Zoster generalisatus

Last Updated: 2019-08-26

Author(s): Anzengruber, Navarini

ICD11: -

Herpes zoster infection with > 25 aberating vesicles which are not arranged segmentally. This mainly occurs in immunosuppression.

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

  • Clinic.
  • Direct immunofluorescence ("Microtrak")

  • Swab with cotton swab firmly from the bladder base (do not use the swab for PCR).

  • Spread out on microscope slide and apply fixing liquid.

  • PCR

    • Swab with cotton swab firmly from the bottom of the bladder.

    • Put cotton swabs into the virus medium, leave for 15 seconds, then remove swabs. 

Myocarditis, pancreatitis, esophagitis, hepatitis.

Protracted course, sometimes it takes weeks to heal in immunosuppression.

Inpatient admission

Analgesia appropriate to the stadium 

Systemic Therapy 

  • Aciclovir (Zovirax®) application: 3x 15mg/kg bw/d intravenously; Contraindication: hypersensitivity, lactation. Side effects (very common): Headache. CAVE: In older patients there is an increased risk of reversible neurological disorders. Adjustment of dosage for reduced kidney function. Sufficient liquid supply.

  • Foscarnet (Foscavir®). Anw.: 3 x 40 mg/kg KG/d i.v.; KI: Überempfindlichkeit, Schwangerschaft, Stillzeit. NW (sehr häufig): Granulozytopenie, Anorexie, Hypokaliämie, Hypomagnesämie, Hypokalzämie, Parästhesien, Kopfschmerzen, Schwindel, Übelkeit, Erbrechen, Durchfall, Rash, erhöhtes Serumkreatinin, Fieber, Müdigkeit, Frösteln, Asthenie. CAVE: Anpassung der Dosierung bei eingeschränkter Nierenfunktion. Genügend Flüssigkeitszufuhr.

Topical Therapy 

  • Tannosynt®-Lsg. several times a day 

  • Fucidine® cream several times a day 
    Fucicort® cream several times a day 
  • Iod-Povidon®sg. several times daily
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