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Resumen
El herpes zoster (HZ) se manifiesta clínicamente como consecuencia de una reactivación de la primoinfección por el virus varicela-zoster. Los pacientes asocian clínicamente la presencia de dolor neurítico agudo, junto con lesiones vesiculosas cutáneas con una distribución dermatómica. Recientemente han aparecido nuevos fármacos antivirales que permiten tratar de forma eficaz el HZ, evitando muchas de las complicaciones secundarias a la infección que pueden aparecer. También, el uso racional y precoz de estos fármacos puede disminuir la virulencia de la neuralgia postherpética en muchos de los casos. Así, es necesario establecer unas pautas claras y definidas de la actuación en cada caso. En concreto, debemos conocer de forma especial qué pautas de actuación debemos tener en pacientes con HZ que están incluidos en grupos de riesgo para presentar una evolución clínica más atípica o grave, como es la que suele ocurrir en pacientes inmunodeprimidos (trasplantados, infección por el virus de la inmunodeficiencia humana o sida, pacientes sometidos a quimioterapia), o también en grupos especiales, como son las mujeres embarazadas o pacientes en edad infantil. Además, junto al tratamiento antiviral, tenemos que instaurar esquemas terapéuticos de analgesia, capaces de controlar el dolor en cada caso, bien en forma aguda, bien en forma de neuralgia postherpética.
Palabras clave:
Virus de la varicela-zoster
Fármacos antivirales
Herpes zoster
Abstract
Herpes zoster (HZ) is a clinical manifestation of the reactivation of latent varicella zoster virus infection. Patients may have acute neuritic pain, together with cutaneous vesicular lesions in a dermatomal distribution. Recently, new antiviral drugs have been highly useful in the treatment of patients with HZ, avoiding many of the secondary complications that can appear after this herpetic infection. In addition, the rational and early use of these antiviral drugs may reduce the virulence of postherpetic neuralgia in a substantial proportion of patients. Consequently, guidelines for the management and treatment of patients with HZ should be established. Specifically, guidelines should be established for certain patient groups at risk for an atypical or severe clinical course, such as immunosuppressed patients (those with solid organ transplants, HIV infection or AIDS, or patients under immunosuppressive treatment) or pregnant and pediatric patients. In addition, antiviral treatment must be administered with analgesic drugs to control neuritic pain in all patients with HZ, whether in the acute phase or in the form of postherpetic neuralgia.
Keywords:
Varicella zoster virus
Antiviral drugs
Herpes zoster
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