From the Research
For a 10-year-old with shingles, recommended follow-up testing should include a complete blood count (CBC) with differential, comprehensive metabolic panel, and potentially HIV testing. These tests are important because shingles (herpes zoster) in children this young is unusual and may indicate an underlying immune system problem. The CBC will evaluate for abnormalities in white blood cell counts that might suggest immunodeficiency, while the metabolic panel assesses overall health and organ function. HIV testing is particularly important as shingles in children can be an early manifestation of HIV infection 1. Additionally, if the child has severe or disseminated shingles, consider testing for other immunodeficiency conditions such as leukemia or lymphoma. Some key points to consider in the management and follow-up of a child with shingles include:
- The potential for postherpetic neuralgia, a complication that can significantly affect quality of life, although the risk may be lower in children compared to adults 2, 3.
- The importance of monitoring for other complications such as involvement of the eyes, which may require more urgent and specialized care.
- The role of antiviral therapy in reducing the severity and duration of shingles, as well as the potential for preventing postherpetic neuralgia, although specific guidelines may vary depending on the patient's age and immune status 1. Follow-up should occur within 1-2 weeks after initial diagnosis to review test results and ensure the shingles lesions are healing properly. If the child is experiencing complications like postherpetic neuralgia or has involvement of the eyes or other concerning areas, more specialized testing and earlier follow-up may be needed. The underlying concern is that while shingles typically affects older adults, its appearance in a young child often signals that further investigation of immune function is warranted. Recent guidelines, such as those published in 2020, provide a comprehensive approach to the diagnosis and treatment of herpes zoster and postherpetic neuralgia, emphasizing the importance of a multidisciplinary approach to care 1.