(參考翻譯)Herpes-Zoster帶狀皰疹課件

WelcomeWelcomeHerpesZoster帶狀皰疹HuangKunHerpesZosterHuangKunTeachingContentsDefinitionEtiologyPathogenesisClinicalmanifestationsDiagnosisDifferentialdiagnosisTreatmentTeachingContentsDefinitionDefinition

HerpesZosterisaviralinfection病毒感染characterizedbyneuralgicpain神經(jīng)痛andclusteredvesicles水泡叢生situated位于

unilaterallyalongthedistributionofasensorynerve感覺神經(jīng).

DefinitionEtiology

Varicella-ZosterVirus水痘-帶狀皰疹病毒(VZV)Humanherpesvirustype3(HHV-3)EtiologyDorsalrootganglionPathogenesis

Varicella水痘Latentinfection潛伏感染Herpeszoster背根神經(jīng)節(jié)DorsalrootganglionPathogenesPathogenesis

ThefollowingmaycausetheVZVtobecomeactive：

Aging衰老Stress應(yīng)激Fatigue疲勞DiseasesthataffecttheimmunesystemAnticancer抗癌的andimmunosuppression免疫抑制treatmentsPathogenesisThefollowingClinicalManifestationsTypicalmanifestationsSpecialmanifestationsSymptomsLesions損傷Ophthalmic眼zosterOtic耳zosterpostherpeticneuralgia帶狀皰疹后遺神經(jīng)痛(PHN)othersClinicalManifestationsTypicalTypicalManifestations—symptomsProdrome前驅(qū)癥狀:fever,headache,malaise不適sensationsofburningpain,itching瘙癢,hyperesthesia感覺過敏Pain:characteristicsymptom特征性癥狀precedes首發(fā)oraccompanies伴隨theeruptionofrash皮疹

moresevereinolderpatientsusuallysubsides平息beforetherashhashealedTypicalManifestations—symptomTypicalManifestations－lesionserythema紅斑andpapules丘疹clusteredvesicles水泡叢生

pustules膿皰crusts結(jié)痂scar瘢痕12-24hs3-4ds7-10dsTypicalManifestations－lesionsTypicalManifestations－lesions

Distribution:

unilateral

(ononesideofthebody)

dermatomal皮區(qū)的

(anareaofskinsuppliedbyonespinal

nerve

脊神經(jīng))TypicalManifestations－lesionsDermatome皮節(jié)Dermatome皮節(jié)TypicalManifestations－lesions

Siteofpredilection好發(fā):

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

Potentiallythemostdevastating

破壞性

formofherpeszoster.Theophthalmicbranchofthetrigeminalnerve三叉神經(jīng)眼支isaffected.Conjunctivitis結(jié)膜炎,keratitis角膜炎,uveitis葡萄膜炎,opticnervepalsies視神經(jīng)麻痹,blindness失明.SpecialManifestation－OphthalSpecialManifestation－Otic耳zoster

VZVreactivate恢復(fù)活動(dòng)inthefacialandauditorynerves聽神經(jīng)Vesicles小水泡areinandaroundtheearEarpainSpecialManifestation－Otic耳SpecialManifestation－Otic耳zoster

thegeniculateganglion膝神經(jīng)節(jié)

isinvolvedperipheralfacialpalsy

周圍性面癱,paininthe

earandface,andvesicles

小水泡intheearormouthauditory

聽覺的andvestibular

前庭的symptomsRamsayhuntsyndrome拉姆齊·亨特綜合征:facialpalsy面癱SpecialManifestation－Otic耳SpecialManifestation－PHN

Postherpeticneuralgia帶狀皰疹后遺神經(jīng)痛（PHN）thepainpersistsaftertherashhashealedthemostcommoncomplicationofherpeszoster

thepaincanbemildorseveretheincidenceanddurationareagedependentSpecialManifestation－PHNSpecialManifestation－othersZostersineherpete

無疹性帶狀皰疹:

patienthasallofthesymptomsexceptrash

Disseminatedzoster播散性帶狀皰疹:

morethan20vesicles小水泡outsideoftheinvolveddermatome

Generalizedzoster泛發(fā)性帶狀皰疹:thelesionsinvolveseveralnon-adjacent不相連的dermatomesandcrossthemidline

中線SpecialManifestation－othersZDiagnosisLaboratorytests:

detectionofVZVspecific特異性IgMantibodyinbloodPCRforVZVDNAinvesicleviralculture病毒培養(yǎng)invesicleClinicalmanifestations:groupedvesiclesinunilateraldermatomaldistributionpainDiagnosisLaboratorytests:detDifferentialDiagnosisBeforerashappears:kidneystones腎結(jié)石pleurisy胸膜炎gallstones膽結(jié)石appendicitis闌尾炎

heartattack心臟病發(fā)作

Afterrashappears:contactdermatitis接觸性皮炎herpessimplex單純皰疹I(lǐng)mpetigo膿皰病DifferentialDiagnosisBeforerTreatmentThegoalsoftreatmentareto:

shortenthedurationoftheeruptivestageorrashspeeduphealingofthelesionsrelievepatientdiscomfortshortentheincidenceand

durationofPHNreducecomplications

TreatmentThegoalsoftreatmenTreatmentSelf-careathomeSystemictreatmentsAntiviraldrugsSystemiccorticosteroids全身用類固醇PainrelieversTopicaltreatmentsCoolcompress

冷敷法Topicalcreams外用藥膏EyedropsTreatmentSelf-careathomeSysTreatmentSelf-careathomeBedrestTry

torelaxandreducestressDonotscratch搔抓the

rashWearloosecotton棉clothes

TreatmentSelf-careathomeBeSystemictherapyAntiviraldrugs:reducepainandhelplesionshealfaster

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

Oraldrugs:ophthalmiczosterdisseminatedzosterRamsayhuntsyndromepatientsfailinginoraltherapy口服治療immunosuppressed免疫抑制的patientsSystemictherapyAntiviraldrugSystemictherapyPainrelievers:Tricyclicantidepressants三環(huán)類抗抑郁藥:amitriptyline阿米替林

Basicanalgesics止痛劑:Indomethacin吲哚美辛Narcoticagents麻醉藥物:morphine嗎啡Nerveblocks神經(jīng)傳導(dǎo)阻滯

Gabapentin加巴噴丁SystemictherapyPainrelieversSystemictherapySystemiccorticosteroidsItcanreduceinflammationandthedurationofpainIthasnotbeenproven證明toreducePHN

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

helpremovethecrusts

痂殼

lidocaine利多卡因creamandcapsaicin辣椒素creamcanrelievepain

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