City doctors tell you what could have caused it and all that you need to know about the viral infectionTelevision actor Sanjit Bedi, who was known for his role as Dr Omi in the long running television serial, Sanjivani, passed away in Marine Lines' Bombay Hospital on Tuesday. It was reported that the actor, who was in his late thirties, was suffering from shingles. Even though Bedi's was an extreme case, city doctors consider the viral infection a common concern. Shingles can occur anywhere on your body and it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso, according to medical practitioners. In fact, the manner in which this stripe wraps itself around patients has earned it the name nagin (snake) in India.Infectious disease consultant Dr Om Shrivastav, who sees nearly 10 cases of shingles a month in his private practice, calls it the “nastier cousin of chickenpox."Shingles, medically termed as herpes zoster, is caused by the herpes viridae family; the same infectious agent that causes chickenpox. In fact, like chickenpox, adds Dr Shrivastav, the period of maximal infectivity occurs before the vesicle is formed -that's when you'll be coughing and running a fever.Dermatologist Dr Sushil Tahiliani explains, “After you've had chickenpox, the virus lies dormant in the nerve tissue near your spinal and cranial nerves (each of 12 pairs of nerves which arise directly from the brain, and pass through separate apertures in the skull). Years later, the virus may reactivate as shingles only amongst 15 per cent of the patients."Although what causes the dormant virus to reactivate is unclear, neurologist Dr Nirmal Surya points out, “If your body is recuperating from an illness, or has poor immunity because of stress, malnutrition and erratic sleeping patterns, the virus may reappear as shingles.“Dr Shrivastav adds, “When your immunity is poor, most of the infections bypass the T cell (a type of white blood cell that plays a central role in cell-mediated immunity) and hit the organs, which in turn causes the body more stress."It is a self-limiting condition, which heals by itself in two to three weeks in an immuno competent person. However, in an immuno compromised person, it can develop in a severe form, involve multiple nerves with cluster of lesions suffering hemorrhage and ulcers going deeper and can cause necrosis (damage to the tissue) and enter the blood stream, which can reach multiple organs, and may sometimes lead to death. Delay in treatment too can affect the brain. The patient can develop encephalitis, a serious condition causing inflammation of the brain, and may go into coma or suffer a stroke. “In fact, I had a patient whose infection had traveled to the spinal cord and he suffered paralysis of both legs," says Dr Surya.Pain is usually the first symptom of shingles. The pain can be constant, dull or experienced as a burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender. The other signs of the virus that usually affects only a small section of one side of the body, include, “pain, burning, numbness or tingling, sensitivity to touch, a red rash that begins a few days after the pain, fluid-filled blisters that break open and crust over and severe itching,“ says Dr Surya. Some people also experience fever, sensitivity to light and fatigue.“Once it heals, the pain can linger and can be quite severe for a variable period," says Dr Surya. If the pain you experience is too much to bear, your doctor may prescribe stronger painkillers or special drugs.Depending on the location of the pain, it can sometimes even be mistaken for a symptom of problems affecting the heart, lungs or kidneys.Some people experience shingles pain without ever developing the rash. Dr Surya adds that post-herpetic neuralgia is a severe complication of shingles and occurs two to three weeks, mostly among the elderly patients, after the rashes have dried.It is advisable to visit your doctor immediately if you suspect the beginning of an outbreak. You may be prescribed antiviral drugs in the early stages to shorten the course of the infection. If the pain and rash occurs near the eye and is left untreated, it can lead to permanent cornea damage. The affected area becomes secondarily infected with bacteria (indicated by spreading redness, swelling, high fever, and pus.) Dr Tahiliani adds, “Those above 60, who have never suffered from chickenpox, can even opt for a vaccine."