Shingles are the second disease after a chickenpox virus infection. A shingle usually occurs decades after infection with the virus.
In Today’s Article, We Will Discuss “What Are The Symptoms Of Internal Shingles Without Rash?”
Table Of Contents
- What Are Shingles
- Shingles Infection
- Are Shingles Contagious
- Risk Factors
- Symptoms Of Shingles
- Shingles Complications
- Shingles Diagnosis
- Shingles Treatment
- Prevent a Shingles
Shingles Without Rash – In Summary
Shingles without rash are characterized by a belt-shaped, reddening and blistering skin rash that can cause severe pain and impact almost any area of the body. It is a reactivation in the shape of remaining chickenpox viruses. The bubble content is contagious. Shingles occur primarily in a defensive weakness and old age.
In particular, in people under 50 years should, therefore, be looking for the reasons for an outbreak. To prevent permanent nerve pain, a so-called postzosteric neuralgia or other complications arise, early treatment is essential. These include drugs that inhibit the virus multiplication and painkillers available.
What Are Shingles And What Are The Causes?
Shingles is a half-sided, belt-like, very painful rash. The cause of shingles (herpes zoster) is an infection with the chickenpox virus (varicella-zoster virus). This virus goes to the family of herpes viruses and can trigger two different clinical pictures.
First, chickenpox (varicella) can develop, a disease that most people have already experienced as children before the introduction of the chickenpox vaccine. However, when the chickenpox rash has disappeared, it is not yet the virus: Like other herpes viruses, it survives throughout life in the human organism and nestles in the cranial nerves and the nerve roots of the spinal cord (spinal and cranial nerve ganglia).
Under certain circumstances for example, with increasing age and weakened immune defense, the viruses begin to multiply again, migrating the nerve along the outside of the skin. In the supply area the nerve, in which the viruses had retreated, shingles occurs. It can affect all parts of the body, the face and even organs like the eyes or the brain.
Chickenpox is very contagious and spread quickly. The viruses are transmitted by droplet infection. It means that the droplets excreted during breathing or coughing are infectious. Also, the pathogen can get carried through contact with virus-containing vesicles or crusts (smear infection).
Are Shingles Contagious?
Yes, even patients with shingles can transmit the virus via a smear infection, also though they are by far not as contagious as, for example, a child suffering from the chickenpox.
Risk Factors For Reactivation
The virus will only become active again under certain circumstances. It is the case in particular with a temporary or disease-related immune deficiency as well as with older age, which likewise leads to a decrease of the defense functions of the immune system.
Also, traumas, stress, UV radiation, and debilitating defensive drugs can promote the occurrence of shingles. Occasionally, herpes zoster also occurs spontaneously in young, healthy people.
Symptoms Of Shingles
Shingles have localized symptoms. While the entire body is affected by chicken pox, the symptoms of shingles develop unilaterally only in the area. the skin that is being supplied by the affected cranial or spinal cord nerve. The first signs of the disease are usually fatigue, possibly mild fever and burning pain in the corresponding skin area. Sometimes itching can be added.
A few days after the attack of pain, one side of a circumscribed area, the skin will develop typical skin conditions: redness, blisters on the reddened ground, which may be clustered in groups and sometimes in the form of rosettes, some of which may be blood-filled.
After a few days, the blisters burst and crust, sometimes leaving behind scars and discolored or discolored areas of the skin (pigmentation or depigmentation). The full resolution of the symptoms can last up to a month for shingles.
Although the varicella-zoster virus mainly affects the nerves of the thoracic and lumbar spine and in older people often the nerves of the face, other regions than the arms, legs, chest, abdomen, back and head can be affected by shingles, In rare cases, severe forms of the disease occur.
It happens in particular when the cranial nerves are involved and, for example, herpes zoster of the eye (zoster ophthalmicus with eye involvement) or of the ear (zoster oticus) develops. If the cornea or the iris of the eye or especially the optic nerve is affected, it can lead to permanently blurred vision to blindness.
Shingles around the ear often cause facial paralysis (facial palsy). Such disease of the facial muscles sometimes develops even in a herpes zoster infection in the neck.
In severe immunodeficiency, shingles can also spread to the entire skin and internal organs (disseminated zoster) and cause life-threatening complications. In sporadic cases, an inflammation of the meninges and the brain develops (meningitis and encephalitis).
In children, a shingle is generally harmless and without complications and almost always completely heals. In adults, the disease can cause severe pain from acute neuritis, which in some cases can become chronic and persist even months and years after the onset of shingles (orthosteric neuralgia).
The risk of developing postzosteric neuralgia is unusually high in the case of shingles in the head area and increases with age.
The drugs that inhibit the proliferation of varicella-zoster virus work particularly well if given early. Therefore, should not hesitate for suspected shingles, but immediately a doctor – ideally a specialist in skin diseases – be sought. He can usually already diagnose the shingles employing a survey of the patient (anamnesis) and the typical symptoms.
In unclear cases, laboratory tests are needed to detect the varicella-zoster virus safely. Using a laboratory method such as the direct immunofluorescence test or by the so-called PCR – polymerase chain reaction – can detect the virus or even tiny amounts of the genome of the pathogen in bladder fluid or nerve water (cerebrospinal fluid).
If you suspect the involvement of the eye or the ear, it makes sense to additionally visit a specialist (ophthalmologist or eye specialist) so that possible complications such as hearing or vision problems can prevent.
It is also important to clarify what has led to the onset of the disease. If there are no apparent reasons, it may be worthwhile looking for conditions that do not initially produce symptoms of their own but still cause a deficiency in the immune system, such as cancer or infection with the human immunodeficiency virus (HIV).
Exclusion of HIV infection should occur in patients with herpes zoster younger than fifty years.
With painkillers and drying and antiseptic solutions for application to the affected parts of the body, the symptoms of shingles can be alleviated. Besides, almost always first drugs that inhibit the multiplication of the virus must be administered in tablet form or as an infusion via the vein.
These so-called antivirals, for example with the active ingredients aciclovir, famciclovir, valaciclovir or brivudine, provide for faster healing of the blisters and can reduce the risk of post-zoster neuralgia (see section Symptoms).
Treatment with these drugs should begin within two to three days of the onset of the first symptoms if possible. Patients younger than fifty years old and with only very slight symptoms of shingles, for example in the chest area, may also be able to do without antiviral therapy.
In older patients with zoster in the head area (zoster ophthalmicus with eye involvement and zoster oticus), an antiviral treatment via the vein should always be preferred, since such severe pain can be relieved quickly and complications prevented.
Especially noteworthy is the early and sufficient pain therapy, in order not to develop a postzosterische neuralgia (see section symptoms and complications) not at all. However, it has come to the fact that persistent nerve pain as a result of shingles occurs, active ingredients such as pregabalin, gabapentin, carbamazepine, desipramine or amitriptyline, which are not painkillers in the real sense, but in the group of antiepileptic drugs or antidepressants.
It does not mean that people who take these remedies are epileptic or depressed. It has found that postzosteric neuralgia is relatively easy to prevent and treat with these medicines.
Prevent A Shingles
Most people become infected with varicella-zoster viruses in their earliest childhood. The pathogens then remain throughout the life of the body.
Even after a chickenpox vaccination can lead to shingles, but this happens much less often than without immunization. Also, the disease is usually less severe in vaccinated persons. Therefore, since 2004, the Standing Vaccination Commission (STIKO) at the Robert Koch Institute recommends vaccination against chickenpox for all children.
In the US (FDA) in 2017 CDC recommends shingles vaccines are now available ( Shingrix ) for persons over the age of 50 years and older get two does (two to six months apart). This vaccination is carried out with the aim of suppressing a new outbreak of the varicella-zoster virus and thus the disease shingles.
In addition to the already approved a few years ago live attenuated vaccine, which is administered once under the skin, there is another vaccine since spring 2018, which injected in two doses in the muscle.
The efficacy of this new vaccine is more than 90 percent in all age groups, according to clinical patient studies. It is a dead vaccine, a so-called recombinant subunit vaccine. In contrast to the live vaccine, it can also be used to vaccinate patients with a weakened immune system.
The permanent vaccination committee of the medical profession (STIKO) has argued in the summer of 2018 that vaccination with this new vaccine after weighing the individual benefit-risk ratio may be useful. Consult your doctor if you are over 50 years old.
This article contains only general information and should not be used for self-diagnosis or treatment. If any problem, please talk to your doctor.