Zoster generalisatus

Herpes zoster infection with >25 aberrant vesicles, which are not arranged segmentally. This occurs especially in immunosuppression.

Herpes zoster without confinement to the dermatomes, often haemorrhagic-necrotic.

• Clinical
• Direct immunofluorescence ("Microtrak")
• Swab firmly from the base of the bubble with cotton swab (do not use the swab for PCR)
• Swab out onto slide and apply fixing fluid
• PCR
  • Swab firmly from the base of the bubble with cotton swab
  • Place cotton swab in virus medium, leave for 15 sec, then remove swab

Myocarditis, pancreatitis, oesophagitis, hepatitis.

Protracted course, sometimes takes weeks to heal with immunosuppression.

• Inpatient admission
• Stage appropriate analgesia

Systemic therapy

• Aciclovir
  • Administration: 3x 15mg/kg bw/d i.v.
  • KI: hypersensitivity, lactation
  • SNW (very common): headache
  • CAVE:
    • Enough fluid intake
    • Adjust dosage if renal function is impaired
    • In elderly patients, there is an increased risk for the occurrence of reversible neurological disorders
• Foscarnet
  • Administration: 3 x 40 mg/kg bw/d i.v.
  • CI: Hypersensitivity, Pregnancy, Lactation
  • SNW (very common): granulocytopenia, anorexia, hypokalaemia, hypomagnesaemia, hypocalcaemia, paraesthesias, headache, dizziness, nausea, vomiting, diarrhoea, rash, increased serum creatinine, fever, fatigue, chills, asthenia
  • CAVE:
    • Adjust dosage if renal function is impaired
    • Enough fluid intake

Topical therapy

• Tanning agents lsg. several times a day
• Fusidic acid cream several times a day
Fusidic acid+betamethasone cream several times a day
• Iodine-povidone solution several times a day

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