Prognosis
The prognosis for shingles is good in immunocompromised patients. Two thirds of the diseases heal without consequences. A therapeutic problem, however, is the long lasting postzosteric neuralgia (nerve pain).
It occurs in about one tenth of patients and can last from months to years. In immunocompromised persons, however, the course of shingles is severe and the prognosis poor. Fatal forms of shingles and complications can occur.
Early or timely antiviral therapy significantly improves the prognosis. In principle, shingles caused by the herpes zoster virus is not fatal. In the majority of patients, the disease takes a normal course and is cured after about 2 weeks.
In rare cases, however, life-threatening situations can occur due to serious complications during the course of the disease or secondary diseases. This is especially the case in patients who have already previously shown a pronounced immune deficiency. Besides congenital weaknesses of the immune system, this can be caused by AIDS or leukemia, for example.
In these patients a generalized blistering of the entire body occurs. Under certain circumstances the virus can spread to internal organs or the entire nervous system and cause serious complications. In such a case one speaks of herpes generalisatus, which can be fatal if not treated.However, this pronounced clinical picture is rare and only occurs in people with pre-existing immune disorders.
Therefore, a clarification must be made at the onset. In addition, there is an increased risk of secondary infection with bacteria due to the open skin areas in the affected area. For these reasons, patients with a pronounced immunodeficiency and existing shingles should be checked often during the course of the disease in order to exclude possible complications.
After the chickenpox or chickenpox symptoms have subsided, the virus remains in the body. If there is a severe weakening of the immune system, e.g. due to enormous stress or illness, the virus may reappear. Shingles usually heals after about 2-3 weeks.
This applies at least to otherwise healthy people. If the patient is severely immunocompromised, shingles can last longer. If there are known previous illnesses that weaken the immune system, it is essential to consult your doctor in order to avoid prolonging the healing phase of shingles unnecessarily.
Since the pathogens causing shingles are already present in the body of the affected person and only need to be reactivated, the exact incubation period (time between infection and the onset of the disease) of shingles is difficult to determine. Many years can pass between the initial infection, which manifests itself in the form of chickenpox, and reactivation of the viruses, which is why most patients only develop shingles at an advanced age. If reactivation occurs, the typical symptoms, such as rash and blistering, develop completely within the next five days.
Since shingles can only break out if there has already been an infection with the varicella zoster virus, vaccination against chickenpox is a suitable prophylaxis. This vaccination is one of the standard vaccinations for children and young people. Women of child-bearing age should always be vaccinated, as a possible infection during pregnancy can damage the child.
No vaccination should be given during pregnancy. Vaccination against shingles should also not be carried out on immunocompromised persons, as there is a risk of so-called “vaccination varicella”, i.e. an outbreak of the disease (chickenpox) due to the vaccination. Transmission usually takes place via body fluids, which is why shingles is counted among the so-called smear infections.
For this reason, it can be said that shingles is contagious as long as wound fluid leaks from the blood blisters and there is an open infection of the skin. It should also be noted that shingles must always have been preceded by chickenpox. Years often pass between these two diseases, but they are caused by the same pathogen.
If a patient with existing shingles infects another person who has never had chickenpox, the latter will first get the chickenpox and not develop shingles. In patients who have already had chickenpox, infection with the herpes zoster virus increases the risk of reactivating the viruses still present in the body and developing shingles. So one should be very careful not to have direct contact with the blister fluid, as it can be potentially contagious. Furthermore, one should pay attention to adequate hand hygiene.
