ABSTRACT
Vericella Zoster Virus (VZV) causes a vesicular rash in children called chicken pox. The virus then travels via the cutaneous nerves and stays dormant in the dorsal root ganglia. During periods of immunosuppression, the virus may get reactivated and can result in a wide variety of syndromes. Typically, it causes a vesicular eruption in a dermatomal distribution called a zoster rash or shingles. This may affect any of the cutaneous or cranial nerves. Characteristic syndromes have been described with the trigeminal and auditory nerves. Upon resolution of the rash, in some patients, pain may persist in the same distribution resulting in a post-herpetic neuralgia. If the neuralgia occurs in the absence of a rash it is termed, Zoster sine herpete. In some patients there maybe segmental involvement of the spinal cord corresponding to the region of the zoster rash. In some patients, there may be a wide dissemination of the virus causing a meningitis encephalitis or retinitis, which may occur in the absence of a rash. The virus can also spread to the blood vessels, resulting in a vasculopathy and has been implicated in giant cell arteritis. The chapter describes the pathophysiology and treatment of each of these conditions.
