Shingles: A Case Study
Ryan Goode
Research in Allied Health
ABSTRACT
Herpes zoster, colloquially known as shingles, is the reactivation of varicella zoster virus (VZV, primary infection of which leads to chickenpox), one of the Herpesviridae group, leading to a crop of painful blisters over the area of a dermatome (Wikipedia). Shingles has adverse affects on the people infected with this uncomfortable disease. This disease usually plagues the elderly and immunocompromised as they grow older and weaker. It’s very rare to hear of a young healthy person stricken with this disease. I am doing a case study on an atypical patient. He is basically a healthy, 22 year old Caucasian male that has been stricken by this disease. Although his symptoms and pain were subtle, he was still not the average shingles patient by any means. The review of the literature makes strong points towards shingles symptoms and signs and the disease in children, also. I will conclude that although this patient is atypical when it comes to shingles, anyone that has had chicken pox is at risk.
INTRO
Shingles, or Herpes Zoster, is a reactivation of the varicella zoster virus which is the same virus that causes chicken pox is children. Shingles appear on the body as red, hive-like clusters that usually cause very intense pain and an overall feeling of being unwell.
Flu-like symptoms minus the fever, itching, tingling, and extreme pain at the site of the rash are the most common signs of the virus. A person with shingles can transmit the virus to others who have not had the chicken pox. A person is not considered contagious before the rash blisters and when post-herpetic neuralgia sets in.Shingles are mainly seen in the elderly and those who are immunocompromised.
However, it is not uncommon to see shingles in young people as well. Most research to date shows that the shingles virus is reactivated due to a weak immune system, or the virus is signifying the onset of an underlying, undiscovered disease. There is currently no cure for the Shingles virus, but there are anti-virals that can be taken within the first few days of signs to reduce the effects of the virus.
This case study involves an otherwise healthy individual who was diagnosed with the shingles. He is a 22-year old male who acutely developed the rash and had no known history of ever being diagnosed with anything that may label him as immunocompromised.
After medical testing, he also has no underlying diseases (i.e. AIDS, cancer) that may have triggered his sudden onset of shingles. His final diagnosis was shingles, brought on by stress.
LITERATURE REVIEW
The researcher has noted that the patient is not a typical shingles patient. The patient, as stated earlier, is an otherwise healthy twenty-two year old caucasian male who has had no medical history of any kind that would label him as immunocompromised. This atypical patient had undoubtedly the signs and symptoms shingles. The patient’s original symptoms were a sharp wave of pain in his back area before the rash of blisters was visible. The area was also itching, as noted by the researcher, very similarly to a bug bite. This statement is confirmed Zamula (2001) stating that “pain may come first, but when the migrating virus finally reaches the skin-usually the second to the fifth day after the first symptoms-the rash tells all.” I took note that he had two big splotches; one on the left side of his back and one just above his left breast which were puss-filled blisters. This corresponds with the Zamula (2001) stating that; “the rash usually begins as clusters of small bumps that soon develop into fluid-filled blisters (vesicles). In turn, the blisters fill with pus (pustules), break open, and form crusty scabs.” The patient claimed his pain as being mild to the doctor as noted by the researcher. There was never a time when he was “doubled-over” in pain. He basically had the occasional mild shooting pain in his back, but he mainly just felt ill. What mostly makes this patient atypical from a regular shingles patient is that he had minor swelling and discomfort of the lymph nodes under his arms. This led the doctor to believe there may have been some type of immunodeficiency as noted by the researcher. I, too, was curious to see if the patient had some type of underlying disease that may have triggered the shingles outbreak.
Once the lab results had returned, the researcher noted that it was confirmed the patient had shingles, and he did not have any underlying diseases such as cancer, AIDS, or anything else to label him as immocompromised. I was a bit curious as to why, or even how, this young man came down with such a dreaded disease? The patient had complained about extreme stress levels, basically to the point of depression. This “psychological stress has also been linked to the occurrence of herpes zoster, but the mechanism involved has not been investigated” as stated by Irwin M, Costlow C, Williams H, Artin KH, Chan CY, Stinson DL, Levin MJ, Hayward AR, Oxman MN (1998).
The patient was prescribed Acyclovir in the amount of 800 mg/5 times daily. The patient took all of his prescribed medication and his shingles have not returned since, nor has he had any post-herpetic neuralgia. Feder & Hoss (2004) stated that “[herpes] zoster in children is frequently mild, post-zoster neuralgia rarely if ever occurs, and antiviral therapy is usually not needed. In a previously normal child with zoster, if the history and physical examination are normal, a laboratory search for occult immunodeficiency or malignancy is not needed.” These statements proved true to the doctors and the researcher, but additional precautions such as the antivirals and underlying disease testing had to be done due to the fact the patient is no longer a child.
METHODS
I obtained all of my study participants from the Johnson City mall. I was looking for an age group of people that could participate in my study ranging from teenage to early twenty’s. Before I gathered my participants I had my study and instruments reviewed and checked by the university IRB. All conditions to protect the participants’ confidentiality based upon HIPPA guidelines were observed as noted in the ETSU IRB webpage, and this study was approved by the ETSU VA IRB. My study did not include any invasive tactics or procedures. Upon review of my methods and Scales of Measurement, the university IRB found my study to be simple and straightforward without the possibility of endangering my participants in anyway. I replicated another study I found in my review of the literature with the most significant difference being the age group between the two studies. The original study surveyed the effects of psychologic stress on shingles patients. Psychologic stress has also been linked to the occurrence of herpes zoster, but the mechanism involved has not been investigated. The study I replicated examined the relationship between major depression and VZV-specific cellular immunity by comparing VZV-specific responder cell frequency (RCF) in adults with major depression (n = 11) to that in age- and sex-matched nondepressed controls (n = 11) and in a larger group of nondepressed adults who were > or = 60 years old. VZV-specific RCF in depressed patients was markedly reduced compared with the RCF in matched controls (t = 2.7, P < .02). In fact, the levels of VZV-specific RCF in the depressed patients were comparable in magnitude to the low levels found in adults > or = 60 years of age. These data indicate that major depression is associated with a marked decline in VZV-specific cellular immunity. Reverting back to my Scale of Measurements, I opted to use the Nonparametric Nominal to see the difference between my one independent variable via the Pearson’s Chi-Square test. I wanted to compare 30 otherwise healthy females and 30 otherwise other males to 30 depressed females and 30 depressed males. I would then ask my participants if they had ever had Herpes Zoster or Shingles before. The basis of this test is to see if the results match the population. It is uncommon for young people in the age range I am studying to develop shingles, but if there were any participants who had had shingles before, it would be very interesting to find out if their lone cause for developing the disease would be due to depression.
DISCUSSION
There will continue to be many atypical patients of diseases in general. In my research, I found that an atypical shingles patient wasn’t that atypical at all. There are actually more cases than I originally expected. My family doctor even said that his infant had shingles. Although it is rare for young people to develop this disease, it can happen. Hopefully, further research will lead to a cure instead of just a vaccine.\
REFERENCES
Zamula, Evelyn. Shingles: An Unwelcome Encore. FDA consumer magazine, May-June 2001 issue.
http://www.fda.gov/FDAC/features/2001/301_pox.html
Rothberg, M.B., Virapongse, A., Smith, K.J. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. 2007 May 15;44(10):1280-8. Epub 2007 Apr 3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17443464&query_hl=2&itool=pubmed_docsum
Irwin, M., Costlow C., Williams, H., Artin K.H., Chan, C.Y., Stinson, D.L., Levin, M.J., Hayward, A.R., Oxman, M.N. Cellular immunity to varicella-zoster virus in patients with major depression. 1998 Nov;178 Suppl 1:S104-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=9852986&query_hl=18&itool=pubmed_docsum
Feder, H.M. Jr., Hoss, D.M. Herpes zoster in otherwise healthy children. The Pediatric Infectious Disease Journal. 2004 May;23(5):451-7; quiz 458-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15131470&dopt=Abstract
Herpes zoster. (2007, April 24). In Wikipedia, The Free Encyclopedia. Retrieved 20:22, April 24, 2007, from http://en.wikipedia.org/w/index.php?title=Herpes_zoster&oldid=125570072