In some cases some of the virus particles leave the skin blisters and move into the nervous system. There the viruses settle down in an inactive (latent) form inside specific nerve cells. When the chickenpox virus reactivates, the virus moves down the long nerve fibers that extend from the sensory cell bodies to the skin. The viruses multiply, the telltale rash erupts, and the person now has herpes zoster, or shingles.
Herpes zoster can occur in people who have never had a history of a "typical" attack of chicken pox. In this situation the attack is subclinical and passes undiagnosed. This is a possible explanation how someone with no history of a typical attack of chicken pox can still develop zoster later in life when the immune system is compromised.
Contact with a person with shingles may cause chickenpox (but not shingles) in someone who has never had chickenpox before.
VZV causes 2 diseases:
- Chickenpox: a ubiquitous and extremely contagious infection, is usually a benign illness of childhood characterized by an exanthematous vesicular rash. The rash is centripetal arranged in crops and heals without scarring.
- Herpes zoster: zoster lesions (shingles). With reactivation of latent VZV (which is most common after the sixth decade of life), herpes zoster presents as a dermatomal vesicular rash, usually associated with severe pain. The pain may continue after the rash subsides (post-herpetic neuralgia).
Unequivocal confirmation of the diagnosis is possible only through the isolation ofVZV in susceptible tissue-culture cell lines, the demonstration of either seroconversion or a fourfold or greater rise in antibody titer between convalescent- and acute-phase serum specimens, or the detection of VZV DNA by polymerase chain reaction (PCR).
Medical management of chickenpox in the immunologically normal host is directed toward the prevention of avoidable complications.
Patients with herpes zoster benefit from oral antiviral therapy, as evidenced by accelerated healing of lesions and resolution of zoster-associated pain with acyclovir, valacyclovir, or famciclovir.
A live attenuated varicella vaccine has been licensed and is recommended for administration to all immunocompetent children and adults at risk of infection.
Immune prophylaxis can consist of the administration of specific zoster immune globulin (ZIG) derived from patients with herpes zoster, varicella-zoster immune globulin (VZIG), or the intravenous formulation of zoster immune plasma (ZIP).