About Shingles
Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.
Shingles is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.
The name shingles comes from the Latin word cingulum, which means "belt" or "girdle." The scientific name for the virus that causes shingles is varicella-zoster, combining the Latin word for "little pox" with the Greek word for "girdle." Another name for shingles is herpes zoster.
The virus that causes shingles is a herpes virus. Once you are infected with this kind of virus, it remains in your body for life. It stays inactive until a period when your immunity is down.
If you have had chickenpox, shingles is not contagious. Nothing will happen to you if you are exposed to someone who has shingles. If you have never had chickenpox, however, avoid contact with anyone who has shingles; the fluid from their open blisters is infectious. You will not get shingles, but you could get chickenpox if exposed.
If you have not had chickenpox and you come into contact with someone who has shingles, ask your doctor whether you should get a chickenpox vaccination.
Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended.
The pain of shingles can be debilitating. If it is severe and persists for months or years, it is called postherpetic neuralgia. And unfortunately, persistent pain is a common symptom in people over 60.
Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.
Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome and necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.
The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression.
In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.
If you are basically healthy, shingles usually resolves without complications. You are not likely to ever get it again!
More importantly, the new shingles vaccine may one day make shingles a rare disease.
Quiz
1. Shingles is a rare disease.
FALSE is the correct answer. At present, a person has a 50 percent chance of coming down with shingles by the time he or she is 80 years old. For a long time, shingles was a very frustrating disease because there was no effective treatment for it.
2. Shingles is sometimes called herpes zoster.
TRUE is the correct answer. Shingles is caused by a herpes virus, which is a kind of virus that stays in your body forever. "Zoster" is a Greek word that means "girdle," which is what shingles often looks like around one side of your waist.
3. You can get shingles from somebody who has shingles.
FALSE is the correct answer. A person who has shingles cannot transmit shingles to someone else. But if you have never had chickenpox, you can get chickenpox from contact with someone who has shingles. The virus is transmitted through contact with the actual blister fluid.
4. Vision problems can be a complication of shingles.
TRUE is the correct answer. When the rash is on the face, the cornea of the eye can be affected. It can cause permanent vision impairment or even blindness.
Causes and Risk Factors
Shingles is caused by a germ called varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores healed and the other symptoms went away, but the virus remained. It is with you for life.
The virus hides out in nerve cells, usually in the spine. But it can reactivate. Somehow, the virus gets a signal that your immunity has become weakened. This triggers the reactivation.
In the reactivation, the virus follows a nerve path called a dermatome. The nerve path begins at specific points in the spine, continues around one side of the body, and surfaces at the nerve endings in the skin. The pattern of the rash reflects the location of that nerve path.
The leading risk factor for shingles is a history of having had chickenpox. One out of every five people who have had chickenpox is likely to get shingles.
Another risk factor is aging. As we age, our natural immunity gradually loses its ability to protect against infection. The shingles virus can take advantage of this and reactivate.
Conditions that weaken immunity can also put people at risk for shingles. Shingles is especially dangerous for anyone who has had cancer, radiation treatments for cancer, HIV infection, or a transplant operation.
Most cases of shingles occur in adults. Only about 5 percent of cases occur in children. With children, immune deficiency is the primary risk factor, but children who had chickenpox before they were one year old may also get shingles before they become adults.
There have been studies of adults who had chickenpox as children and were later exposed to children who had chickenpox. Interestingly, that exposure apparently boosted the adult's immunity, which actually helped them avoid getting shingles later in life.
Stress is another factor that may contribute to outbreaks. While stress alone does not cause the outbreaks, shingles often occurs in people who have recently had a stressful event in their lives.
Quiz
1. What kind of germ, or microbe, causes shingles?
A. bacteria
B. virus
C. fungus
B is the correct answer. Shingles is caused by a virus. People often use the word germ to describe the many bacteria, viruses, and fungal organisms that surround us. They are a normal part of our environment, but some can make you sick. Viruses, for instance, can cause diseases such as colds, flu, hepatitis, and shingles.
2. Where does the virus hide out while it is inactive?
A. in the lungs
B. circulating in the blood
C. in the nerve cells
C is the correct answer. As you recover from the chickenpox, your immune system drives the virus to retreat to the nerve cells along the spine. The virus remains there for the rest of your life.
3. Who is most at risk for getting shingles?
A. children
B. elderly people who have had chickenpox
C. young adults who have had measles
B is the correct answer. Anyone who has had chickenpox can get shingles, but it is most common in people over 60.
4. What is one of the questions doctors might ask if they suspect a patient has shingles?
A. Have you had chickenpox?
B. How old were you when you had the measles?
C. Has anyone near you had the flu recently?
A is the correct answer. Shingles is caused by a reactivation of the chickenpox virus, so if a patient does not recall having had chickenpox, a shingles diagnosis is less likely.
