American Board of Internal Medicine (ABIM) Certification Practice Exam

In which situations are airborne and contact precautions indicated for zoster infections?

1. Localized zoster infection only

2. Disseminated zoster infection or immunocompromised patients

3. Both localized and disseminated zoster infections

4. Only in the presence of respiratory symptoms

The correct answer is: Disseminated zoster infection or immunocompromised patients

Airborne and contact precautions are specifically indicated for cases of disseminated zoster infection, particularly in immunocompromised patients. Disseminated zoster, also known as shingles, occurs when the varicella-zoster virus reactivates and spreads beyond the dermatomes associated with the initial infection. In such cases, the risk of transmission increases, particularly to those who are immunocompromised, as their ability to fight off infections is significantly weakened. Airborne precautions are essential because the varicella-zoster virus can be transmitted through respiratory droplets, and contact precautions help prevent direct transmission from lesions that may cause secondary infections. In immunocompromised individuals, even localized zoster can lead to more severe illness and complications, warranting more stringent precautions to protect both patients and healthcare workers. Localized zoster infections do not usually require the same level of precautions since they are typically confined to a specific area of the skin and pose a lower risk of spreading through airborne transmission. Therefore, the comprehensive precaution measures in cases of disseminated zoster aim to safeguard those most vulnerable to severe infection and complications.