From the Guidelines
Disseminated varicella-zoster virus (VZV) infection is diagnosed when a patient has evidence of widespread VZV beyond a single dermatome, typically with 20 or more vesicular lesions outside the primary or adjacent dermatomes, and is a medical emergency requiring prompt treatment with intravenous acyclovir. The diagnosis of disseminated VZV is based on the presence of widespread cutaneous lesions plus at least one of the following: involvement of visceral organs, laboratory confirmation of VZV in affected tissues or fluids, or positive VZV PCR from blood samples 1. Key points to consider in the diagnosis and management of disseminated VZV include:
- The presence of 20 or more vesicular lesions outside the primary or adjacent dermatomes is a key criterion for diagnosis
- Immunocompromised individuals, particularly those with cell-mediated immune deficiencies, transplant recipients, patients on immunosuppressive medications, and those with HIV/AIDS are at highest risk
- Treatment should be initiated promptly with intravenous acyclovir at 10-15 mg/kg every 8 hours for 7-10 days, with consideration for longer treatment in severe cases or those with CNS involvement 1
- Patients should be isolated with airborne and contact precautions until all lesions have crusted
- Disseminated VZV is a medical emergency with mortality rates of 5-15% even with treatment, so early recognition and aggressive management are essential to improve outcomes 1.
From the Research
Disseminated vZV Criteria
- Disseminated varicella-zoster virus (VZV) infection can occur in both immunocompromised and immunocompetent patients 2, 3
- The infection can cause severe mucosal ulcerations, leading to acute abdominal pain, even in the absence of dermatological manifestations 2
- Characteristic histomorphological findings from mucosal ulcerations can lead to the immediate initiation of antiviral therapy and specific molecular evaluation 2
- Disseminated VZV infection can involve multiple organs, including the gastrointestinal tract, pancreas, and liver 4, 3
- Clinical suspicion for disseminated HZ is crucial to facilitate timely diagnosis and initiation of antiviral therapy, especially in immunocompromised patients 4
- Antiviral agents, such as acyclovir, valacyclovir, famciclovir, brivudine, and foscarnet, can be used to treat disseminated VZV infection 5, 6
- Vaccination is the most effective strategy for prevention of herpes zoster and postherpetic neuralgia 6
- Disseminated VZV infection should be considered in patients with unexplained inflammatory lesions of the gastrointestinal tract or pancreas 3