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Varizellen und Herpes zoster

Teil 1: Virologie, Epidemiologie, Klinik, Labordiagnostik

Varicella and Herpes Zoster. Part 1: Virology, Epidemiology, Clinical Picture, Laboratory Diagnostics

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Zusammenfassung

Das Varicella-Zoster-Virus (VZV) gehört zu den acht bisher bekannten Herpesviren des Menschen, zeigt ein ubiquitäres Vorkommen und verursacht die akute exanthematöse Kinderkrankheit „Windpocken“. Typisch ist der hohe Kontagiositätsindex. Die Hauptübertragung erfolgt über Aerosole, seltener über direkten Kontakt mit Bläschenflüssigkeit. Eine Eigenschaft aller Herpesviren ist ihre Latenz. Nach der Primärinfektion wandert das Virus retrograd mit dem Zytoplasmastrom der Neurone zum Spinalganglion. Das Virusgenom verbleibt dort latent, weitgehend inaktiv im Kern der Spinalganglienzelle. Reaktivierungen sind bei allen latent Infizierten möglich. Gewöhnlich werden Reaktivierungen im höheren Alter (> 50 Jahre) sowie bei Abfall der Gedächtniszellen für die T-Lymphozyten beobachtet. Gerade bei älteren Menschen und Risikogruppen (Immunsupprimierte) werden im Zusammenhang mit Reaktivierungen schwere Krankheitsverläufe beschrieben. Eine häufig auftretende und schwer behandelbare Komplikation stellt die postzosterische Neuralgie (PZN) dar, ein neuropathischer Schmerz, der definitionsgemäß > 6 Wochen nach dem akuten Infekt persistiert und eine adäquate antivirale Therapie und Schmerzbehandlung erfordert.

Abstract

Varicella-zoster virus (VZV), known as one of the eight human herpesviridae, shows a ubiquitous distribution and is the cause for acute exanthema in childhood (chickenpox). VZV is highly infectious, spread by respiratory droplets and direct contact with fluid in vesicles. As a characteristic of the α-herpesviridae, VZV establishes latency in the nucleus of the paraspinal cells. Reactivation of VZV (zoster) is possible in all infected persons, but becomes more common with increasing age and a decline of VZV-specific cell-mediated immunity. Immunocompromised patients and older people (> 50 years) have an increased risk for a severe course of disease. The postherpetic neuralgia (PHN), as one of the most common and feared complications, is defined as a neuropathic pain (burning character), which persists for > 6 weeks after onset of disease and needs adequate antiviral and pain treatment.

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Authors and Affiliations

  1. Institut für Medizinische Virologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany

    Miriam Wittek, Hans Wilhelm Doerr &  Regina Allwinn

  2. Institut für Medizinische Virologie, Universitätsklinikum Frankfurt am Main, Paul-Ehrlich-Straße 40, 60596, Frankfurt/Main, Germany

    Regina Allwinn

Authors
  1. Miriam Wittek
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  2. Hans Wilhelm Doerr
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  3. Regina Allwinn
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Correspondence to Regina Allwinn.

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Teil 2 dieses Beitrags erscheint in Heft 6/2010.

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Wittek, M., Doerr, H.W. & Allwinn, R. Varizellen und Herpes zoster. Med Klin 105, 334–338 (2010). https://doi.org/10.1007/s00063-010-1061-3

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