisdom dictated that the sooner a child contracted chickenpox, the better the outcome, with the understanding that the virus could only be contracted once, then it was forever nullified. Up until the 1980’s, this flawed logic sent scores of us running to the houses of afflicted neighborhood children to roll about in their infected belongings seeking the proverbial “one and done” self-vaccination. The resulting fever, sore throat, and swaths of itchy sores that dotted our bodies from stem to stern were considered a childhood rite of passage that left parents secure in the satisfaction of their immunological efforts.

As a long-term plan, unfortunately, this turned out to be a poor practice. The viral culprit, Varicella zoster, has evolved a nasty survival mechanism; rather than being snuffed out by your immune system, it hides out at the base of nerve roots along the spinal column. Often dormant for decades, V. zoster patiently awaits the immunocompromised state that inevitably accompanies old age and infirmity. Once reactivated by a weakened immune system, childhood chickenpox can reemerge with a considerable vengeance.

How is it different from chicken pox?

The initial infection with chickenpox usually occurs in childhood, rendering a milder case of itchy or tender sores and fatigue that lasts seven to ten days and typically leaves no lasting effects in its wake. This highly contagious virus is shed from an infected individual’s open sores into the mouth or respiratory tract of another. The initial infection is “systemic” or occurs throughout the body, hence spattering lesions across all skin surfaces. An immune response puts the virus in check.

Although it can’t completely destroy it, it suppresses the virus’s activity for years, preventing it from becoming active again.

Until it doesn’t. Shingles is what we call the resurfacing of that same virus years later, when it erupts heavily in weeping sores along the length of one or multiple nerves and causes severe pain that can last for weeks or even be permanent. In terms of severity, chickenpox pales by comparison. Usually afflicting older adults, reemergence can be triggered by a decrease in immunity or a severe viral infection by another pathogen that depletes the immune system. Advanced age, HIV, chemotherapy, malnutrition, or severe chronic stress can potentially let the horseback out of the barn.

Lesions typically create a fern-like pattern, with rows of sores that blister and ooze clear fluid. Although they can emerge from any spinal nerve root, the most common places are the middle of the trunk and tailbone.

Could it be dangerous?

Although it’s incredibly unpleasant, the incidence is common, and most people can manage their symptoms without long-term effects. That is not to say that zoster cannot generate its share of complications, however. The assault on the nerve tissue by the virus causes severe inflammation and pain. If severe damage occurs, the pain can become a permanent condition called post-herpetic neuralgia (PHN). Ten to eighteen percent of shingles victims experience this unfortunate effect. PHN can include tingling, numbness, or shooting pains along the previously infected area. Bacteria introduced into open lesions can also cause a secondary infection known as cellulitis. In addition to amplifying the pain, cellulitis can progress to sepsis if it is not treated immediately with antibiotics. If you have shingles and notice that the area has become hot or swollen, has begun to produce white discharge, or if you develop a fever, call your physician right away.

In some cases, the virus may inhabit the nerves that originate from the brain. These are called our cranial nerves, and they provide sensory and motor information for the scalp, face, eyes, mouth, and shoulders. Eruptions along these nerves can be more debilitating and do more damage than those in the lower nerve tracts. Although rare, lesions within the ear or near the eye’s cornea can cause hearing loss or blindness. One pattern of symptoms described by Dr. J. Ramsay Hunt identified facial paralysis that coincided with ear pain, vertigo, and tinnitus in several patients. Ramsay Hunt syndrome has recently been identified as a product of zoster infection. Most people who experience zoster will never progress to the complications mentioned above, but it’s important to remember to seek medical help as soon as symptoms begin. The damage is directly proportional to the severity of the outbreak, and early treatment is critical.

What is the best treatment?

Three treatment goals are:

  • Pain management.
  • Shortening of the duration of the outbreak.
  • Prevention of a secondary infection.

It’s essential to see your doctor at the first possible signs of an outbreak, characterized by excessive fatigue, body aches, and an area of numbness and prickly pain, with or without signs of lesions. There is a narrow window of opportunity to get antiviral medication onboard, usually within the first 72 hours of symptoms. Antivirals can significantly reduce the severity and shorten the length of time you have to endure the disease. Pain can generally be controlled with over-the-counter medication such as ibuprofen or acetaminophen or natural alternatives like turmeric.

How is it prevented?

Varicella vaccines have been available to children since 1995. Being vaccinated prevents an individual from developing protective antibodies without the risk of live viral dormancy and resurrection. For those of us for whom a vaccine came too late, there is an amplified version of the same shot, known as Zostavax. This vaccine is approved for anyone over the age of sixty or younger high-risk patients who have a history of chickenpox infection.

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