the photo below is taken from the skin of a human patient with shingles, Explain

Question

the photo below is taken from the skin of a human patient with shingles, Explain the pathophysiological mechanism by which this occurs in the skin. The answer should be based around neuroscience not virology. You need to explain briefly and clearly: (a) What are major symptoms and the cause of Shingles? (1 mark) (b) What is a dermatome? (1 mark) (c) Why is a dermatome relevant to Shingles? (1 mark) (d) What are dorsal root ganglia (DRG)? (1 mark) (e) Do DRG neurons receive synaptic inputs from other neurons, and if so, what types of inputs are they? (1 mark) (f) Regarding the pain sensation underlying shingles, where does this sensory information enter the spinal cord? (1 mark) (g) What major types of nerve fibres make up the ventral thoracic nerve roots? (1 mark) (h) What would it mean if a patient with Shingles had skin lesions over many body regions compared with a patient who had lesions only over a small part of the body (e.g. as is shown in the image)? (1 mark) (i) What is postherpetic neuralgia? (1 mark) (j) What types of nerve fibres transmit inflammatory (slow pain) from skin? (1 mark)

Explanation / Answer

Shingles is a painful skin rash caused by the reactivation of varicella zoster virus that causes chicken pox. Its symptoms include pain, irritation, fever and nausea. A Dermatome is an area of skin supplied by nerves from a single spinal root. The virus that causes shingles inflames the spinal nerve along a specific skin Dermatome. These could be the dorsal root ganglia which is a cluster of neurons in the dorsal root of spinal nerve. Dorsal root ganglion receives afferent input from other synaptic nerves. Shingles affected people experience pain at the lumbar region of spinal cord. The ventral thoracic nerve roots are made by unmyelinated nerve fibres. Shingles usually don't spread. If there are rashes in multiple parts it implies that many dermatones are affected by different viruses. Postherpetic neuralgia is a complicated version of shingles that affects nerve fibres and skin causing burning pain that lasts long after the rash of shingles disappears. C-nerve fibres transmit inflammatory pain from skin.

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