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Symptom Management:

Symptom Management

Side Effects of Treatment
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Herpes and Varicella

Symptom and Description Herpes and varicella are viruses that often cause infections in patients who are getting treatment for cancer. Herpes appears as fever blisters and varicella is seen as chicken pox or shingles.

Most of us have been exposed to these viruses at some time in our lives. When our immune systems are normal, the viruses are simply ‘‘in our system’’ and do not cause any problems. During treatment for leukemia or lymphoma and bone marrow transplants or other organ transplants, the normal functions of the immune system are damaged. During this time, the viruses can become active (‘‘reactivated’’) and can cause fever blisters, shingles, or more serious problems such as lung infections.

Often, these viruses will become active in the patient without any symptoms that can be seen. They may cause fever, a flulike symptom, or pain and redness at the site(s) where they are starting. Herpes occurs around the mouth or the genitals. Shingles appears along a nerve track and so seems to be following a line on the skin. Tear-shaped blisters may form at the sites of redness. If blisters occur, they will dry and become crusty within 10 days after the start of treatment.

Learning Needs Your doctor will tell you if you are likely to have an infection with a herpes or varicella virus. You should inform your doctor or nurse if any of these occur:

  • Temperature greater than 38.5° C or 101.3° F
  • Pain or redness of the skin or mucous membranes of the mouth or genitalia or in a line anywhere on the body
  • You are around anyone who has fever blisters, chicken pox, or shingles
  • You are around anyone who has been exposed to someone with the active virus

Prevention If you have ever had fever blisters, shingles, or chicken pox, please inform your health care team. Also, you may have blood samples taken at the start of your treatment to see if you have been exposed to these viruses in the past.

Herpes and varicella are catching during the first stages, until the blisters become crusty. Since your immune system is not working well, the most likely way the virus spreads to you is from visitors or members of the health care team. You should avoid:

  • Anyone with a cold sore, chicken pox, or shingles
  • Children who have not had chicken pox and are in day care or grade school. They can often be exposed to the virus without knowing it.

Management The diagnosis of herpes or varicella is made by what the blister looks like and by taking a test or ‘‘culture.’’ The goals of treatment are to relieve symptoms and to control the growth of the virus. Acyclovir is the medicine used most often for treatment. Acyclovir can be given as a pill or through the vein, or put on the blisters as a cream. It is important to take the medicine just the way the doctor has written the prescription.

Follow-up As the immune function improves, the infection slowly heals. At this time, it is said to be ‘‘dormant’’ or at rest and should no longer cause any problems.

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