Talk:Herpes zoster

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Good article Herpes zoster has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do. If it no longer meets these criteria, you can delist it, or ask for a reassessment.
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[edit] reassessment

This page is undergoing a Good article reassessment. Snowman (talk) 10:37, 29 December 2007 (UTC)

Why does the milestones template at the top of this talk page indicate the result of the GAR is "keep"? --Una Smith (talk) 18:43, 9 January 2008 (UTC)

It was removed from GAR assessment temporarily until the FAR was completed, which was later the same day. There is some text preserved about this somewhere. I think that it would be better to record this as postponed rather than kept. Snowman (talk) 22:31, 9 January 2008 (UTC)
The previous GAR result was "keep", for procedural reasons. The current GAR will be listed as a new article history action once it is complete Geometry guy 17:39, 12 January 2008 (UTC)
Now added. The result was "delist". Geometry guy 19:24, 18 January 2008 (UTC)

[edit] Nerve cell bodies

My issue with "nerve cell bodies", apart from the vague terminology, is that it is irrelevant to Herpes zoster. Latent HZ has been shown to be integrated into the host cell DNA, in the cell nucleus. The location of the nucleus in the host cell does not matter and is at best a tangent. By the way, to me "nerve cell bodies" implies that the viral genome is latent not in the nucleus but rather outside the nucleus, in a restricted portion of the cytoplasm. That would be highly bizarre. Why not refer to "nerve cell nuclei" or "nerve cell DNA"? --Una Smith (talk) 06:23, 13 January 2008 (UTC)

Can you quote a reference for the HZV genome being incorporated in the host DNA? Preferably a reference on the web, because that would solve some of the problems here. Snowman (talk) 12:23, 13 January 2008 (UTC)
It sure would: nerve cell DNA is something that an educated general reader can understand. Geometry guy 18:03, 13 January 2008 (UTC)
I should not write late at night. VZV is a dsDNA virus, not a retrovirus. Make it "nerve cell nucleus" and you're home free. A ganglion is a node in a nerve. WP does not explain it well. Here is some text, with inline comments and a ref. --Una Smith (talk) 18:42, 13 January 2008 (UTC)

Some VZV genes are transcribed during latency; this transcription requires VZV DNA to be in a cellular compartment that has the machinery needed for transcription. Human nerve cells (neurons) have two kinds of compartment with this machinery: many mitochondria and a single cell nucleus. In situ hybridization detects VZV DNA only in the nucleus.[1]

I think that this is getting down to the much-needed minute details needed to make the article easier to understand. I think that some of the references currently quoted on the article page do not refer to this in detail, so I was reluctant to write down what was not in a reference, especially as the article is under a microscope at the present time. To me, your suggestions sound good. Snowman (talk) 20:07, 13 January 2008 (UTC)

[edit] GA review

GA review (see here for criteria)
  1. It is reasonably well written.
    a (prose):
    In the lead "the mechanism is not understood", would be clearer to say "exactly how the virus persists is not understood." if this is the meaning you intended.
    Comment Actually it's both how it persists and what causes it to suddenly reappear that is not understood. I'll rewrite OrangeMarlin Talk• Contributions 19:51, 23 March 2008 (UTC)
    The sentence "The nerve cell bodies of dorsal root, cranial nerve or autonomic ganglion may contain the latent virus" seems to repeat what the first sentence in that paragraph says.
    Fixed. I hope! OrangeMarlin Talk• Contributions 16:55, 24 March 2008 (UTC)
    Need to explain what "person-years" are, probably better to put it in words. "1.2 to 3.4 per 1,000 person-years" = in a group of 1,000 healthy people, about 1 to 3 cases appear every year.
    Fixed. OrangeMarlin Talk• Contributions 16:57, 24 March 2008 (UTC)
    "sensitivity to stimuli" - what stimuli? Too general to be clear.
    Comment. Well, just about any stimuli, heat, cold, light, touch. I'm not sure it would be useful to list out everything, but it is almost everything. OrangeMarlin Talk• Contributions 19:52, 23 March 2008 (UTC)
    Further information. I checked the reference, and matched it exactly. it refers to hyperesthesia and paresthesia, both of which sound very general, but it sounds more medical now!!! Anyways, I know that wasn't your intent, but I think it really is a general pain that is sensitive to heat, cold, light or touch. OrangeMarlin Talk• Contributions 17:03, 24 March 2008 (UTC)
    ''"pain may be extreme in the affected nerve below" - Unclear, "the pain may be extreme in the affected nerve below the rash"?
    It is actually the dermatome, which I believe is described in the lead. So, I think it's now clear.OrangeMarlin Talk• Contributions 22:12, 27 March 2008 (UTC)
    "100% rate of consistent prevalence" - unclear, does this mean the prevalence doesn't change from generation to generation?
    I'm thinking we should delete the sentence. I did a google search, and that sentence is used in a lot of articles and online epidemiology courses. And when I read them, it gives no definition. To me, it reads like a bunch of random words, and it makes no sense to me. A virologist or microbiologist will have to define it for us. OrangeMarlin Talk• Contributions 22:30, 27 March 2008 (UTC)
  2. It is factually accurate and verifiable.
    a (references): - All external links check OK with LinkChecker
    b (citations to reliable sources) - Well-referenced to reliable sources
    c (OR) - None
  3. It is broad in its coverage.
    a (major aspects): Yes, good overall coverage.
  4. It follows the neutral point of view policy.
    Fair representation without bias: - Yes, although data from the USA is over-represented in the section on epidemiology
  5. It is stable.
    No edit wars etc.: - None
  6. It is illustrated by images, where possible and appropriate.
    a (images are tagged and non-free images have fair use rationales): - No non-free images used
    b (appropriate use with suitable captions): - EM image of virus needs to give approximate magnification in caption.
  7. Overall:
    Pass/Fail: Pass
    Tim Vickers (talk) 18:44, 23 March 2008 (UTC)

I'm finished editing the text, and am putting this on hold until the last few questions are sorted and the image caption dealt with. Tim Vickers (talk) 03:39, 26 March 2008 (UTC)

Pass, good work everybody! Tim Vickers (talk) 04:53, 28 March 2008 (UTC)
Does anyone in the US call it plain zoster? I've never heard that here in Oz..Cheers, Casliber (talk · contribs) 04:06, 26 March 2008 (UTC)
Some people do, but I would say 90% of physicians and "victims" call it shingles. OrangeMarlin Talk• Contributions 05:47, 26 March 2008 (UTC)
The image looks like it might have initially been pulled from CDC's Image Library, ID#1878 (Electron micrograph of a Varicella (Chickenpox) Virus.), but still does not specify magnification level. Erskine Palmer on pubmed central turns up Complement-Fixing Antigens of Herpes Simplex Virus Types 1 and 2... which gives a similar but not identical image. Found the image credit based on http://www.nih.gov/news/research_matters/october2006/10272006shingles.htm, but still no magnification level. -Optigan13 (talk) 06:13, 26 March 2008 (UTC)
Another link (much higher res image), still no luck on mag level - Link -Optigan13 (talk) 06:30, 26 March 2008 (UTC)

[edit] Immunization

In Canada, varicella immunization is given at 12 months of age as part of the routine immunization schedule.

Here's some references... http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-01-eng.php

http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-vari-eng.php

Would it be reasonable to add a short paragraph about this in the prevention section?

Pdrowemd (talk) 19:32, 26 March 2008 (UTC)

Please don't take this wrong, but Canada is kind of small, and it would make it unwieldy to add information for every country in the world. Moreover, I'm not sure what the varicella immunization has to do with Herpes zoster. I would suggest it could be in Varicella zoster article. OrangeMarlin Talk• Contributions 22:59, 26 March 2008 (UTC)
No problem. There is wide discussion about the effect of Varicella immunization on the incidence of Shingles. There is an idea that wide implementation of Varicella vaccination may lead to increased episodes of Shingles due to less subclinical exposure to the virus as adults. Probably best in the Varicella section though. Pdrowemd (talk) 00:26, 27 March 2008 (UTC)
I meant to say something slightly different. I meant to say, "varicella immunization of infants", because it wouldn't prevent shingles, except indirectly by preventing chickenpox. After helping write this article, I pulled a vial of varivax out of stock and immunized myself, since I had chickenpox as a kid. OrangeMarlin Talk• Contributions 01:13, 27 March 2008 (UTC)

[edit] Immunocompromised

I am struggling with the second line in the second introductory paragraph referring to an immunocompromised individual. Shingles can occur in otherwise healthy individuals with decreased disease specific cell-mediated immunity, and the onset of shingles would not trigger a search for occult immunosuppression such as with occult cancer. Perhaps we can add the phrase "or in an individual with a decrease in cell-mediated immunity".Pdrowemd (talk) 15:48, 27 March 2008 (UTC)

I think the sources state immunocompromised meaning anything from stress to AIDS. The problem with "cell mediated immunity" is that we're trying to write this for a college student, and that needs explanation. OrangeMarlin Talk• Contributions 21:40, 27 March 2008 (UTC)
True enough, although "cellular immunity" is commented on in the last section as well. My problem is with the term immunocompromised and how a layperson would interpret the term, although this may be better solved by editing that wiki-entry. I'll have a closer look at that entry.Pdrowemd (talk) 22:44, 27 March 2008 (UTC)

[edit] Diagnosis with PCR

Has anyone been able to confirm the numbers within the referenced article for the last paragraph in this section? I have been unable to confirm the stated 100% sensitivity and specificity. Also, the PPV and NPV seem more confusing than helpful to me, especially when we don't know the prevalence in the study.Pdrowemd (talk) 18:33, 27 March 2008 (UTC)

I'm not sure where that paragraph came from. I'm not sure intense language about the clinical trials for a diagnostic test has much value to the article, especially since visual determination during a differential diagnosis is about all that is used today, and it's pretty successful. I'd delete it. OrangeMarlin Talk• Contributions 21:43, 27 March 2008 (UTC)
Just a note that I agree with the edit that Animeita suggested for removing those two sentences. I still can't confirm their accuracy, and I think they are needlessly confusing. Maybe you could resubmit with an edit summary.Sisyphus (talk) 18:00, 28 March 2008 (UTC)

[edit] Playing with the lead

The first and second paras duplicated content somehwat so I am trying torejig it a bit. It is tricky considering what the scope of the article is...Cheers, Casliber (talk · contribs) 23:40, 27 March 2008 (UTC)

Adjusted your changes slightly. I like your semi-solon comment.Pdrowemd (talk) 00:53, 28 March 2008 (UTC)

PS: 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 - would be better to be more specific here as the general idea of it being considered less benign as time goes on is conveyed in the previous few sentences. Cheers, Casliber (talk · contribs) 23:43, 27 March 2008 (UTC)

I thought we had topic banned you from any article that didn't have to do with fungi. Last time I checked zoster is not a fungus. I'm going to ArbCom.  :) Oh, we should be serious here. Thanks. OrangeMarlin Talk• Contributions 00:06, 28 March 2008 (UTC)

[edit] Epidemiology and Chickenpox

The second paragraph of the epidemiology section seems for appropriate for Chickenpox than Zoster, except for the first sentence. I would suggest it be deleted. Thoughts? Sisyphus (talk) 19:10, 28 March 2008 (UTC)

The first two sentences of that paragraph need to be removed, so I would partially agree with you. The problem is we have three overlapping articles: chickenpox, varicella zoster virus, and herpes zoster. There's a small conversation going on at Wikiproject Medicine about separating the disease from the virus. Maybe chickenpox and herpes zoster (or shingles) needs to be merged. OrangeMarlin Talk• Contributions 19:58, 28 March 2008 (UTC)
The more I think about it, the more I like the idea of merging these two topics. One's a natural extension of the other. By the way, I'm rapidly discovering the need to keep my language precise in the world of Wiki :) Sisyphus (talk) 05:26, 29 March 2008 (UTC)

(I've moved further comment on merging to the Wikipedia talk:WikiProject Medicine#Viruses and diseases discussion to keep things in one place. Colin°Talk 08:59, 29 March 2008 (UTC))

[edit] Article cluster

For the record, the current article cluster relating to varicella zoster virus is:

Discussions of this cluster include:

--Una Smith (talk) 20:30, 29 March 2008 (UTC)

[edit] Chickenpox causality

The article currently says Herpes zoster occurs only in people who have had chickenpox, which to me implies it does not occur in people who have had the vaccine. Chickenpox is a clinical diagnosis of infection, not infection per se. I suggest instead Herpes zoster occurs only in people who have been previously infected with VZV followed directly by an explanation of whether this includes or excludes people who have been vaccinated. --Una Smith (talk) 14:43, 30 March 2008 (UTC)

I agree that this needs to be changed. However, I don't believe it is known whether vaccination for varicella decreases your chances for developing shingles. The CDC and the manufacturer are quite careful not to make that claim. It is possible that patients immunized with Varicella vaccine could still develop Zoster. I wonder if the phrase should be Herpes Zoster occurs only in people who have been previously infected with VZV. This is typically individuals with clinical varicella (chickenpox), but may included individuals vaccinated with Varicella vaccine.Sisyphus (talk) 18:44, 30 March 2008 (UTC)

[edit] Zoster

Re the question above, does anyone in US say "zoster", yes. Google searching shows the term used more often when blisters are not present (ie, zoster sine herpete), and esp involving the eye or ear. --Una Smith (talk) 14:52, 30 March 2008 (UTC)

From personal experience in Canada, Zoster and Shingles are used interchangeably.Sisyphus (talk) 18:45, 30 March 2008 (UTC)