Som J Lakhani

Abstract

Herpes zoster is a viral infection characterised by unilateral grouped vesicular eruption caused by varicella zoster virus. It occurs because of reactivation of the latent virus in the sensory root ganglion. This article aims to study the incidence, clinical profile, precipitating factors, type of dermatomal involvement and clinical variations of herpes zoster along with its association with HIV infection. The study was done at VS Hospital, Ahmedabad and total of 120 patients (72 male and 48 females) were included in the study. All patients (of all ages) diagnosed clinically as herpes zoster and confirmed by Tzanck smear were included in the study. Data related to demographic profile, clinical profile and complications of herpes zoster was collected and analysed. All patients were also screened for HIV and other comorbidities. Most patients presented with vesicular lesions and the most common prodrome was burning sensation. Thoracic ganglion was most commonly involved. The most frequent complications were post herpetic neuralgia and dyspigmentation. Nineteen of our patients had multidermatomal involvement. Twenty of 120 patients (16.6%) of herpes zoster were HIV positive. Twelve of 120 patients were below 12 years of age. The chances of post herpetic neuralgia increased when treatment was initiated late. This study helped analyse the varied clinical presentations and complications of herpes zoster. Herpes zoster serves as an important early marker for HIV infection. Interesting change in trend was noticed in the demography of herpes zoster and its relatively high incidence in the paediatric age group

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Abstract

Preamble: Skin and soft tissue infections (SSTI) are an important cause of sepsis. Acute skin failure may result from many dermatological conditions. In this study we tried to highlight the role of skin failure as a component of multiple organ dysfunctions. Materials and Methods: All adult patients (>18 years) diagnosed clinically as sepsis due to skin and soft tissue infections were included. Risk assessment was done using various parameters. Identification of pathogens and their antibiotic sensitivity pattern was performed by blood and skin swab cultures. Results: A total of 55 patients (31 male and 24 female) were included in the study. The common causes of SSTI were surgical site infections, cellulites, necrotisingfasciitis, traumatic open wounds, Toxic epidermal necrolysis, acute generalized exanthematous pustulosis, burns, bed-sores, unknown wounds and others. The major risk factors identified were the percentage of skin involvement, depth of wounds, presence of unhealthy granulation tissue and co morbidities like diabetes and immunodeficiency. MRSA and ESBL producing gram negative bacteria were important causative microbes for SSTI induced sepsis. Conclusion: SSTI is one of the important causes of sepsis. Early recognition and management of risk factors can prevent adverse outcome. Knowing microbiological etiology and drug sensitivity pattern is important is connection with SSTI related sepsis. Septic shock was identified as most important organ failure on admission leading to death in patients having SSTI related sepsis. Keywords: Skin and Soft tissue infections (SSTI), Multiple organ dysfunction syndrome, Risk factors, SCORTEN.

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