Herpes Zoster Holistic Treatment

How To Cure Shingles In 3 Days

In order to help each and every case of shingles, whether old or young patient or affected in any part of the body, Bob Carlton has written a 75- page e-book which is a step by step guide to cure shingles fast. He has himself suffered and after a lot of research for 5 years has got down to write this book. Fast Shingles Cure is a unique book that reveals to people symptoms of shingles, and strategies on how to get rid of these symptoms. In addition, the book covers advanced shingles treatment methods that are suitable for all ages such as shingles for seniors, shingles for adults, shingles for teenagers, shingles for pregnant women, and other methods. Besides the main guide, purchasing the Fast Shingles Cure treatment right today, you also have chance to get attractive free bonuses. The full package of Fast Shingles Cure includes the Fast Shingles Cure main book. and four bonuses. More here...

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Epidemiology of Herpes Zoster What has Changed

Segmente Zoster

Herpes zoster (shingles) is an inflammatory neurodermatologic disease, usually localized on a skin segment of the body which is innervated by a sensory nerve. More than 100 years ago, an association between Varicella and herpes zoster has been suggested (see preface of the book). Shingles is a secondary disease to passed Varicella virus (VZV) infection, which latently persists lifelong in the spinal ganglia of the host. The presumably proviral latency is switched to productive infection by several trigger factors resulting in shingles ('girdle rose'). The most important trigger factor is a waning cell-mediated immunity to VZV along a big time interval after primary infection during childhood. Thus, the majority of patients are elderly or those who suffer from immunocompromising diseases. Nevertheless, many case reports remind that herpes zoster occurs also in immunocompetent adolescents and even in children. Numerous clinical observations have elucidated the epidemiology of herpes...

Varicella Zoster Virus Infections during Pregnancy

John Kennedy Death Body

Frequency and Consequences ofVaricella-Zoster In most industrial countries, chickenpox is a rare disease during pregnancy as more than 90 of women of child-bearing age possess virus-specific IgG class antibodies. Only 3-4 of women in Germany were found to be susceptible to primary varicella-zoster virus (VZV) infection 1 . In early reports, the average incidence of varicella in pregnant women was calculated as 0.7 per 1,000 pregnancies 2, 3 , but the current rates appear to be 2-3 per 1,000 pregnancies 4 . Table 1. Varicella-zoster virus infections and their potential consequences during pregnancy Maternal varicella zoster timing Intrauterine death, neonatal or infantile zoster Congenital varicella syndrome Normal zoster at any stage Nearly 20 of infants with intrauterine acquired VZV primary infection develop neonatal or infantile zoster, usually with uncomplicated course 13 . The disease is thought to represent reactivation of the virus after primary infection in utero. The...

Antiviral Therapy of Shingles in Dermatology

The major goals of therapy in patients with herpes zoster are (3) reduction of acute zoster-associated pain (ZAP), clovir, famciclovir, and brivudin, started as early as possible, can significantly shorten viral replication, prevent lesion dissemination and reduce intensity and duration of ZAP particularly in elderly patients, provided that treatment is started early in the course of disease. This suggests that antiviral therapy (table 1) should be offered to all patients as soon as herpes zoster is diagnosed, preferably within 72 h after onset of rash. In patients of any age with ophthalmic herpes zoster and in all immunocompromised patients antiviral therapy should be started even later as long as viral replication can be considered in skin and nerves, e.g. as long as new blisters appear in the skin. Dermatologists are trained to diagnose early skin lesions as herpes zoster and should be consulted in time. Table 1. Antiviral therapy in immunocompetent patients with herpes zoster...

Epstein Barr Herpes Simplex and Herpes Zoster Infections

& Complications and Prognosis 128 & Summary 129 & Herpes Simplex Virus Type 1 129 & Introduction 129 & Definition 130 & Epidemiology 130 & Pathogenesis 130 & Clinical Manifestations 131 & Diagnosis 137 & Treatment 137 & Complications and Prognosis 139 & Herpes Zoster Virus 139 & Introduction 139 & Epidemiology 140 & Pathogenesis 140 & Clinical Manifestations 140

Herpes zoster

Herpes zoster is the reactivation of an earlier infection with varicella virus, which subsequently resides lifelong in the spinal ganglia. Herpes zoster episodes occur even in HIV patients with relatively good immune status, and are also seen during immune reconstitution (Martinez 1998). With more advanced immunodeficiency, herpes zoster tends to become generalized. In addition to involvement of one or more dermatomes, dangerous involvement of the eye (affecting the ophthalmic branch of the trigeminal nerve, herpes zoster ophthalmicus , with corneal involvement) and ear (herpes zoster oticus) may occur. Most feared is involvement of the retina with necrotizing retinitis. The neurological complications include meningoencephalitis, myelitis and also involvement of other cranial nerves (Brown 2001).

Live Attenuated Varicella Vaccine

Varicella-zoster virus (VZV) is the etiologic agent of varicella and zoster. Varicella is the primary infection, and zoster is due to reactivation of latent VZV acquired during chickenpox. Each disease is characterized by a macu-lopapular and vesicular skin eruption, which in varicella is generalized, and in zoster is unilateral and usually localized. Varicella is often mild and uncomplicated in otherwise healthy children, but it may unpredictably be associated with significant morbidity and even mortality. In the United States, in the pre-vaccine era, there were about 100 annual deaths from varicella and 11,000 hospitalizations 1 . Most deaths from varicella occurred in individuals who were healthy before contracting varicella. The risk of developing zoster is increased in the immunocompromised and the elderly, and zoster may be severe but is rarely fatal. A second dose of varicella vaccine may prove useful to avoid possible primary and secondary vaccine failure 36 . Breakthrough...

Postherpetic Neuralgia and Other Neurologic Complications

Postherpetic Neuralgia

The acute herpes zoster radiculoneuritis affects mainly elderly patients with an incidence of 125 100,000 per year. The clinical onset of acute herpes zoster infection is heralded by pain in the affected segment (preherpetic neuralgia). The characteristic vesicopapular rash usually appears a few days after the onset of pain and takes 3-4 weeks to heal. In most patients, the rash and pain disappear completely within a period of 1-2 months. These patients develop neither local neuropathy nor other cutaneous sensory changes. In other patients, the acute neurocutaneous symptoms may be followed by irreversible skin damage and sensory abnormalities and, in a significant number of patients, there is persistent pain or the initial pain subsides and a second pain, often of different character, begins. This condition is called postherpetic neuralgia (PHN). In the overall population on average 12-20 suffer from pain at the time of skin healing and 2-5 at 1 year after zoster. The incidence of PHN...

General Aspects of Therapy

Patients suffering from herpes zoster should be encouraged to see a physician as early as possible for immediate medical care based on administration of systemic antiviral therapy. In addition symptomatic local therapy and analgetic therapy in order to achieve painlessness are equally important. Since years it has become clear, that systemic antiviral therapy is indicated for most patients suffering from herpes zoster. In general the aims of therapy for herpes zoster comprise the following decrease viral replication as early as possible, thus lowering the viral load, accelerate healing, limit or relieve severity and duration of acute and chronic pain (postherpetic neuralgia, PHN). Further options are to prevent or alleviate other acute and chronic herpes zoster complications and reduce the risk of cutaneous extension and visceral dissemination of VZV, which is particularly a problem in immunocompromised patients. Alternative therapies such as hypnosis and others are definitely of...

Penis Schingles

Penis Schingles

Infectious VZV is usually recoverable from vesicle fluid or the base of a fresh zoster lesions for up to 7 days 24, 27 . A spectrum of cultured cells, either of primary or of established cell lines can be used for the isolation and growth of VZV (fig. 3). The most recommended cell cultures are either primary or low passage cultures of human fibroblasts derived from embryonic skin, lung tissue, or preputial tissues. Even under improved conditions, a significant percentage of viral cultures remains negative, despite positive VZV-antigen or -DNA detection 4, 10, 17 . Methods like 'shell vial' cultures with centrifugation and VZV protein staining improve the sensitivity and allow a more rapid identification of positive specimens 28, 29 . Positive results may be available within 1-3 days after inoculation of cell culture 30, 31 , while in conventional cultures up to 21 days are required 27 . Serological assays are frequently used for the diagnosis of chickenpox and herpes zoster. The...

AIDSHuman Immunodeficiency Virus

Central nervous system disease is present in 69 of cases, with the peripheral nervous system affected in 8 of HIV cases. Of the peripheral nervous system dysfunctions, the facial nerve is most common, found in approximately 5 of patients (61). A similar study of 170 AIDS patients found a 4.1 incidence of facial paralysis (62). Facial paralysis is abrupt in onset and usually unilateral (63). The mechanism of facial nerve injury may be a direct effect of the neurotropic virus, secondary involvement due to parotid or other neoplastic processes, or immunosuppression leading to reactivation of herpes zoster or other viruses. Multidrug therapy is the current standard therapy for HIV infection. Reverse transcriptase and protease inhibitors are effective and block HIV replication fusion inhibitors are also used and block HIV entry into the cell. The prognosis for facial paralysis is good, with the majority of patients having complete or near-complete recovery of facial function (64).

Ultrastructure and Assembly of Human Herpesvirus6 HHV6

Ultrastructure Herpesvirus

The eight known human herpesviruses are classified into three subfamilies (alpha-, beta- and gammaherpesviruses) based on shared biological properties (Table 1) (Roizman and Pellett, 2001). Alphaherpesviruses have a variable host range, short reproductive cycle, and rapid spread in culture. They establish latent infection primarily in neurons. This subfamily includes the human pathogens herpes simplex virus types 1 and 2 (HSV-1 and -2 or HHV-1 and -2) and varicella-Zoster virus (VZV or HHV-3). Betaherpesviruses have a more restricted host range, longer reproductive cycle, and slower growth in culture. The virus can remain latent in salivary glands, neurons, lymphocytes, and possibly other tissues. HCMV (i.e. HHV-5) and human herpesvirus types 6 and 7 (HHV-6, HHV-7) are members of this subfamily. Gammaherpesviruses include Epstein-Barr virus (EBV or HHV-4) and Kaposi's sarcoma-associated herpesvirus (KSHV) or HHV-8, both associated with certain lymphomas and other cancers. HHV-8...

Clinical Manifestations

Start Shingles Behind Ear

Because VZV becomes latent in cranial nerve, dorsal root, and autonomic ganglia along the entire neuroaxis, the virus can manifest anywhere on the body. Typically, the activated virus causes a prodrome consisting of skin sensitivity and mild-to-severe radicular pain, and after five days, a rash appears. The pain is associated with itching and dysesthesia. As with HSV-1, VZV infection decreases sensation in the affected dermatome, yet the affected skin is exquisitely sensitive to touch. The rash may continue to produce pustules that lead to crusting and ulceration. In many affected patients, healing is delayed beyond two weeks and is accompanied by increased skin pigmentation and scarring. Lesions can erupt outside the affected dermatome but rarely cross the midline and are not clinically significant. Distribution of 10 or more lesions outside a single dermatome suggests early evidence of viral dissemination. The term zoster sine herpete is used to describe VZV that is reactivated...

Patterns Reflected by the Skin

Nervus Peroneus Sensory Innervation

The sensory innervation of the skin is structured segmentally, according to the dermatomes (Fig. 11.2a,b). Some skin disorders, such as herpes zoster, may reflect this dermatome distribution. It is extremely useful to know the sensory nerve distribution of specific nerves when trying to pinpoint a neurological disorder. The distribution of motor nerves is also segmented but follows a different distribution than the sensory distribution.

Electrical Stimulation Of The Spinal Cord And Peripheral Nerves

In additional studies involving neuropathic pain, Harke et al. found that SCS relieved pain in 23 of 28 patients with postherpetic neuralgia and 4 of 4 with acute herpes zoster (24). Katayama et al. found that deep brain stimulation led to pain control in 6 of 10 patients with phantom limb pain, whereas SCS was only efficacious in 6 of 19 patients (25).

Statistics in Epidemiology

The incidence rate is often stated per 100,000 of the population at risk, or as a percentage. Incidence rates are found by the use of cohort studies, which are therefore sometimes also known as incidence studies (see Chapter 5). For example, if the incidence of shingles in a community is 2000 per 100,000 per annum, this tells us that in 1 year, 2 of the population experiences an episode of shingles. Like incidence rates, prevalence rates are often stated per 100,000 people, or as a percentage. They are generally found by prevalence surveys. For example, at a given time 170 of every 100,000 people (0.17 ) in a community might be suffering from shingles. The incidence and prevalence rates of shingles given in the above examples suggest that the average episode of this illness lasts approximately 1 month, as the prevalence is one-twelfth of the annual incidence. If a new treatment cut the duration of an episode of shingles in half, to 2 weeks, but did nothing to prevent shingles from...

Physical Examination

Differential Diagnosis Calculus cholecystitis, cholangitis, peptic ulcer, pancreatitis, appendicitis, gastroesophageal reflux disease, hepatitis, nephrolithiasis, pyelonephritis, hepatic metastases, gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome), pleurisy, pneumonia, angina, herpes zoster.

Plate 43 Hair Follicle And Nail

The cells that will develop into the shaft of the hair are seen just to the right of the expanded bulb. They constitute the cortex (C), medulla (M), and cuticle (asterisks) of the hair. The cells of the cortex become keratinized. This layer will come to constitute most of the hair shaft as a thick cylinder. The medulla forms the centrally located axis of the hair shaft it does not always extend through the entire length of the hair and is absent from some hairs. The cuticle consists of overlapping cells that ultimately lose their nuclei and become filled with keratin. The cuticle covers the hair shaft like a layer of overlapping shingles.

HAART Influence on skin and mucocutaneous diseases

Immunosuppressive therapies, such as ultraviolet light and cyclosporin, should be limited to a few conditions such as severe autoimmune diseases, and used only with careful clinical and laboratory monitoring. Photo(chemo)therapy is able to provoke viral infections such as herpes zoster and herpes simplex, epithelial tumors, and to

Asymptomatic Patients above 350 CD4 cellspl

It is now more widely recognized that only two studies have been able to show the advantage of beginning with HAART at these CD4 cell counts all others have not found any such advantage for the patient. Proponents of early initiation of therapy often cite a matched-pair analysis from Switzerland, which indicated a small, though statistically significant clinical benefit if HAART was started with CD4 cells above this level (Opravil 2002). 283 patients, who were started on HAART with a count above 350 CD4 cells l, were matched by age, sex, CD4 count, viral load and risk group for HIV infection with control patients who had been untreated for at least 12 months. At follow up around three years later, the AIDS risk was more than twice as high in the untreated group. However, besides considerable methodological problems due to the design of this study, one challenging question remains when looking more closely at the 52 CDC Category B illnesses (including 10 AIDS cases) which occurred...

Local Delivery In Rat Brain Tumor Models

A second generation replication-conditional herpes simplex virus type 1 (HSV) vector defective for both ribonucleotide reductase (RR) and the neurovirulence factor gamma 34.5 was developed and tested for therapeutic efficacy in rats bearing intracranial 9L tumors 24 . This modified viral vector was designated MGH-1. The modified viruses were injected intratumorally or intrathecally with or without administration of ganciclovir. There was no toxicity due to administration of the MGH-1 virus, however, there was a decreased therapeutic effect with the MGH-1 virus compared with the parental vector. To investigate the potential of the thymidine kinase gene from Varicella zoster virus (VZVtk) to act as a suicide gene, VZVtk was transferred via a dicistronic retroviral construct in 9L rat gliosarcoma cells 25, 26 . The 9L gliosarcoma cells infected with the VZVtk-carrying vector were implanted in vivo. When the tumor-bearing animals were treated with (E)-5-(2-bromovinyl)-2'-deoxyuridine...

What conditions are often missed

This question refers to the common 'pitfalls' so often encountered in general practice. This area is definitely related to the experience factor and includes rather simple non-life-threatening problems that can be so easily overlooked unless doctors are prepared to include them in their diagnostic framework. Classic examples include smoking or dental caries as a cause of abdominal pain allergies to a whole variety of unsuspected everyday contacts foreign bodies occupational or environmental hazards as a cause of headache, respiratory discomfort or malaise and faecal impaction as a cause of diarrhoea. We have all experienced the 'red face syndrome' from a urinary tract infection whether it is the cause of fever in a child, lumbar pain in a pregnant woman or malaise in an older person. The dermatomal pain pattern caused by herpes zoster prior to the eruption of the rash (or if only a few sparse vesicles erupt) is a real trap. Herpes zoster

Nonneoplastic Conditions

Viral infection may occur in the lungs due to respiratory viruses such as influenza or in the immunocompromised patient (cytomegalovirus, respiratory syncytial virus, Varicella zoster or Herpes simplex). Histological examination shows alveolar cell injury with a mononuclear cell interstitial infiltrate.

In Vivo Immune Effects Of Senescent T Cells

In addition to the role that putatively senescent CD8+ T cells may play in regulating functions of other immune cell types, these cells also show alterations in the normal functional attributes of CD8+ T cells. First, CD8+CD28 T cells isolated ex vivo are unable to proliferate (like their cell culture counterparts), even in response to signals that bypass cell surface receptors, such as PMA and ionomycin (Effros et al., 1996). This observation is consistent with extensive research on replicative senescence in a variety of cell types documenting the irreversible nature of the proliferative block, and its association with upregulation of cell cycle inhibitors and p53-linked checkpoints (Campisi, 2001). If the CD8+CD28 T cells present in elderly persons are virus-specific, their inability to undergo the requisite clonal expansion in response to antigen re-encounter will compromise the immune control over that particular virus. Indeed, as noted above, senescent HIV-specific CD8+ T cells...


Gabapentin is used in combination with other antiseizure (anticonvulsant) drugs to manage partial seizures with or without generalization in individuals over the age of 12. Gabapentin can also be used to treat partial seizures in children between the ages of three and 12. Off-label uses (legal uses not specifically approved by the United States Food and Drug Administration FDA ) include treatment of severe, chronic pain caused by nerve damage (such as occurs in shingles, diabetic neuropathy, multiple sclerosis, or post-herpetic neuralgia). Studies are also looking at using gabapentin to treat bipolar disorder (also known as manic-depressive disorder).


Herpes zoster, especially in the elderly patient with unilateral abdominal pain in the dermatomal distribution, is a trap. Referred pain from conditions above the diaphragm such as myocardial infarction, pulmonary embolism and pneumonia can be misleading. The rare general medical causes such as diabetes ketoacidosis, acute porphyria, Addison's disease, lead poisoning, tabes dorsalis, sickle cell disease, haemochromatosis and uraemia often create a diagnostic dilemma and should be kept in mind.


Toxic Epidermal Necrolysis

Both primary herpes simplex and erythema multiforme (EM) exhibit a sudden onset of disease. The lip lesions of primary herpetic gingivostomatitis may bear a resemblance to the crusted lip lesions of EM (Fig. 4). Exfoliative cytology may be useful to differentiate the two by demonstrating the characteristic viral cytopathic effect produced as the epitheliotropic herpes virus replicates within the keratinocytes. Viral culture may also be useful. Lesions of herpangina, caused by the Coxsackie virus, may clinically resemble oral herpes virus infections but typically affect the more posterior areas of the oral cavity. Oral mucosal involvement in herpes zoster may be difficult to distinguish from a zosteriform presentation of recurrent intraoral herpes simplex. Recurrent aphthous stomatitis can be readily differentiated from herpetic infections since it is neither preceded by vesicles nor accompanied by fever or gingivitis. Recurrent aphthous stomatitis generally involves the VARICELLA...

Pediatric Stroke

Chickenpox (varicella zoster) is associated with an angiopathy which can lead to stroke. Over time this angiopathy may resolve. Varicella infections have also been associated with an acquired antibody to protein S and this may also play a role in stroke formation. Another infectious cause of stroke is vascular inflammation from meningitis or encephalitis.

Topical Reactions

Another adult suffered garlic burns after applying a compress of crushed garlic wrapped in cotton to her chest and abdomen for 18 hours (102). The erythematous, blistering rash was in a dermatomal distribution on the right side of the patient's chest and upper abdomen, approximating the dermatomal distribution of thoracic segments 8 and 9. She reported that the pain had been present for 1 week and had a stabbing quality. She was initially diagnosed with Herpes zoster and was prescribed acyclovir before admitting to use of topical garlic after further questioning. Biopsy revealed full thickness necrosis, many pyknotic nuclei, and focal separation of the necrotic epidermis from the dermis. The burns healed with scarring. The patient refused patch testing, and specific IgE RAST testing to garlic was negative. The nonspecific appearance of garlic burns has been exploited. Three soldiers applied fresh ground garlic to their lower legs and antecubital fossa to produce an erythematous,...


Varicella and herpes zoster are different manifestations of the same virus. The primary infection produces chickenpox during childhood in the United States, although varicella is a disease of the reproductive years in subtropical and tropical climate countries. Chickenpox is a highly contagious disease and humans are the only reservoir. It is transmitted by droplets from vesicular fluid or secretions from the upper respiratory tract. There are approximately 1-7 cases per 10,000 pregnancies (Freij & Sever, 1997 Gilstrap, 1997 Paryani & Arvin, 1986 Preblud, Cochi, & Orenstein, 1986). The manifestations of congenital varicella include cortical atrophy and other neurological findings. Varivax, the live attenuated varicella vaccine, was approved in the United States in 1995 (Gibbs & Sweet, 1999).

Symptomatic Patients

However Herpes zoster (Stage B) may occur even with a slight immune defect and does not necessarily indicate immunological deterioration. Thrombocytopenia or constitutional symptoms may also have other causes. A further example tuberculosis, which is an AIDS-defining illness and therefore implies an urgent indication for therapy, is a facultative opportunistic infection. It may occur without or with only moderate immunodeficiency. In our experience, one is justified in waiting with HAART in a TB patient with good CD4 T cells. The British treatment guidelines (http www.bhiva.org) specifically mention pulmonary tuberculosis as being a possible exception in which treatment may be deferred. A relevant case study is outlined in Table 5.3.

St Johns wort

Historical note St John's wort (SJW) has been used medicinally since ancient Greektimes when, it is believed, Dioscorides and Hippocrates used it to rid the body of evil spirits. Since the time of the Swiss physician Paracelsus (c. 1493-1 541), it has been used to treat neuralgia, anxiety, neurosis and depression. Externally, it has also been used to treat wounds, bruises and shingles. The name 'St John's wort' is related to its yellow flowers, traditionally gathered for the feast of St John the Baptist and the term 'wort' is the old English word for plant. St John's wort has enjoyed its greatest popularity in Europe and comprises 25 of all antidepressant prescriptions in Germany (Schrader 2000). In the past few decades its popularity has also grown in countries such as Australia and the United States.

Persistent Infection

Infections or viral latency in the nervous system. In the former category are measles virus (SSPE), HIV, HTLV-1, papovavirus, and rubella virus encephalopathies. Herpes simplex, herpes zoster, EBV, certain retroviruses, and human herpes virus 6 (HHV-6) are examples of common viruses that persist in neural or other tissue, usually in a latent form. In these models, chronic low grade infection, periodic reactivation of latent virus, or seeding of the brain through a hematogenous route could cause direct injury to glial cells or neurons. Alternatively, the agent could initiate an autoimmune response secondary to release or alteration of previously sequestered self-antigens with epitope spread or through molecular mimicry (36,37). In addition, the infectious agent could prime macrophages and lymphocytes, so that subsequently non-encephalitogenic activated T- or B-cells could enter the CNS and release cytokines or antibodies causing demyelination by a bystander effect (37). Lastly, the...

Viral Infections

Orofacial herpes zoster infection usually follows the distribution of one of the three branches of the trigeminal nerve on one side of the face. It may also be disseminated. HIV infection has been associated with a 17-fold relative risk increase for zoster, which occurs at any CD4 count but becomes more severe as immunosuppression worsens (18) Involvement of the ophthalmic branch and the eye should be ruled out, and the patient presenting with suspicious lesions on the forehead or pinna should be referred for evaluation to an ophthalmologist, to rule out zoster ophthalmicus from involvement of the nasociliary branch of cranial nerve V (Fig. 15). Facial nerve involvement with facial palsy may occur (Ramsay-Hunt syndrome). Chronic forms and up to 20 recurrence rate have been reported. Treatment is most efficacious when started early. Oral acyclovir at high doses of up to 4 g in daily divided doses can be used (or alternatively, valacyclovir 1 g three times...


About one in eight patients with herpes zoster infection has at least one complication of this condition. Major complications include postherpetic neuralgia, uveitis, motor deficits, skin infection, and systemic involvement (with manifestations such as meningoencephalitis, pneumonia, deafness, or dissemination). Postherpetic neuralgia occurs most frequently in patients older than 50 years of age and can be prolonged and intractable despite early antiviral therapy. The pain is often excruciating and does not respond well to conventional methods of pain control. Granulomatous vasculitis has recently been added to the list of complications (25).


Management of non-herpes viral encephalitis is supportive, though herpes simplex virus and varicella-zoster encephalitis are treated with acyclovir, 30-60 mg kg day divided q 8 h, in addition to supportive measures. Acyclovir should be administered until the virus is identified, especially if there is evidence of focality on physical or neurodiagnostic evaluation. Antibiotics should also be given until a bacterial etiology is excluded. Medical management of rabies is prevention of infection by the administration of rabies vaccine and rabies immune globulin after an exposure to a potentially rabid animal. Once infection occurs, it is uniformly fatal. Arboviral infections can be prevented by using insect repellents and protective clothing to avoid mosquito bites. Treatment of infection is supportive.

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