Primary infection – chicken pox (lesion at varying stage on the trunk, face, and extremities)
Reactivation – shingles (painful, unilateral rash in a restricted dermatome)

Clinical manifestations – 1) Rash – most common location is thoracic and lumbar dermatomes
2) Acute neuritis – 75% of patients have pain/burning/throbbing prior to onset of rash

Complications in immunocompetent hosts – post-herpetic neuralgia (7.9%), ocular complications (1.6%),, meningitis (0.5%), oticus (0.2%)

Disseminated if > 3 contiguous dermatomes or 2 dermatomes on separate parts of the body

Diagnosis for encephalitis/meningitis – elevated WBC with lymphocytic predominance, elevated protein, positive VZV PCR or IgM

Treatment: IV acyclovir

Vaccines: Age > 60 give live vaccine unless immunosuppressed
VZIG – give to exposed pregnant or immunosuppressed patients