(参考翻译)Herpes-Zoster带状疱疹课件

WelcomeWelcomeHerpesZoster带状疱疹HuangKunHerpesZosterHuangKunTeachingContentsDefinitionEtiologyPathogenesisClinicalmanifestationsDiagnosisDifferentialdiagnosisTreatmentTeachingContentsDefinitionDefinition

HerpesZosterisaviralinfection病毒感染characterizedbyneuralgicpain神经痛andclusteredvesicles水泡丛生situated位于

unilaterallyalongthedistributionofasensorynerve感觉神经.

DefinitionEtiology

Varicella-ZosterVirus水痘-带状疱疹病毒(VZV)Humanherpesvirustype3(HHV-3)EtiologyDorsalrootganglionPathogenesis

Varicella水痘Latentinfection潜伏感染Herpeszoster背根神经节DorsalrootganglionPathogenesPathogenesis

ThefollowingmaycausetheVZVtobecomeactive：

Aging衰老Stress应激Fatigue疲劳DiseasesthataffecttheimmunesystemAnticancer抗癌的andimmunosuppression免疫抑制treatmentsPathogenesisThefollowingClinicalManifestationsTypicalmanifestationsSpecialmanifestationsSymptomsLesions损伤Ophthalmic眼zosterOtic耳zosterpostherpeticneuralgia带状疱疹后遗神经痛(PHN)othersClinicalManifestationsTypicalTypicalManifestations—symptomsProdrome前驱症状:fever,headache,malaise不适sensationsofburningpain,itching瘙痒,hyperesthesia感觉过敏Pain:characteristicsymptom特征性症状precedes首发oraccompanies伴随theeruptionofrash皮疹

moresevereinolderpatientsusuallysubsides平息beforetherashhashealedTypicalManifestations—symptomTypicalManifestations－lesionserythema红斑andpapules丘疹clusteredvesicles水泡丛生

pustules脓疱crusts结痂scar瘢痕12-24hs3-4ds7-10dsTypicalManifestations－lesionsTypicalManifestations－lesions

Distribution:

unilateral

(ononesideofthebody)

dermatomal皮区的

(anareaofskinsuppliedbyonespinal

nerve

脊神经)TypicalManifestations－lesionsDermatome皮节Dermatome皮节TypicalManifestations－lesions

Siteofpredilection好发:

Thoracic胸部dermatome55%Cranial颅部dermatome20%(trigeminalnerve三叉神经)Lumbar腰部dermatome15%Sacral骶部dermatome5%TypicalManifestations－lesionsSpecialManifestation－Ophthalmic眼zoster

Potentiallythemostdevastating

破坏性

formofherpeszoster.Theophthalmicbranchofthetrigeminalnerve三叉神经眼支isaffected.Conjunctivitis结膜炎,keratitis角膜炎,uveitis葡萄膜炎,opticnervepalsies视神经麻痹,blindness失明.SpecialManifestation－OphthalSpecialManifestation－Otic耳zoster

VZVreactivate恢复活动inthefacialandauditorynerves听神经Vesicles小水泡areinandaroundtheearEarpainSpecialManifestation－Otic耳SpecialManifestation－Otic耳zoster

thegeniculateganglion膝神经节

isinvolvedperipheralfacialpalsy

周围性面瘫,paininthe

earandface,andvesicles

小水泡intheearormouthauditory

听觉的andvestibular

前庭的symptomsRamsayhuntsyndrome拉姆齐·亨特综合征:facialpalsy面瘫SpecialManifestation－Otic耳SpecialManifestation－PHN

Postherpeticneuralgia带状疱疹后遗神经痛（PHN）thepainpersistsaftertherashhashealedthemostcommoncomplicationofherpeszoster

thepaincanbemildorseveretheincidenceanddurationareagedependentSpecialManifestation－PHNSpecialManifestation－othersZostersineherpete

无疹性带状疱疹:

patienthasallofthesymptomsexceptrash

Disseminatedzoster播散性带状疱疹:

morethan20vesicles小水泡outsideoftheinvolveddermatome

Generalizedzoster泛发性带状疱疹:thelesionsinvolveseveralnon-adjacent不相连的dermatomesandcrossthemidline

中线SpecialManifestation－othersZDiagnosisLaboratorytests:

detectionofVZVspecific特异性IgMantibodyinbloodPCRforVZVDNAinvesicleviralculture病毒培养invesicleClinicalmanifestations:groupedvesiclesinunilateraldermatomaldistributionpainDiagnosisLaboratorytests:detDifferentialDiagnosisBeforerashappears:kidneystones肾结石pleurisy胸膜炎gallstones胆结石appendicitis阑尾炎

heartattack心脏病发作

Afterrashappears:contactdermatitis接触性皮炎herpessimplex单纯疱疹Impetigo脓疱病DifferentialDiagnosisBeforerTreatmentThegoalsoftreatmentareto:

shortenthedurationoftheeruptivestageorrashspeeduphealingofthelesionsrelievepatientdiscomfortshortentheincidenceand

durationofPHNreducecomplications

TreatmentThegoalsoftreatmenTreatmentSelf-careathomeSystemictreatmentsAntiviraldrugsSystemiccorticosteroids全身用类固醇PainrelieversTopicaltreatmentsCoolcompress

冷敷法Topicalcreams外用药膏EyedropsTreatmentSelf-careathomeSysTreatmentSelf-careathomeBedrestTry

torelaxandreducestressDonotscratch搔抓the

rashWearloosecotton棉clothes

TreatmentSelf-careathomeBeSystemictherapyAntiviraldrugs:reducepainandhelplesionshealfaster

Intravenous静脉注射acyclovir:5-10mg/kgiv.q8h×7-10dsAcyclovir阿昔洛韦:800mg5×/day×7dsFamciclovir泛昔洛韦:250mgtid×7dsValacyclovir伐昔洛韦:1000mgtid×7ds

Oraldrugs:ophthalmiczosterdisseminatedzosterRamsayhuntsyndromepatientsfailinginoraltherapy口服治疗immunosuppressed免疫抑制的patientsSystemictherapyAntiviraldrugSystemictherapyPainrelievers:Tricyclicantidepressants三环类抗抑郁药:amitriptyline阿米替林

Basicanalgesics止痛剂:Indomethacin吲哚美辛Narcoticagents麻醉药物:morphine吗啡Nerveblocks神经传导阻滞

Gabapentin加巴喷丁SystemictherapyPainrelieversSystemictherapySystemiccorticosteroidsItcanreduceinflammationandthedurationofpainIthasnotbeenproven证明toreducePHN

Inophthalmiczoster,Ramsayhuntsyndrome—prednisone强的松+antiviralmedicinePrednisone:10mgtid每日三次×3-5dsSystemictherapySystemiccortiTopicaltreatmentCoolcompress:helpvesiclesdryfasterdecreasesecondarybacterialinfectioncoolcompressapplied20minutesseveraltimesadayTopicalcreams:

helpremovethecrusts

痂壳

lidocaine利多卡因creamandcapsaicin辣椒素creamcanrelievepain

Eyedrops:whentheeyeisinvolvementTopicaltreatmentCoolcompreThankYou!ThankYou!SummaryEtiology:VZV(HHV-3)Pathogenesi