11/06/2023
VARICELLA ZOSTER VIRUS (VZV) INFECTION (RAMSAY HUNT SYNDROME)
The mechanism of disease is reactivation of the latent VZV virus in the geniculate ganglion.
CF:
The onset of palsy is usually preceded by pain which may persist and be excruciating.
In a small proportion of patients, the facial palsy is accompanied by labyrinthine symptoms including tinnitus, vertigo and a sensorineural hearing loss.
Diagnosis
is clinical but may be confirmed by rising titres of antibodies to VZV.
PCR to detect VZV in ear exudates is more sensitive than VZV PCR performed on tears or blood mononuclear cells and may be positive before the development of vesicles.
Regarding management,
. Most advocate a combination of steroids and antiviral agents, but for a longer period of time, 2–3 weeks.
The recommended regime is prednisone 1 mg/kg/day for 5 days followed by a 10-day taper, as well as intravenous acyclovir (250 mg three times daily), or oral acyclovir (800 mg five times daily). The combination of steroids and acyclovir are seems to reduce otalgia, vertigo and post-herpetic neuralgia.
The prognosis for Ramsay Hunt is worse than idiopathic facial palsy. Persistent weakness is observed in 30–50% of patients and only 10% recover completely after complete loss of function without treatment.
Photo credit: Asst prof Dr Mushfiqur Rahman sir