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Gross GE, Eisert L, Doerr HW, Fickenscher H, Knuf M, Maier P, Maschke M, Müller R, Pleyer U, Schäfer M, Sunderkötter C, Werner RN, Wutzler P, Nast A. [S2k guideline for the diagnosis and therapy of zoster and post-zoster neuralgia]. GMS INFECTIOUS DISEASES 2020; 8:Doc01. [PMID: 32373426 PMCID: PMC7187398 DOI: 10.3205/id000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diese Leitlinie richtet sich an Dermatologen, Ophthalmologen, HNO-Ärzte, Pädiater, Neurologen, Virologen sowie Infektiologen, Anästhesisten und Allgemeinmediziner in Klinik und Praxis und dient zur Information für andere medizinische Fachrichtungen, die an der Behandlung des Zoster beteiligt sind. Darüber hinaus soll die Leitlinie Kostenträgern und politischen Entscheidungsträgern zur Orientierung dienen. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen, Virologen/Infektiologen, Ophthalmologen, HNO-Ärzten, Neurologen, Pädiatern und Anästhesisten/Schmerzmedizinern erstellt. Die Leitlinie stellt einen Überblick über die klinische und molekulare Diagnostik sowie den Antigennachweis, die Antikörperkultur und Viruskultur dar. Diagnostisch besondere Situationen und komplizierte Verläufe der Erkrankung finden ebenfalls Berücksichtigung. Die antivirale Therapie des Zoster und der Postzosterneuralgie wird im Allgemeinen und für besondere Situationen dargelegt. Detaillierte Angaben zur Schmerzbehandlung finden Erwähnung und sind in einer Übersicht dargestellt. Ebenso werden die lokaltherapeutischen Maßnahmen thematisiert.
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Affiliation(s)
- Gerd E. Gross
- Universitätsmedizin Rostock, Universitätsklinik für Dermatologie und Venerologie, Rostock, Deutschland
| | - Lisa Eisert
- Vivantes Klinikum Neukölln, Klinik für Dermatologie und Venerologie, Berlin, Deutschland
| | - Hans Wilhelm Doerr
- Universitätsklinikum Frankfurt, Institut für Medizinische Virologie, Frankfurt (Main), Deutschland
| | - Helmut Fickenscher
- Christian-Albrechts-Universität zu Kiel und Universitätsklinikum Schleswig-Holstein, Institut für Infektionsmedizin, Kiel, Deutschland
| | - Markus Knuf
- Helios Dr. Horst Schmidt Kliniken Wiesbaden, Kinder- und Jugendklinik, Wiesbaden, Deutschland
| | - Philip Maier
- Universitätsklinikum Freiburg, Klinik für Augenheilkunde, Freiburg, Deutschland
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie, Neurophysiologie und neurologische Frührehabilitation, Trier, Deutschland
| | - Rainer Müller
- Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Dresden, Deutschland
| | - Uwe Pleyer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augenklinik, Berlin, Deutschland
| | - Michael Schäfer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Deutschland
| | - Cord Sunderkötter
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Halle (Saale), Deutschland
| | - Ricardo N. Werner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland
| | - Peter Wutzler
- Universitätsklinikum Friedrich-Schiller-Universität Jena, Virologie, Jena, Deutschland
| | - Alexander Nast
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland,*To whom correspondence should be addressed: Alexander Nast, Charité – Universitätsmedizin Berlin Department of Dermatology, Venereology und Allergy Division of Evidence-based Medicine (dEBM), Charitéplatz 1, 10117 Berlin, Deutschland, Tel.: +49(0)30-450618313, Fax: +49(0)30-4507518977, E-mail:
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Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-Operacz M, Agius AM, Bata-Csörgő Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment. J Eur Acad Dermatol Venereol 2016; 31:20-29. [PMID: 27579792 DOI: 10.1111/jdv.13957] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
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Affiliation(s)
- R N Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - B Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Schäfer
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - A M Agius
- Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G E Gross
- Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany
| | - S Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Lapid-Gortzak
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T H Lesser
- Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
| | - U Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - G M Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - P Wutzler
- Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany
| | - C Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kim CH, Kang SI, Kim YH. A case of ramsay hunt syndrome with cranial polyneuropathy. KOREAN JOURNAL OF AUDIOLOGY 2012; 16:80-2. [PMID: 24653876 PMCID: PMC3936570 DOI: 10.7874/kja.2012.16.2.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/15/2012] [Accepted: 04/06/2012] [Indexed: 11/29/2022]
Abstract
Ramsay Hunt syndrome is an infectious disease caused by the varicella zoster virus. It is characterized by the symptoms of facial paralysis, otalgia, and erythematous vesicular rash on the auricle and/or oral cavity. We present a case of a patient with clinical evidence of Ramsay Hunt syndrome involving the cranial nerves VI, VII, and VIII. The patient, a 66-year-old woman, showed left facial palsy associated with vesicular eruptions on her left auricle, impaired gaze to left side, and left hearing loss. Four months after the treatment with systemic steroid and antiviral agents, her all symptoms and signs including facial paralysis and diplopia disappeared.
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Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Il Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government, Seoul National University, Boramae Medical Center, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government, Seoul National University, Boramae Medical Center, Seoul, Korea
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Shim HJ, Jung H, Park DC, Lee JH, Yeo SG. Ramsay Hunt syndrome with multicranial nerve involvement. Acta Otolaryngol 2011; 131:210-5. [PMID: 21070092 DOI: 10.3109/00016489.2010.520167] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Ramsay Hunt syndrome (RHS) with multiple involvement of cranial nerves is more severe and intractable than RHS without such involvement. OBJECTIVES Typically, RHS involves VII and VIII nerves and unilaterally, and RHS accompanied by multiple cranial neuropathy is very rare. We describe 11 patients who developed RHS with multicranial nerve involvement and we analyzed their clinical characteristics and compared them with those of patients with RHS not accompanied by multiple cranial neuropathy. METHODS During the period 1995-2009, we treated 339 patients with RHS; of these, 11 patients had concurrent multiple cranial neuropathy. We assessed the clinical characteristics of RHS patients with and without multiple cranial neuropathy. RESULTS The mean age of the 11 patients with multiple cranial neuropathy (6 men, 5 women) was 49.2 ± 19.4 years, although 7 were aged 50 years or older. Eight patients had right-sided and three had left-sided facial paralysis. The initial degree of facial paralysis was House-Brackmann (HB) grade IV in four patients (36.4%) and HB grade V in seven (63.6%). Six patients showed improvement in symptoms, whereas five (45.6%) showed no improvement. The recovery rates from facial paralysis in patients with and without multiple cranial neuropathy were 54.5% and 82.9%, respectively, and the complete recovery rates were 27.3% and 67.7%, respectively.
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Affiliation(s)
- Hyun Joon Shim
- Department of Otolaryngology, College of Medicine, EulJi University, Seoul, Korea
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