Herpes Zoster

Gürtelrose.

Kontagiöse, segmental angeordnete Hautkrankheit, welche durch Reaktivierung des VZV in den Spinal- und Hirnnervenganglien hervortritt.

Lebenszeitprävalenz: 20%.

• Inkubationszeit: 1-2 Wochen
• Prädisopsitionierende Faktoren:
  • Immunsuppression
  • Stress
  • Höheres Lebensalter

Herpetiforme, gruppierte, segmental angeordnete Bläschen auf erythematösen Grund. Im Verlauf platzen die Blasen auf und es bilden sich Krusten. Sofern keine Blasen mehr bestehen, ist der Patient nicht mehr als infektiös einzustufen. In manchen Fällen kommt es zu Schmerzen, Allodynie, Juckreiz, reduziertem AZ und selten auch Fieber.

• Klinik
• Tzanck-Test: Abstrich mit Wattetupfer vom Blasengrund (fest aufdrücken)
  • Auf einen Objektträger ausstreichen, Färben mit Methylenblau
• PCR
  • Abstrich mit Wattetupfer vom Blasengrund (fest aufdrücken). Wattetupfer ins Virusmedium geben, 15 Sek. belassen, dann Tupfer entfernen

Unilateral am Körper. Meistens thorakales Dermatom, zweithäufigsten im Trigeminus-Bereich. 

Selten auch andere Lokalisationen, z.B. genital.

• Postzoster-Neuralgie
• ZNS-Beteiligung des Zosters
• Pyogene Infektionen
• Herpetische Keratitis bei V.1 Befall

Shingrix-Impfung empfohlen, in CH noch nicht zugelassen, wird importiert 2 x 140 CHF Selbstzahlerleistung. Zostavax ist von der Wirkung her weit schlechter. 

Impfung auch nach einem Zoster empfohlen. In 6% kommt es nach Zoster zu Rezidiven, davon in ca. 50% an der gleichen Stelle. 

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