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      Case Report: When Shingles Disrupts Bladder Function

      case-report
      ,
      Iberoamerican Journal of Medicine
      Hospital San Pedro
      Varicella zoster virus, Shingles, Urinary dysfunction

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          Abstract

          Abstract Varicella Zoster (shingles) virus is a double stranded DNA in the Herpesviridae family that can present as both chicken pox and as shingles. The virus enters through the respiratory system, replicating in the nasopharynx, and causes a viremia upon primary infection. Varicella Zoster spreads to other organs and often lies dormant in the dorsal root ganglion. Reactivation of the virus is more common in older or immunocompromised patients and often presents as a painful vesicular rash in a unilateral dermatomal distribution with possible concurrent radiculopathy. A rare complication of herpes zoster is urinary dysfunction. We report a case of a 42-year-old patient diagnosed with herpes zoster whose primary complaint was left buttock pain and a maculovesicular rash in the S2-S4 dermatomal distribution. She was prescribed Valacyclovir and began to experience urinary retention two days after starting the medication.

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          Most cited references13

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          Herpes zoster infection

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            Urinary tract infection in the neurogenic bladder

            There is a high incidence of urinary tract infection (UTI) in patients with neurogenic lower urinary tract function. This results in significant morbidity and health care utilization. Multiple well-established risk factors unique to a neurogenic bladder (NB) exist while others require ongoing investigation. It is important for care providers to have a good understanding of the different structural, physiological, immunological and catheter-related risk factors so that they may be modified when possible. Diagnosis remains complicated. Appropriate specimen collection is of paramount importance and a UTI cannot be diagnosed based on urinalysis or clinical presentation alone. A culture result with a bacterial concentration of ≥103 CFU/mL in combination with symptoms represents an acceptable definition for UTI diagnosis in NB patients. Cystoscopy, ultrasound and urodynamics should be utilized for the evaluation of recurrent infections in NB patients. An acute, symptomatic UTI should be treated with antibiotics for 5–14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient-based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Asymptomatic bacteriuria (AB) should not be treated because of rising resistance patterns and lack of clinical efficacy. The most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible. The use of hydrophilic or impregnated catheters is not recommended. Intravesical Botox, bacterial interference and sacral neuromodulation show significant promise for the prevention of UTIs in higher risk NB patients and future, multi-center, randomized controlled trials are required.
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              Shingrix for Herpes Zoster: A Review

              Herpes zoster (HZ), also known as shingles, results from reactivation of the latent varicella-zoster virus (VZV), which commonly causes chickenpox in childhood. Greater than 90% of adults are infected with this virus, putting them at risk for reactivation. HZ presents as a painful, vesicular rash distributed in a unilateral and dermatomal pattern along dorsal root or cranial nerve ganglia. The rash often presents with prodromal symptoms and progresses to include clear vesicular clusters, evolving through stages of pustulation, ulceration, and crusting. HZ therapy currently involves the use of antiviral agents and pain management; however, HZ prophylaxis has been strongly recommended in older adults through vaccination with a live attenuated vaccine, Zostavax®. A new recombinant subunit vaccine, HZ/su (Shingrix®), is the subject of this review. In clinical trials, HZ/su demonstrated an overall vaccine efficacy of 97.2% among participants 50 years of age or older, indicating a significantly reduced risk of HZ in these individuals. Shingrix® was approved by the US FDA in October 2017 as HZ prophylaxis.
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2021
                : 3
                : 1
                : 95-97
                Affiliations
                [4] NY orgnameTouro College of Osteopathic Medicine New York Estados Unidos de América
                [1] NJ orgnameSaint Barnabas Medical Center Livingston Estados Unidos de América
                [2] NY orgnameTouro College of Osteopathic Medicine New York Estados Unidos de América
                [3] NJ orgnameSaint Barnabas Medical Center Livingston Estados Unidos de América
                Article
                S2695-50752021000100014 S2695-5075(21)00300100014
                10.5281/zenodo.4382235
                55401e33-64c2-49ff-9858-5dc9ece88871

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 11 December 2020
                : 21 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 3
                Product

                SciELO Spain

                Categories
                Case Report

                Varicella zoster virus,Shingles,Urinary dysfunction
                Varicella zoster virus, Shingles, Urinary dysfunction

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