198.4 📌 章末速蚘

  • VZV: dsDNA herpes, 1 serotype, latency in DRG
  • Primary varicella: vesicular rash in successive crops, “dewdrop on rose petal”; adult/pregnant/immunocompromise severe
  • Pregnancy: 1st trim congenital varicella syndrome; near delivery neonatal varicella
  • Zoster: dermatomal painful rash; thoracic > others
  • Hutchinson’s sign = nose tip lesion → eye risk (V1 nasociliary)
  • Ramsay Hunt: VII palsy + ear vesicles + vertigo (geniculate)
  • PHN: > 90 d pain post-zoster; gabapentinoid / TCA / lidocaine / capsaicin
  • Vaccines: Shingrix ≥ 50 yr (or ≥ 19 immunocompromise), 2-dose; > 90% efficacy
  • Treatment: valacyclovir 1 g tid × 7d (within 72 hr); IV acyclovir for severe
  • Empirical IV acyclovir for encephalitis / ophthalmicus / disseminated / immunocompromise
  • Avoid aspirin in children (Reye’s)
  • VZV vasculopathy → stroke in elderly post-zoster