Question

1. A 55 year old woman presented to her family with a 3 day history of burning and pain over her left forearm. The symptoms were rather abrupt in onset, and she had not experienced anything like this before. Over the previous 2 days, several vesicles had developed in a band like distribution on her arm, and new ones were erupting daily. On the day she went to see her family doctor, the lesions had started turning purplish. At no time did she have any fever, but her appetite was markedly reduced. She had previously been healthy except for childhood illness of measles, chickenpox, and mumps. The patient was a caregiver to elderly individuals. She had no known allergies. What was her underlying viral illness? How is the diagnosis made? How could you treat and/or prevent this infection? (10 pts)

Answer 1

Answer- chicken pox or shingles due to reactivation of varicwlla vorus in geniculate ganglion.

She was a caregiver to elderly , in elderly individuals shingles can occur due to immunocompression , shingles is infectious and the resulting infection is chicken pox . The burning skin or dermatome , vesicular rash are consistent with chicken pox or shingles . But aince ahingles cannot spread from another person ,it agoyld be chicken pox.

Diagnosis is based on clinical symptoms ,confirmation cam be done by immunofluorescent antibody staining or PCR- polymerase chain reaction of the scrappings from the lesion.

Tzank Smear of the scrappings will show multinucleated giant cells.

Varicella skin test and interferon gamma enzyme linked immunispot test for screening can be sone for confirmation.

General measures for prevention-

Shingles is self limiting and symptoms can only bw reduced

Isolation of patient until crusts disappear .

Bed rest

Skin is kept clean , antihistamine and analgesics for pruritis and rash .

Prophylaxis -

Zoster immunoglobulin is indicated in unvaccinated persons ,pregnant women and for immunocompromised patients.

Antiviral drugs like acyclovir is indicated for immunocompromised patients

Steroids in decreasing doses .

Local soothing agents to prevent irritation and pruritis from rash .,

Antiseptic powder to be sprinkled to prevent secondary infection.

If this helps please give it a positive rating thank you!