Shingles

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Progression of shingles. A cluster of small bumps (1) turns into blisters (2). The blisters fill with lymph, break open (3), crust over (4), and finally disappear. Postherpetic neuralgia can sometimes occur due to nerve damage (5). Source: By Renee Gordon – fda.gov; Public Domain, Wikipedia Commons

 

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Peter Krukenberg (1787-1865)

By Unknown – Public Domain: Wikipedia Commons

 

 

Varicella-Zoster Virus (VZV) also called Shingles, has a long recorded history. However, historical accounts often fail to distinguish between the poc marks caused by VZV and those caused by small pox. It was only in the late eighteenth century that William Heberden Senior, established a way to clinically differentiate between the two diseases.

 

Peter Krukenberg (14 February 1787 – 13 December 1865) was a German pathologist who was a native of Konigslutter. He was son-in-law to anatomist Johann Christian Reil (1759-1813), and grandfather to pathologist Friedrich Ernst Krukenberg (1871-1946) and surgeon Hermann Krukenberg (1863-1935). Krukenberg studied at the Collegium Carolinum in Braunschweig and at the Universities of Gottingen and Berlin. In 1814 he became an associate professor of pathology and therapy at the University of Halle, and from 1822 to 1856 was a full professor of pathology and director of the university clinic. In 1816 Krukenberg founded an ambulatory clinic at Halle. One of his better known assistants was dermatologist Friedrich Wilhelm Felix von Barensprung (1822-1864). It was this assistant, Barensprung, who in 1861 published a paper confirming that the disease, shingles, arose from the dorsal root ganglion. Studying and working with Krukenberg was a great advantage for Barensprung, because the senior physician was a pioneer of scientific knowledge-based medicine and was considered one of the leading clinicians of his era.

 

Friedrich Wilhelm Felix von Barensprung, (30 March 1822 – 26 August 1864) was a German dermatologist born in Berlin. His father, Friedrich von Barensprung (1779-1841), was mayor of Berlin in 1832-34. In 1843 he obtained his doctorate at Halle an der Saale, then furthered his studies in pathology at Prague, where he was also involved with entomological research. In 1845 he became a clinical assistant to Peter Krukenberg (1788-1865) at Halle, and several years later, founded a private clinic in Halle (1850). In 1853 he was appointed chief physician at the Syphilisklinik at the Berlin Charite, and in 1857 became an associate professor at the University of Berlin. Barensprung is credited as being the first physician to demonstrate a definite link between herpes zoster and a lesion of the dorsal root ganglion. Subsequently, he identified nine varieties of the disorder, of which he classified according to the nerve involved. In 1854, he provided the first description of tinea cruris, a fungal condition that is sometimes referred to as “Barensprung’s disease“ in medical literature. Barensprung was in favor of housing projects for the impoverished, and also advocated the creation of day nurseries and children’s homes. These measures, he reasoned, were an effective means to stop the spread of epidemics such as tuberculosis and scrofulosis (tuberculosis of the lymph nodes, particularly of the neck). Among his written works was Atlas der Hautkrankheiten, an atlas on skin diseases that was edited and published posthumously by Ferdinand von Hebra (1867). In the field of entomology, he was instrumental in the founding of the journal, Berliner Entomologische Zeitschrift, in which he published papers on Hemiptera (a large order of insects that have mouthparts adapted to piercing and sucking and usually two pairs of wings, undergo an incomplete metamorphosis. Examples include cicadas, aphids, planthoppers, leafhoppers, and shield bugs.

 

In 1888, it was suggested by Dr. James von Bokay that chicken pox and shingles were caused by the same virus. Physicians began to report that cases of shingles were often followed by chickenpox in the younger people who lived with the person with shingles. The idea of an association between the two diseases gained strength when it was shown that lymph from a person with shingles could induce chickenpox in young volunteers. However, it was not until 1953 that Weller and Stoddard isolated virus both from chickenpox and zoster and compared the viruses, that this connection was confirmed: chickenpox and herpes zoster were indeed due to the same virus! This was finally proved by the first isolation of the virus in cell cultures, by the Nobel laureate Thomas Huckle Weller, in 1953.

 

Until the 1940s the disease was considered benign, and serious complications were thought to be very rare. However, by 1942, it was recognized that shingles was a more serious disease in adults than in children, and that it increased in frequency with advancing age. Further studies during the 1950s on immunosuppressed individuals showed that the disease was not as benign as once thought, and the search for various therapeutic and preventive measures began. By the mid-1960s, several studies identified the gradual reduction in cellular immunity in old age, observing that in a cohort of 1,000 people who lived to the age of 85, approximately 500 (i.e., 50%) would have at least one attack of shingles, and 10 (i.e., 1%) would have at least two attacks. In historical shingles studies, shingles incidence generally increased with age. However, in his 1965 paper, Dr. Hope-Simpson suggested that the “peculiar age distribution of zoster may in part reflect the frequency with which the different age groups encounter cases of varicella and because of the ensuing boost to their antibody protection have their attacks of zoster postponed“. Lending support to this hypothesis that contact with children with chickenpox boosts adult cell-mediated immunity to help postpone or suppress shingles, a study by Thomas et al. reported that adults in households with children had lower rates of shingles than households without children.

 

Varicella-Zoster Virus

Shingles (herpes zoster) Animation – Michael Freudiger PhD

 

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