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Hüning S, Werner M, Susok L. [Clinical presentation and treatment of herpes zoster and postherpetic neuralgia]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00105-024-05367-y. [PMID: 38935292 DOI: 10.1007/s00105-024-05367-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Herpes zoster (HZ) is a common disease caused by reactivation of varicella zoster virus. Diagnosis is usually based on the typical clinical presentation. Standard treatment includes antiviral, topical and analgesic therapies. As a complication, postherpetic neuralgia (PHN) can result from acute HZ infection, particularly in older and/or immunocompromised people. This can seriously impair the quality of life of those affected and requires adequate analgesia. In addition to the genesis, clinical presentation and treatment recommendations for HZ and PHN, this article also deals in particular with the vaccination prophylaxis recommended by the standing vaccination commission of the Robert Koch Institute (STIKO).
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Affiliation(s)
- S Hüning
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - M Werner
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - L Susok
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland
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Zhang Y, Chen S, Tian Y, Fu X. Host factors of SARS-CoV-2 in infection, pathogenesis, and long-term effects. Front Cell Infect Microbiol 2024; 14:1407261. [PMID: 38846354 PMCID: PMC11155306 DOI: 10.3389/fcimb.2024.1407261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024] Open
Abstract
SARS-CoV-2 is the causative virus of the devastating COVID-19 pandemic that results in an unparalleled global health and economic crisis. Despite unprecedented scientific efforts and therapeutic interventions, the fight against COVID-19 continues as the rapid emergence of different SARS-CoV-2 variants of concern and the increasing challenge of long COVID-19, raising a vast demand to understand the pathomechanisms of COVID-19 and its long-term sequelae and develop therapeutic strategies beyond the virus per se. Notably, in addition to the virus itself, the replication cycle of SARS-CoV-2 and clinical severity of COVID-19 is also governed by host factors. In this review, we therefore comprehensively overview the replication cycle and pathogenesis of SARS-CoV-2 from the perspective of host factors and host-virus interactions. We sequentially outline the pathological implications of molecular interactions between host factors and SARS-CoV-2 in multi-organ and multi-system long COVID-19, and summarize current therapeutic strategies and agents targeting host factors for treating these diseases. This knowledge would be key for the identification of new pathophysiological aspects and mechanisms, and the development of actionable therapeutic targets and strategies for tackling COVID-19 and its sequelae.
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Affiliation(s)
| | | | - Yan Tian
- Department of Endocrinology and Metabolism, Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Medical School, West China Hospital and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, Sichuan, Chengdu, China
| | - Xianghui Fu
- Department of Endocrinology and Metabolism, Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Medical School, West China Hospital and Cancer Center, Sichuan University and Collaborative Innovation Center of Biotherapy, Sichuan, Chengdu, China
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Leyh C, Roderburg C, Luedde T, Loosen SH, Kostev K. Herpes zoster is not associated with subsequent gastrointestinal cancer: data from over 200,000 outpatients in Germany. J Cancer Res Clin Oncol 2023; 149:17115-17121. [PMID: 37759134 PMCID: PMC10657323 DOI: 10.1007/s00432-023-05432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Gastrointestinal (GI) cancers are an increasing global health challenge. Viral diseases play an important role in the development of GI cancers. For example, Epstein-Barr virus, which belongs to the human herpesvirus family, is a well-recognized risk factor for the development of gastric cancer. The purpose of this study was to investigate a possible association between varicella-zoster virus reactivation and subsequent diagnosis of GI cancer. METHODS In this retrospective cohort study, a total of 103,123 patients with a first diagnosis of herpes zoster (HZ) between 2005 and 2021 were propensity score matched to a cohort of 103,123 patients without HZ. Patient data was extracted from the Disease Analyzer database (IQVIA). The incidence of GI cancer was compared as a function of HZ. Cox regression analysis was used to examine the association between HZ and GI cancer. RESULTS Over a follow-up period of up to 10 years, the incidence of GI cancer did not differ between the two cohorts (HZ cohort 2.26 cases per 1000 patient-years vs. non-HZ cohort 2.37 cases per 1000 patient-years, p = 0.548). In regression analysis, HZ was not associated with an increased risk of developing GI cancer (HR: 0.97; 95% CI 0.89-1.05). Furthermore, no significant effect of the presence of HZ on the incidence of different GI cancer entities was found. CONCLUSION In this retrospective cohort study consisting of well-matched patients, we observed no significant association between a HZ infection and the development of GI cancer during a long-term follow-up.
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Affiliation(s)
- Catherine Leyh
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany.
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Sven H Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany.
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Dugerdil A, Semenzato L, Weill A, Zureik M, Flahault A. Severe SARS-CoV-2 infection as a marker of undiagnosed cancer: a population-based study. Sci Rep 2023; 13:8729. [PMID: 37253848 PMCID: PMC10227779 DOI: 10.1038/s41598-023-36013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/27/2023] [Indexed: 06/01/2023] Open
Abstract
No study has yet investigated if a severe SARS-CoV-2 infection represents a marker of an undiagnosed cancer. This population-based study, using the SNDS database, identified from 02/15/2020 to 08/31/2021, 41,302 individuals hospitalized in intensive care unit due to SARS-CoV-2 (ICU-gr) and 713,670 control individuals not hospitalized for SARS-CoV-2 (C-gr). Individuals were matched according to year of birth, sex and French department. The cancer incidence was compared in the two groups during the follow-up period (index date-12/31/2021), using Cox proportional hazards models adjusted on matching variables, socioeconomic characteristics and comorbidities. In the ICU-gr, 2.2% (n = 897) was diagnosed with a cancer in the following months, compared to 1.5% (n = 10,944) in the C-gr. The ICU-gr had a 1.31 higher risk of being diagnosed with a cancer following hospital discharge compared to the C-gr (aHR 1.31, 95% CI 1.22-1.41). A global similar trend was found when competing risk of death was taken into account (aHR 1.25, 95% CI 1.16-1.34). A significant higher risk was found concerning renal (aHR 3.16, 95% CI 2.33-4.27), hematological (aHR 2.54, 95% CI 2.07-3.12), colon (aHR 1.72, 95% CI 1.34-2.21), and lung (aHR 1.70, 95% CI 1.39-2.08) cancers. This suggests that a severe SARS-CoV-2 infection may represent a marker of an undiagnosed cancer.
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Affiliation(s)
- Adeline Dugerdil
- Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.
| | - Laura Semenzato
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, 93285, Saint-Denis Cedex, France
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
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Yin M, Huang P, Yang S, Wang W. Ramsay Hunt syndrome and mandibular alveolar bone necrosis following herpes zoster: A case report and literature review. Front Neurol 2022; 13:1073607. [PMID: 36588911 PMCID: PMC9797838 DOI: 10.3389/fneur.2022.1073607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Reactivation of latent varicella-zoster virus (VZV) can induce herpes zoster (HZ). Ramsay Hunt syndrome (RHS) occurs through the reactivation and proliferation of VZV in the geniculate ganglion, which can lead to vesicular rash in the ear or oral mucosa, accompanied by neurological disorders. Materials and methods A 50-year-old man sought a remedy for pain in the right ear and face. Within 1 week, all his lower right teeth fell out, and in the following 3 months, his lower right mandibular alveolar bone gradually became necrotic. In the past 20 days, he experienced blister rash, hearing and taste loss, and slight facial paralysis. Results After ruling out tumors and other infectious diseases, he was diagnosed with trigeminal HZ and RHS. Conclusion Ramsay Hunt syndrome with tooth loss and alveolar osteonecrosis is rare. It requires long-term treatment of pain, and prevention and treatment of tooth loss and alveolar bone necrosis are difficult and warrant further study.
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Affiliation(s)
- Maojia Yin
- Department of Pain Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Panchuan Huang
- Department of Pain Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Sen Yang
- Department of Stomatology Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Wuchao Wang
- Department of Pain Medicine, Daping Hospital, Army Medical University, Chongqing, China,*Correspondence: Wuchao Wang
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Ferreira DA, Tayyar Y, Idris A, McMillan NAJ. A "hit-and-run" affair - A possible link for cancer progression in virally driven cancers. Biochim Biophys Acta Rev Cancer 2020; 1875:188476. [PMID: 33186643 DOI: 10.1016/j.bbcan.2020.188476] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is well-known that certain cancers are caused by viruses. However, viral oncogenesis is complex and only a small fraction of the infected people develop cancer. Indeed, a number of environmental factors can contribute to virally infected cells developing cancer hallmarks, promoting tumorigenesis. SCOPE OF REVIEW The hit-and-run theory proposes that viruses facilitate the accumulation of mutations and promote genomic instability until the virus becomes dispensable for tumour maintenance. Indeed, several studies have reported viral genome, episome and/or oncogene loss in tumour cells without losing malignant phenotype. MAJOR CONCLUSIONS The current evidence supports the clear contribution of certain viruses to develop cancers. Importantly, the evidence supporting the sustained maintenance of malignancy after the loss of viral "presence" is sufficient to support the hit-and-run hypothesis of viral cancer development. Long-term tracking of vaccination outcome over the decades will test this theory. GENERAL SIGNIFICANCE If the hit-and-run theory is true, viruses might cause more cancers than previously thought and will have implications in the prevention of many cancers through implementing vaccination programs.
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Affiliation(s)
- Danyelle A Ferreira
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Yaman Tayyar
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Adi Idris
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Queensland, Australia.
| | - Nigel A J McMillan
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Queensland, Australia
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Tsao YH, Hsieh CJ, Juan YS, Lee YC, Shen JT, Wang HS, Jhan JH, Geng JH. Herpes zoster and the subsequent risk of prostate cancer in an Asian population: A nationwide population-based cohort study. Medicine (Baltimore) 2020; 99:e22441. [PMID: 33019427 PMCID: PMC7535763 DOI: 10.1097/md.0000000000022441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It has been suggested that herpes zoster may increase the risk of subsequent prostate cancer (PCa). We aimed to assess the risk of PCa following herpes zoster by the population-based follow-up study.This is a retrospective study and data are from the Taiwan National Health Insurance Research Database (NHIRD). The study cohort comprised all patients with a diagnosis of herpes zoster (International Classification of Diseases, 9th Revision, Clinical Modification code 053.0-053.9) and followed for PCa from 1997 to 2013 (n = 11,376). Subjects younger than 20 years of age were excluded. The match-control cohort was identified from the Registry of Beneficiaries of the NHIRD and randomly selected by matching with the study cohort at a 3:1 ratio based on age (every 5-year span), and year of herpes zoster diagnosis (n = 34,128). We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) for subsequent PCa, after controlling for potential cormobidities.Men with and without herpes zoster had similar age and comorbidity distributions. Among the 45,504 sampled patients, 1011 (2.22%) developed PCa during the 10 years of follow-up, 276 (2.43%) from the study cohort and 735 (2.15%) from the match-control cohort and the incidence rate was 3.13 and 2.72 per 1000 person years respectively. Patients with herpes zoster were more likely to develop PCa than patients in the match-control cohort (HR = 1.15; 95% confidence interval (CI) = 1.00-1.32, P value = .045). After adjusting for age and comorbidities, herpes zoster was associated with a 1.15 increased risk of PCa (adjusted HR = 1.15, 95% CI = 0.99-1.32, P value = .054).Our study indicates that preceding herpes zoster infection is a suggestive risk marker for subsequent PCa after controlling for potential confounders. Further prospective studies are needed to determine the relationship between herpes zoster and PCa.
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Affiliation(s)
- Yao-Hsuan Tsao
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Oriental Institute of Technology, New Taipei City
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
| | - Jung-Tsung Shen
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
| | - Hsun-Shuan Wang
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
| | - Jhen-Hao Jhan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital
- Department of Urology, Kaohsiung Medical University Hospital
- Kaohsiung Medical University, Kaohsiung
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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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Choi HG, Zehnder JL, Lee YK, Lim H, Kim M. Increased risk of lymphoid malignancy in patients with herpes zoster: a longitudinal follow-up study using a national cohort. BMC Cancer 2019; 19:1148. [PMID: 31775678 PMCID: PMC6882027 DOI: 10.1186/s12885-019-6349-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/08/2019] [Indexed: 12/23/2022] Open
Abstract
Background The association between herpes zoster and the risk of lymphoid neoplasms in Asian populations has not yet been established. We performed a longitudinal follow-up study using a nationwide cohort to assess the risk of lymphoid neoplasms arising after herpes zoster infection in the adult Korean population. Methods Data from participants ≥20 years of age who were registered in the Korean National Health Insurance Service-National Sample Cohort database between 2002 and 2013 were collected. We extracted the data of participants with herpes zoster (n = 59,495) as well as those of matched references at a ratio of 1:4 (n = 237,980) and investigated the subsequent occurrence of lymphoid neoplasms. A stratified Cox proportional hazards model was used to calculate unadjusted hazard ratios (HRs) as well as those adjusted for the Charlson comorbidity index score. Results The rate of lymphoid neoplasms was higher in the herpes zoster group (0.15% [90/59,495]) than in the reference group (0.08% [212/237,980], P < 0.001). The unadjusted and adjusted HRs of herpes zoster in patients with lymphoid neoplasms were 1.68 (95% confidence interval [CI] = 1.31–2.15) and 1.58 (95% CI = 1.23–2.02), respectively (P < 0.001 for both). On subgroup analyses according to age and sex, herpes zoster was associated with an increased risk of lymphoid neoplasms in all subgroups; the adjusted HRs were 1.53 (95% CI = 1.05–2.24) for patients < 60 years old, 1.58 (95% CI = 1.14–2.20) for patients ≥60 years old, 1.64 (95% CI = 1.16–2.31) for men, and 1.51 (95% CI = 1.06–2.16) for women (P < 0.05 for all). On subgroup analysis of lymphoid neoplasm subtypes, herpes zoster was associated with the risk of Hodgkin’s disease (adjusted HR: 3.23 [95% CI = 1.17–8.93]) and multiple myeloma/malignant plasma cell neoplasms (adjusted HR: 2.17 [95% CI = 1.33–3.54]) (P < 0.05 for both). Conclusion Herpes zoster is associated with lymphoid neoplasm development in the Korean population irrespective of age and sex. The risks of Hodgkin’s disease and plasma cell neoplasms are significantly elevated in patients with herpes zoster.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - James L Zehnder
- Department of Pathology, Stanford University, Stanford, CA, USA.,Division of Hematology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Republic of Korea. .,Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea.
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Brooks JK, Rostami AM, McCorkle DC, Benesh SI. Trigeminal herpes zoster and Ramsay Hunt syndrome in an elderly adult: Presentation with prodromal toothache. Gerodontology 2018; 35:276-278. [PMID: 30465330 DOI: 10.1111/ger.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This article describes an atypical herpes zoster (HZ) infection heralded by prodromic dental pain. BACKGROUND Trigeminal HZ is associated with any of the three divisions of the trigeminal nerve, and Ramsay Hunt syndrome is a rare variant of HZ infection of the ear, often accompanied with unilateral facial nerve palsy. MATERIALS AND METHODS An 87-year-old man sought remedy for tooth-like pain. Within a week, he developed cutaneous, intraoral and otic eruptions, hearing loss, and mild facial palsy. RESULTS After ruling out odontogenic pain, he was diagnosed with trigeminal HZ and Ramsay Hunt syndrome. CONCLUSION Herpes zoster infection should be included as a possible aetiologic factor with atypical presentations of odontogenic pain. Diagnosis of trigeminal HZ infection and the Ramsay Hunt syndrome may lead to timely intervention with antivirals and improved patient outcomes.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Arash M Rostami
- Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD, USA
| | | | - Samuel I Benesh
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Herpes zoster risk after 21 specific cancers: population-based case-control study. Br J Cancer 2017; 116:1643-1651. [PMID: 28463961 PMCID: PMC5518853 DOI: 10.1038/bjc.2017.124] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Some malignancies are known to be associated with increased risk of herpes zoster, but little is known about how associations between cancer and subsequent zoster risk vary by cancer site, by time since cancer diagnosis, and by age. METHODS An age-, sex-, calendar time-, and practice-matched case-control study, nested in the broadly UK representative Clinical Practice Research Datalink (CPRD) primary care database, was analysed using conditional logistic regression to estimate the association between 21 of the most common specific malignancies and subsequent zoster risk. We adjusted for comorbid conditions and other potential confounders, and investigated effect modification by age and time since malignancy diagnosis. RESULTS A total of 192 081 adult zoster patients and 732 035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.27-1.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.33-2.60). Among specific malignancies, there was evidence that oral, oesophageal, stomach, colorectal, lung, breast, ovarian, prostate, kidney, bladder, and CNS cancers, as well as lymphoma, myeloma, and leukaemia were associated with increased zoster odds (P⩽0.05 in each case), but the magnitude of associations varied widely. The association was typically strongest within 2 years of malignancy diagnosis and decreased with older age for both haematological and solid malignancies. CONCLUSIONS Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. Evaluation of whether patients diagnosed with cancer would benefit from early zoster vaccination is warranted.
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Schmidt S, Mor A, Schønheyder H, Sørensen H, Dekkers O, Cronin-Fenton D. Herpes zoster as a marker of occult cancer: A systematic review and meta-analysis. J Infect 2017; 74:215-235. [DOI: 10.1016/j.jinf.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 01/14/2023]
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El Hayderi L, Rübben A, Nikkels AF. [The alpha-herpesviridae in dermatology : Varicella zoster virus. German version]. Hautarzt 2017; 68:187-191. [PMID: 28197700 DOI: 10.1007/s00105-016-3930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The second part of this publication deals with varicella zoster virus (VZV) and presents an overview of new, rare, and atypical clinical manifestations, including photolocalized varicella, hemorrhagic bullae during varicella, the implication of VZV in immunoglobulin A vasculitis, VZV-related alopecia, ulcerative varicella skin lesions, childhood herpes zoster (HZ), prolonged prodromal pains, recurrent HZ, VZV implication in burning mouth syndrome, verruciform VZV lesions, the significance of satellite lesions during HZ, and late HZ complications, either neurological or internal. Furthermore, certain associations between the occurrence of HZ and subsequent internal pathologies, as well as risk factors for HZ and new developments in vaccination against HZ will be addressed.
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Affiliation(s)
- L El Hayderi
- Department of Dermatology, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgien
| | - A Rübben
- Hautklinik, Universitätsklinikum der Rheinisch-Westfälischen Technischen Hochschule Aachen, Pauwelsstraße 30, Aachen, 52074, Deutschland
| | - A F Nikkels
- Department of Dermatology, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgien.
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14
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15
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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 1: Diagnosis. J Eur Acad Dermatol Venereol 2017; 31:9-19. [PMID: 27804172 DOI: 10.1111/jdv.13995] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
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 of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined 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 first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific 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
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, 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, UK
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, 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
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Nast
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Yamaoka K. Benefit and Risk of Tofacitinib in the Treatment of Rheumatoid Arthritis: A Focus on Herpes Zoster. Drug Saf 2016; 39:823-40. [DOI: 10.1007/s40264-016-0430-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Chung WS, Lin HH, Cheng NC. The Incidence and Risk of Herpes Zoster in Patients With Sleep Disorders: A Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e2195. [PMID: 26986095 PMCID: PMC4839876 DOI: 10.1097/md.0000000000002195] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lack of sleep can compromise the immune system, which may reactivate latent varicella-zoster virus. Studies on sleep disorders and the risk of herpes zoster (HZ) are scant.We conducted a population-based cohort study to evaluate the risk of HZ in patients with sleep disorders and potential risk factors for HZ development. We identified patients with sleep disorders without apnea from 2002 to 2005 by using the Taiwan Longitudinal Health Insurance Database. The patients without sleep disorders were randomly selected and frequency matched with patients with sleep disorders according to age, sex, and index year. We estimated the follow-up time in person-years for the patients from the entry date until HZ diagnosis, loss to follow-up, or the end of 2010. We used Cox proportional hazards regression models and a sensitivity analysis to estimate the risk of HZ while controlling for demographic characteristics and comorbidities. A total of 131,001 study participants (follow-up, 948,177 person-years; mean age, 51.2 ± 16.5 years; 62.2% women) were included in the study. Patients with sleep disorders exhibited a higher incidence of HZ compared with a comparison cohort when stratified by age, sex, and comorbidities. After adjustment for covariates, the sleep disorder cohort exhibited a 1.23-fold greater risk of HZ compared with the comparison cohort (95% confidence interval [CI] = 1.17-1.30). The incidence of HZ increased with age. Adults ages 65 years and older exhibited a 6.11-fold greater risk of HZ development compared with their younger counterparts (95% CI = 5.34-7.00). Cancers and autoimmune diseases were independent risk factors of HZ development. The patients with sleep disorders may carry an increased risk of developing HZ.
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Affiliation(s)
- Wei-Sheng Chung
- From the Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare (W-SC, N-CC); Department of Health Services Administration, China Medical University (W-SC); and Department of Healthcare Administration (W-SC) and Department of Management Information Systems (H-HL), Central Taiwan University of Science and Technology, Taichung, Taiwan
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Sun LM, Wu JN, Lin CL, Day JD, Liang JA, Liou LR, Kao CH. Infective Endocarditis and Cancer Risk: A Population-Based Cohort Study. Medicine (Baltimore) 2016; 95:e3198. [PMID: 27015220 PMCID: PMC4998415 DOI: 10.1097/md.0000000000003198] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study investigated the possible relationship between endocarditis and overall and individual cancer risk among study participants in Taiwan.We used data from the National Health Insurance program of Taiwan to conduct a population-based, observational, and retrospective cohort study. The case group consisted of 14,534 patients who were diagnosed with endocarditis between January 1, 2000 and December 31, 2010. For the control group, 4 patients without endocarditis were frequency matched to each endocarditis patient according to age, sex, and index year. Competing risks regression analysis was conducted to determine the effect of endocarditis on cancer risk.A large difference was noted in Charlson comorbidity index between endocarditis and nonendocarditis patients. In patients with endocarditis, the risk for developing overall cancer was significant and 119% higher than in patients without endocarditis (adjusted subhazard ratio = 2.19, 95% confidence interval = 1.98-2.42). Regarding individual cancers, in addition to head and neck, uterus, female breast and hematological malignancies, the risks of developing colorectal cancer, and some digestive tract cancers were significantly higher. Additional analyses determined that the association of cancer with endocarditis is stronger within the 1st 5 years after endocarditis diagnosis.This population-based cohort study found that patients with endocarditis are at a higher risk for colorectal cancer and other cancers in Taiwan. The risk was even higher within the 1st 5 years after endocarditis diagnosis. It suggested that endocarditis is an early marker of colorectal cancer and other cancers. The underlying mechanisms must still be explored and may account for a shared risk factor of infection in both endocarditis and malignancy.
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Affiliation(s)
- Li-Min Sun
- From the Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung (L-MS); General Affairs Office, China Medical University Hospital, Taichung (J-NW); Department of Industrial Engineering and Management, National Kaohsiung University of Applied Sciences, Kaohsiung (J-NW, J-DD); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine (C-LL); Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung (J-AL, C-HK); Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung (L-RL); Department of Radiation Oncology (J-AL); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Mahale P, Yanik EL, Engels EA. Herpes Zoster and Risk of Cancer in the Elderly U.S. Population. Cancer Epidemiol Biomarkers Prev 2015; 25:28-35. [PMID: 26578536 DOI: 10.1158/1055-9965.epi-15-1033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) arises in older people due to age-related decline in immunity. We assessed whether HZ, as a marker of immune suppression, is associated with increased cancer risk. METHODS We conducted a case-control study in U.S. adults with ages ≥ 65 years using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Cases (n = 1,108,986) were people with first cancers identified in cancer registries (1992-2005). Controls (n = 100,000) were cancer-free individuals frequency matched to cases on age, sex, and year of selection. We identified HZ diagnosis using Medicare claims. Logistic regression models were constructed to determine adjusted associations between cancer and HZ. RESULTS HZ prevalence was modestly higher in cases than controls (1.4% vs. 1.2%). We identified significant associations between HZ and oral cavity/pharyngeal [adjusted OR (aOR) = 1.21], colon (aOR = 1.10), lung (aOR = 1.11), and non-melanoma skin (aOR = 1.46) cancers; myeloma (aOR = 1.38); diffuse large B-cell lymphoma (aOR = 1.30); lymphoplasmacytic lymphoma (aOR = 1.99); and chronic lymphocytic leukemia/small lymphocytic lymphoma (aOR = 1.55). Among solid cancers, HZ was mostly associated with regional and/or distant stage tumors. Associations were strongest when HZ was diagnosed 13 to 35 months before cancer diagnosis/selection; they were significant for some cancers in the 36 to 59 months period, and 60+ months for lymphoplasmacytic lymphoma (OR = 1.99). CONCLUSION HZ is associated with modestly increased risk of a few cancers, particularly hematologic malignancies. Associations were strongest at short latency intervals for many cancers, and for regional/distant stages among solid cancers, perhaps reflecting reverse causality. IMPACT Age-related immune decline does not play a major role in cancer development in older people, but it may be important for some lymphomas.
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Affiliation(s)
- Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Elizabeth L Yanik
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
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Blein C, Gavazzi G, Paccalin M, Baptiste C, Berrut G, Vainchtock A. Burden of herpes zoster: the direct and comorbidity costs of herpes zoster events in hospitalized patients over 50 years in France. BMC Infect Dis 2015; 15:350. [PMID: 26286598 PMCID: PMC4545556 DOI: 10.1186/s12879-015-1059-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background The objectives of this study were to describe hospital stays related to HZ and to evaluate the direct and indirect cost of hospitalizations due to HZ among patients aged over 50 years. Methods The hospitalizations of people aged over 50 years were selected from the French national hospital 2011 database (PMSI) using ICD-10 diagnosis codes for HZ. Firstly, stays with HZ as principal or related diagnostic were described through the patient characteristics, type of hospitalization and the related costs. Secondly, a retrospective case–control analysis was performed on stays with HZ as comorbidity in 5 main hospitalizations causes (circulatory, respiratory, osteo-articular, digestive systems and diabetes) to assess the impact of HZ as co-morbidity on the length of stay, mortality rate and costs. Results In the first analysis, 2,571 hospital stays were collected (60 % of women, mean age: 76.3 years and mean LOS: 9.5 days). The total health assurance costs were 10,8 M€. Mean cost per hospital stay was 4,206€. In the second analysis, a significant difference in LOS and costs was shown when HZ was associated as comorbidity in other hospitalization’s causes. Conclusions HZ directly impacts on the hospital cost. When present as comorbidity for other medical reasons, HZ significantly increases the length of hospital stay with subsequent economic burden for the French Health System.
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Affiliation(s)
| | - Gaetan Gavazzi
- Université de Grenoble-Alpes et GREPI, clinique universitaire de médecine gériatrique, CHU de Grenoble, la tronche, France.
| | - Marc Paccalin
- Geriatrics Department University Hospital La Milétrie, Poitiers, France.
| | | | - Gilles Berrut
- Hôpital Saint Jacques, CHU de Nantes, Nantes, France.
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Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, Smeeth L. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol 2015; 44:827-36. [PMID: 26050254 PMCID: PMC4521131 DOI: 10.1093/ije/dyv098] [Citation(s) in RCA: 1822] [Impact Index Per Article: 202.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 12/05/2022] Open
Abstract
The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of anonymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist referrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, therapies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality records enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 research studies, published in peer-reviewed journals across a broad range of health outcomes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassification and development of disease definitions for research.
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Affiliation(s)
- Emily Herrett
- London School of Hygiene & Tropical Medicine, London, UK,
| | - Arlene M Gallagher
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands and
| | | | - Harriet Forbes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- London School of Hygiene & Tropical Medicine, London, UK
| | - Tjeerd van Staa
- London School of Hygiene & Tropical Medicine, London, UK, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands and Health eResearch Centre, University of Manchester, Manchester, UK
| | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
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Khan H, Gucalp R, Shapira I. Evolving Concepts: Immunity in Oncology from Targets to Treatments. JOURNAL OF ONCOLOGY 2015; 2015:847383. [PMID: 26060497 PMCID: PMC4427847 DOI: 10.1155/2015/847383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 01/09/2023]
Abstract
Cancer is associated with global immune suppression of the host. Malignancy-induced immune suppressive effect can be circumvented by blocking the immune checkpoint and tip the immune balance in favor of immune stimulation and unleash cytotoxic effects on cancer cells. Human antibodies directed against immune checkpoint proteins: cytotoxic T lymphocytes antigen-4 (CTLA-4) and programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1), have shown therapeutic efficacy in advanced melanoma and non-small-cell lung cancer and other malignancies. Immune check point blockade antibodies lead to diminished tolerance to self and enhanced immune ability to recognize and eliminate cancer cells. As a class these agents have immune-related adverse events due to decreased ability of effector immune cells to discriminate between self and non-self. Seventy percent of patients participating in clinical trials have experienced anticancer activities and varying degrees of immune mediated dose-limiting side effects.
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Affiliation(s)
- Hina Khan
- Department of Hematology Oncology, Montefiore Medical Center, Albert Einstein School of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Rasim Gucalp
- Department of Oncology, Montefiore Medical Center, Albert Einstein School of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Iuliana Shapira
- Department of Hematology Oncology, Hofstra North Shore LIJ School of Medicine, Hempstead, NY 11549, USA
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Mortality in cancer patients previously diagnosed with herpes zoster in the hospital setting: a nationwide cohort study. Br J Cancer 2015; 112:1822-6. [PMID: 25880013 PMCID: PMC4647253 DOI: 10.1038/bjc.2015.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/09/2015] [Accepted: 03/17/2015] [Indexed: 11/08/2022] Open
Abstract
Background: Herpes zoster (HZ) is associated with underlying immunodeficiency and may thereby predict mortality of subsequent cancer. Methods: By using Danish nationwide medical databases, we identified all cancer patients with a prior hospital-based HZ diagnosis during 1982–2011 (n=2754) and a matched cancer cohort without prior HZ (n=26 243). We computed adjusted mortality rate ratios (aMRRs) associating prior HZ with mortality following cancer. Results: Prior HZ was associated with decreased mortality within the year after cancer diagnosis (aMRR 0.87; 95% confidence interval (CI): 0.81–0.93), but not thereafter (aMRR 1.07; 95% CI: 0.99–1.15). However, prior HZ predicted increased mortality throughout the entire follow-up among patients aged <60 years (aMRR 1.39; 95% CI: 1.15–1.68) and those with disseminated HZ (aMRR 1.18; 95% CI: 1.01–1.37). The increased mortality rates were observed primarily for haematological and immune-related cancers. Conclusions: Overall, HZ was not a predictor of increased mortality following subsequent cancer.
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Wu PH, Lin YT, Lin CY, Huang MY, Chang WC, Chang WP. A nationwide population-based cohort study to identify the correlation between heart failure and the subsequent risk of herpes zoster. BMC Infect Dis 2015; 15:17. [PMID: 25592871 PMCID: PMC4307190 DOI: 10.1186/s12879-015-0747-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background The association between heart failure (HF) and herpes zoster has rarely been studied. We investigated the hypothesis that HF may increase the risk of herpes zoster in Taiwan using a nationwide Taiwanese population-based claims database. Method Our study cohort consisted of patients who received a diagnosis of HF in 2001 ~ 2009 (N = 4785). For a comparison cohort, three age- and gender-matched control patients for every patient in the study cohort were selected using random sampling (N = 14,355). All subjects were tracked for 1 year from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 1-year herpes zoster-free survival rates. Results The main finding of this study was that patients with HF seemed to be at an increased risk of developing herpes zoster. Of the total patients, 211 patients developed herpes zoster during the 1-year follow-up period, among whom 83 were HF patients and 128 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with HF was higher (AHR: 2.07; 95% confidence interval (CI): 1.54 ~ 2.78; p < 0.001) than that of the controls during the 1-year follow-up. Our study also investigated whether HF is a gender-dependent risk factor for herpes zoster. We found that male patients with HF had an increased risk of developing herpes zoster (AHR: 2.30 95% CI: 1.51 ~ 3.50; p < 0.001). Conclusions The findings of our population-based study suggest that patients with HF may have an increased risk of herpes zoster. These health associations should be taken into consideration, and further studies should focused on the cost-effectiveness of the herpes zoster vaccine should be designed for HF patients.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Yi-Ting Lin
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Chun-Yi Lin
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
| | - Ming-Yii Huang
- Department of Radiation Oncology, Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan. .,Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Wei-Pin Chang
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
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BUNTINX F, BARTHOLOMEEUSEN S, BELMANS A, MATHEI C, OPDENAKKER G, SWELDENS K, TRUYERS C, VAN RANST M. Association between recent herpes zoster but not herpes simplex infection and subsequent risk of malignancy in women: a retrospective cohort study. Epidemiol Infect 2014; 142:1008-17. [PMID: 23906263 PMCID: PMC9151161 DOI: 10.1017/s0950268813001702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 04/28/2013] [Accepted: 06/26/2013] [Indexed: 11/07/2022] Open
Abstract
The association between herpes zoster and subsequent cancer risk is still unclear. Consequently, doubts remain regarding the need for investigation of herpes patients for co-existing or subsequent malignancy. This is a retrospective cohort study comparing cancer risk in patients after herpes zoster and age-/sex-matched non-herpes zoster patients, in a primary care-based continuous morbidity database. We tested for interaction by gender, age, diabetes, HRT use or antiviral therapy. Analyses were repeated for patients with and without herpes simplex. The hazard ratio (HR) comparing cancer risk in herpes zoster vs. control patients was significant in all women, women aged > 65 years and subgroups of breast and colorectal cancer (HRs 1·60, 1·82, 2·14, 2·19, respectively). For men, a significant association was found for haematological cancers (HR 2·92). No associations were found with herpes simplex. No interaction was identified with antiviral therapy, diabetes or HRT treatment. We concluded that there was a moderate significant association between herpes zoster and subsequent cancer risk in women aged > 65 years, without any influence of antiviral therapy. No association was found with herpes simplex. There is insufficient reason for extensively testing older patients with herpes zoster or herpes simplex for the presence of occult cancer.
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Affiliation(s)
- F. BUNTINX
- Department of General Practice and Intego Registry, Katholieke Universiteit Leuven, Belgium
- Research Institute Caphri, University of Maastricht, The Netherlands
| | - S. BARTHOLOMEEUSEN
- Department of General Practice and Intego Registry, Katholieke Universiteit Leuven, Belgium
| | - A. BELMANS
- Biostat-L, Katholieke Universiteit Leuven, Belgium
| | - C. MATHEI
- Department of General Practice and Intego Registry, Katholieke Universiteit Leuven, Belgium
| | - G. OPDENAKKER
- Department of Immunology, University hospitals Leuven, Belgium
| | | | - C. TRUYERS
- Department of General Practice and Intego Registry, Katholieke Universiteit Leuven, Belgium
| | - M. VAN RANST
- Laboratory of Clinical Virology, Department of Microbiology and Immunology Rega Institute, Katholieke Universiteit LeuvenBelgium
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