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Giovannini S, Coraci D, Brau F, Galluzzo V, Loreti C, Caliandro P, Padua L, Maccauro G, Biscotti L, Bernabei R. Neuropathic Pain in the Elderly. Diagnostics (Basel) 2021; 11:diagnostics11040613. [PMID: 33808121 PMCID: PMC8066049 DOI: 10.3390/diagnostics11040613] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Neuropathic pain due to a lesion or a disease of the somatosensory system often affects older people presenting several comorbidities. Moreover, elderly patients are often poly-medicated, hospitalized and treated in a nursing home with a growing risk of drug interaction and recurrent hospitalization. Neuropathic pain in the elderly has to be managed by a multidimensional approach that involves several medical, social and psychological professionals in order to improve the quality of life of the patients and, where present, their relatives.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Correspondence: ; Tel.: +39-063015-4341
| | - Daniele Coraci
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio Brau
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Galluzzo
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Pietro Caliandro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
| | - Luca Padua
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Biscotti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Presiding Officer of Geriatric Care Promotion and Development Centre (C.E.P.S.A.G), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Bernabei
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.C.); (F.B.); (V.G.); (C.L.); (P.C.); (L.P.); (G.M.); (L.B.); (R.B.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Jeon Y, Jin Y. Caudal block with steroid in the treatment of acute voiding dysfunction and pain caused by sacral herpes zoster: A case report. Medicine (Baltimore) 2020; 99:e20680. [PMID: 32569199 PMCID: PMC7310887 DOI: 10.1097/md.0000000000020680] [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: 11/25/2022] Open
Abstract
RATIONALE Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. PATIENT CONCERNS A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. DIAGNOSES Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). INTERVENTIONS Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. OUTCOMES One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. LESSONS A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.
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Affiliation(s)
- Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- Department of Anesthesiology and Pain medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yehun Jin
- Department of Anesthesiology and Pain medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
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Zheng C, Luo Y, Mercado C, Sy L, Jacobsen SJ, Ackerson B, Lewin B, Tseng HF. Using natural language processing for identification of herpes zoster ophthalmicus cases to support population-based study. Clin Exp Ophthalmol 2018; 47:7-14. [DOI: 10.1111/ceo.13340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/13/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Chengyi Zheng
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Yi Luo
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Cheryl Mercado
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Lina Sy
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Steven J Jacobsen
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
| | - Brad Ackerson
- South Bay Medical Center; Kaiser Permanente Southern California; Harbor City California USA
| | - Bruno Lewin
- Los Angeles Medical Center; Kaiser Permanente Southern California; Los Angeles California USA
| | - Hung Fu Tseng
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena California USA
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Berlinberg EJ, Deiner MS, Porco TC, Acharya NR. Monitoring Interest in Herpes Zoster Vaccination: Analysis of Google Search Data. JMIR Public Health Surveill 2018; 4:e10180. [PMID: 29720364 PMCID: PMC5956160 DOI: 10.2196/10180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/15/2022] Open
Abstract
Background A new recombinant subunit vaccine for herpes zoster (HZ or shingles) was approved by the United States Food and Drug Administration on October 20, 2017 and is expected to replace the previous live attenuated vaccine. There have been low coverage rates with the live attenuated vaccine (Zostavax), ranging from 12-32% of eligible patients receiving the HZ vaccine. Objective This study aimed to provide insight into trends and potential reasons for interest in HZ vaccination. Methods Internet search data were queried from the Google Health application programming interface from 2004-2017. Seasonality of normalized search volume was analyzed using wavelets and Fisher’s g test. Results The search terms “shingles vaccine,” “zoster vaccine,” and “zostavax” all exhibited significant periodicity in the fall months (P<.001), with sharp increases after recommendations for vaccination by public health-related organizations. Although the terms “shingles blisters,” “shingles itch,” “shingles rash,” “skin rash,” and “shingles medicine” exhibited statistically significant periodicities with a seasonal peak in the summer (P<.001), the terms “shingles contagious,” “shingles pain,” “shingles treatment,” and “shingles symptoms” did not reveal an annual trend. Conclusions There may be increased interest in HZ vaccination during the fall and after public health organization recommendations are broadcast. This finding points to the possibility that increased awareness of the vaccine through public health announcements could be evaluated as a potential intervention for increasing vaccine coverage.
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Affiliation(s)
- Elyse J Berlinberg
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S Deiner
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Travis C Porco
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nisha R Acharya
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
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5
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Shiraki K, Toyama N, Shiraki A, Yajima M. Age-dependent trigeminal and female-specific lumbosacral increase in herpes zoster distribution in the elderly. J Dermatol Sci 2018; 90:166-171. [DOI: 10.1016/j.jdermsci.2018.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
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Abstract
Chronic pruritus (>6 week's duration) in the geriatric population (≥65 years old), is an increasing health care problem. The pathophysiologic predisposing factors are abnormalities of the epidermal barrier, immune system, and nervous system. Causes can be dichotomized into histaminergic and nonhistaminergic pruritus. Topical treatments are generally safe. Systemic treatments are chosen depending on the condition, comorbid diseases, and drug interactions. Treatment options are limited. Progress has been made in identifying itch-selective mediators over the last decade. Numerous new medications are currently undergoing clinical trials and they are anticipated to enter the clinics in the near future.
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Lim DH, Kim YJ, Kim SO, Hong S, Lee CK, Yoo B, Kim YG. The risk of herpes zoster in patients with ankylosing spondylitis: Analysis of the Korean National Health Insurance Service – Sample cohort database. Mod Rheumatol 2017; 28:168-173. [DOI: 10.1080/14397595.2017.1325034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ye-Jee Kim
- Department Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Seon Ok Kim
- Department Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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8
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Dolor en el herpes zóster: prevención y tratamiento. Semergen 2017; 43:318-327. [DOI: 10.1016/j.semerg.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 12/30/2022]
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Abstract
Postherpetic neuralgia is a common and challenging complication of herpes zoster infection, particularly in older people. In recent decades, first-line treatments, including oral or topical medication, have become well established. However, few studies have reported the efficacy of interventional procedures for the treatment of postherpetic neuralgia. Here, the authors present a case of intractable postherpetic neuralgia treated with musculocutaneous peripheral nerve block under ultrasound guidance. Symptoms remained controlled at 1 mo follow-up. Ultrasound can be readily applied to improve the accuracy and efficiency of peripheral nerve block as it is currently widely used to evaluate the musculoskeletal system in clinical settings.
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Lerman IR, Chen JL, Hiller D, Souzdalnitski D, Sheean G, Wallace M, Barba D. Novel High-Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note. Neuromodulation 2015; 18:487-93; discussion 493. [PMID: 25832898 DOI: 10.1111/ner.12281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 01/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aims to describe an ultrasound (US)-guided peripheral nerve stimulation implant technique and describe the effect of high-frequency peripheral nerve stimulation on refractory postherpetic neuralgia. MATERIALS AND METHODS Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52-year-old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic-guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high-frequency stimulation paradigm. RESULTS At 9 months follow-up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency-specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high-frequency paresthesia-free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100-1200 Hz, and a pulse width of 130 μsec, to paresthesia-mediated pain relief associated with low-frequency stimulation. CONCLUSION We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high-frequency program resulting in sustained suppression of intractable postherpetic neuralgia.
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Affiliation(s)
| | | | - David Hiller
- University of California San Diego, San Diego, CA, USA
| | | | | | - Mark Wallace
- University of California San Diego, San Diego, CA, USA
| | - David Barba
- University of California San Diego, San Diego, CA, USA
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Nimmrich S, Horneff G. Incidence of herpes zoster infections in juvenile idiopathic arthritis patients. Rheumatol Int 2015; 35:465-70. [PMID: 25583050 DOI: 10.1007/s00296-014-3197-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/18/2014] [Indexed: 12/19/2022]
Abstract
The risk of herpes zoster among patients with juvenile idiopathic arthritis (JIA) exposed to biologics has not been evaluated. We determined incidence rates of herpes zoster among children with JIA in correlation with medication at time of occurrence and total drug exposure. The German biologics register database was used to identify patients with herpes zoster. Crude infection rates and incidence ratios (IRR) were compared to published rates. Demographics and overall exposure and particular exposure time to corticosteroids, immunosuppressive drugs and biologics were analyzed. The JIA cohort included 3,042 patients with 5,557.9 person-years of follow-up; 1,628 have used corticosteroids, 2,930 methotrexate and 1,685 etanercept. In total, 17 herpes zoster events have been documented [6/1,000 patients (3.5-9.0); 3.1/1,000 patient-years (1.9-4.9)]. Thus, the incidence rate in JIA patients was higher than expected [IRR 2.9 (1.8-4.5), p < 0.001]. In all patients, the event resolved completely. There were two complications, one patient developed intercostal neuralgia, and one had a recurrent herpes zoster. Compared to the healthy population, a significant higher IRR is observed in JIA patients who received a monotherapy with etanercept or in combination with steroids and methotrexate, but not in JIA patients exposed to methotrexate without biologics. In comparison with our control group of patients treated with methotrexate, the IRR was higher for exposure to etanercept monotherapy and combination of etanercept and corticosteroids irrespective of methotrexate use. A generally higher incidence rate in JIA patients treated with etanercept was observed. No serious or refractory manifestations occurred.
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Affiliation(s)
- S Nimmrich
- Department of Pediatrics and Neonatology, Asklepios Clinics, Arnold Janssen Str. 29, 53757, Sankt Augustin, Germany,
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Chronic Pain Syndromes, Mechanisms, and Current Treatments. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 131:565-611. [DOI: 10.1016/bs.pmbts.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis 2013; 13:170. [PMID: 23574765 PMCID: PMC3637114 DOI: 10.1186/1471-2334-13-170] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV) and mainly affects individuals aged ≥50 years. The forthcoming European launch of a vaccine against HZ (Zostavax®) prompts the need for a better understanding of the epidemiology of HZ in Europe. Therefore the aim of this systematic review was to summarize the available data on HZ incidence in Europe and to describe age-specific incidence. Methods The Medline database of the National Library of Medicine was used to conduct a comprehensive literature search of population-based studies of HZ incidence published between 1960 and 2010 carried out in the 27 member countries of the European Union, Iceland, Norway and Switzerland. The identified articles were reviewed and scored according to a reading grid including various quality criteria, and HZ incidence data were extracted and presented by country. Results The search identified 21 studies, and revealed a similar annual HZ incidence throughout Europe, varying by country from 2.0 to 4.6/1 000 person-years with no clearly observed geographic trend. Despite the fact that age groups differed from one study to another, age-specific HZ incidence rates seemed to hold steady during the review period, at around 1/1 000 children <10 years, around 2/1 000 adults aged <40 years, and around 1–4/1 000 adults aged 40–50 years. They then increased rapidly after age 50 years to around 7–8/1 000, up to 10/1 000 after 80 years of age. Our review confirms that in Europe HZ incidence increases with age, and quite drastically after 50 years of age. In all of the 21 studies included in the present review, incidence rates were higher among women than men, and this difference increased with age. This review also highlights the need to identify standardized surveillance methods to improve the comparability of data within European Union Member States and to monitor the impact of VZV immunization on the epidemiology of HZ. Conclusions Available data in Europe have shortcomings which make an accurate assessment of HZ incidence and change over time impossible. However, data are indicative that HZ incidence is comparable, and increases with age in the same proportion across Europe.
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Affiliation(s)
- Sybil Pinchinat
- Epidemiology Department, Sanofi Pasteur MSD, 8 rue Jonas Salk, Lyon, 69007, France
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Gawecka E, Viken O. Postherpetic neuralgia: New hopes in prevention with adult vaccination and in treatment with a concentrated capsaicin patch. Scand J Pain 2012; 3:220-228. [DOI: 10.1016/j.sjpain.2012.05.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 05/10/2012] [Indexed: 12/01/2022]
Abstract
Abstract
Background and purpose
Postherpetic neuralgia (PHN) is a complication of acute herpes zoster (HZ). The evidence base for management of PHN has increased by recent publications. Therefore, we reviewed incidence of HZ, prevalence, risk factors, and mechanism of PHN pain, prevention and treatment of PHN with special interest in studies on adult vaccination and topical application of lidocaine and concentrated capsaicin patch.
Methods
We searched databases with an English language restriction: MEDLINE 1944–2011, EMBASE 1988–2011, PubMed, and the Cochrane Controlled Trial Register and Cochrane Library (2011). From retrieved publications, we selected studies focusing on our main goals, prevention and treatment of PHN in particular. The review was therefore systematic, but with a pragmatic approach to which studies to select for closer review.
Results
From the large number of abstracts retrieved we selected 65 papers for closer review and as evidence base for our conclusions and recommendations for prevention and treatment of HZ and PHN. The incidence of HZ and risks of having PHN after HZ increases markedly with age above 60–70. Severity of symptoms and their impact on quality of life is a major health problem of persons above 70 years of age. Adult vaccination with the reinforced varicella virus vaccine reduces the incidence of HZ and PHN by about 50%. This is an important health and quality of life gain for the elderly. Antiviral drugs given early in an episode of HZ reduce pain and duration of HZ and decrease the risk of PHN.
Pharmacological management of PHN are with nortriptyline (or amitriptyline in the younger patients), and or a gabapentinoid as first line drugs. Early treatment also is with topical lidocaine for immediate but short-lasting relief of burning hyperalgesia, and topical capsaicin relieving hypersensitivity for up to 12 weeks. A number of second and third line drugs have less evidence-base for effect, and often more adverse effects than the first line drugs: serotonin and noradrenaline uptake inhibitors (venlafaxin, duloxetin), antiepileptics (valproate), and opioid analgesics. Opioids are indicated for bridging in patients with severe PHN-symptoms while waiting for the more specific first line drugs to take effect. In these elderly patients, systemic pharmacological treatments are always a difficult balance between effects and adverse effects. It is important with close supervision of the patients, especially during start-up of systemically administered drugs, in order to prevent tragic complications from falls in sedated, dizzy, and confused elderly patients. Topical treatment with lidocaine and capsaicin patches does not have these problems.
Conclusions
Prevention of this significant health problem of the increasing elderly population is now possible through adult vaccination against varicella zoster virus (VZV) reactivation, as well as vigorous and early antiviral treatment during acute HZ. The evidence -base supports the oral use of tricyclic antidepressants, gabapentinoids, and opioids for bridging till the first line drugs take effect. Topical therapy with lidocaine and capsaicin patches is effective and well supported by evidence. A number of second and third line drugs and treatments are available, but have less evidence-base. All drug treatments, except topical lidocaine and capsaicin, have adverse effects that are often problematic and can be dangerous in the elderly patients. Close supervision of the patients is mandatory.
Implications
Recent advances in prevention and management of this serious health problem should be better known and implicated: Adult vaccination for prevention of varicella zoster virus reactivation, antiviral drugs and combinations of drugs can reduce the suffering from acute HZ and chronic PHN. Topical lidocaine and capsaicin are now evidence-based therapies that reduce suffering from hypersensitivity and hyperalgesia in patients with PHN. When properly applied, they have few complications.
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Affiliation(s)
- Ewa Gawecka
- Oslo University Hospital , Department of Pain Management and Research , Rikshospitalet , Oslo , Norway
- Oslo University Hospital , Department of Anaesthesiology and Intensive Care Medicine , Rikshospitalet , Oslo , Norway
| | - Oddbjørn Viken
- Oslo University Hospital , Department of Pain Management and Research , Rikshospitalet , Oslo , Norway
- Oslo University Hospital , Department of Anaesthesiology and Intensive Care Medicine , Rikshospitalet , Oslo , Norway
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Chen YH, Rau RH, Keller J, Lin HC. Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries. Br J Anaesth 2012; 108:278-82. [DOI: 10.1093/bja/aer386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
BACKGROUND During the past decade, important advances have been made in understanding the epidemiology, pathogenesis, prevention and treatment of post herpetic neuralgia pain as well as treatment of other neuropathic pain conditions. PHN is accepted as a model for management and clinical trials of neuropathic pain of less clear etiologies. In palliative medicine, where the etiology of pain may be nociceptive, neuropathic, or mixed, it is frequently to the research on PHN that we turn in order to extrapolate the data to the patients at hand. OBJECTIVE To review and summarize what is known about epidemiology, pathogenesis, clinical features and prevention strategies for post herpetic neuralgia. Discuss the available including the most recent therapeutic options as regards to their mechanism of action, efficacy, safety and tolerability in an attempt to explain the rationale for their use. CONCLUSION A multidisciplinary and integrative approach has the best chance of success in the management of patients with PHN pain, a problem that can be often frustrating to the patient and challenging to the clinician. Prevention strategies for PHN include administration of zoster vaccine, treatment with antiviral therapy within 72 hours of rash onset and aggressive pain control. First and second line pharmacotherapy include anticonvulsants, antidepressants, topical lidocaine, high dose capsaicin, and opioids either used individually or in combination. Interventional techniques play a limited role in the management of PHN although some data indicate that Intrathecal methylprednisolone and spinal cord stimulation may be effective.
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Affiliation(s)
- Annie Philip
- Department of Anesthesiology and Physical Medicine and Rehabilitation, University of Rochester, School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Kang JH, Sheu JJ, Kao S, Lin HC. Increased risk of multiple sclerosis following herpes zoster: a nationwide, population-based study. J Infect Dis 2011; 204:188-92. [PMID: 21653524 DOI: 10.1093/infdis/jir239] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED (See the editorial commentary by Corona and Flores, on pages 177-8.) OBJECTIVE Varicella zoster virus (VZV) has been proposed to be involved in the pathogenesis of multiple sclerosis (MS). However, the epidemiological data regarding the MS occurrence rate following herpes zoster are still scanty. The goal of this study is to investigate the frequency and risk for MS following occurrence of herpes zoster. METHODS This study used the Taiwan National Health Insurance Research Database. A total of 315,550 patients with herpes zoster were included as the study group, and the control group consisted of 946,650 randomly selected subjects. The stratified Cox proportional hazard regression was performed to calculate the 1-year MS-free survival rate. RESULTS Of 1,262,200 sampled patients, 29 from the study group (.009%) and 24 from the control group (.003%) had MS during the 1-year follow-up period. After adjusting for monthly income and geographic region, the hazard of MS was 3.96 times greater (95% CI = 2.22-7.07, p < 0.001) for the study group than controls. CONCLUSIONS Our findings support the notion that occurrence of MS could be associated with herpes zoster attack. We found a significantly higher risk for MS within 1 year of herpes zoster attack compared with the control population.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University, Taipei, Taiwan
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Emad MR, Emad M, Taheri P. The efficacy of intradermal injection of botulinum toxin in patients with post-herpetic neuralgia. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:323-7. [PMID: 22737488 PMCID: PMC3371972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/01/2010] [Accepted: 12/10/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several treatments have been suggested in shingles viral infection caused by Varicella zoster virus that may lead to complications such as PHN (Post-herpetic neuralgia). Intradermal injection of botulinum toxin was shown with few side effects. This study evaluates the efficacy of intradermal injection of botulinum toxin in patients suffering from PHN. METHODS Fifteen patients suffering from PHN for more than1 month were enrolled. Data collected were patients' age, sex, and lesion site, the dermatome involved and the duration and severity of pain by visual analog scale (VAS). Botulinum (15 units /every 10 cm(2) of body involved) was injected intradermally. The patients were followed 2, 14 and 30 days after injection. RESULTS Of participants, 6 were males and 9 females. The mean age was 60 years and the mean duration of neuralgia was 6.5 months. The mean VAS on day 2 was 6.4, on day 14 was 7.2 and after 30 days was 7.6. The overall pain after injection decreased but was not significant. CONCLUSION It seems that intradermal injection of botulinum toxin decreases pain in PHN patients and this decrease is less prominent by passing time.
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Affiliation(s)
- M R Emad
- Department of Physical Medicine and Rehabilitation,Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Emad
- Department of Dermatology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Taheri
- Department of Physical Medicine and Rehabilitation,Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Park KS, Yoon TR, Kim SK, Park HW, Song EK. Acute postoperative herpes zoster with a sciatic nerve distribution after total joint arthroplasty of the ipsilateral hip and contralateral knee. J Arthroplasty 2010; 25:497.e11-5. [PMID: 19056216 DOI: 10.1016/j.arth.2008.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 10/10/2008] [Indexed: 02/01/2023] Open
Abstract
The differential diagnosis of a patient with acute onset of hip pain during the postoperative recovery period after total hip arthroplasty includes sciatic nerve injury, infection, incisional pain, hardware, or simply muscular issues related to overactivity. Moreover, because the rash of herpes zoster develops after 4 or 5 days of pain, it is difficult to diagnose herpes zoster during the early period. A number of reports have been issued on herpes zoster after surgery or trauma, but no report is available on herpes zoster development with a sciatic nerve distribution after ipsilateral total hip arthroplasty. The authors report the case of 75-year-old woman with herpes zoster with a sciatic nerve distribution after 2 primary total joint arthroplasties of a hip and knee.
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Affiliation(s)
- Kyung Soon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
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Kang JH, Ho JD, Chen YH, Lin HC. Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Stroke 2009; 40:3443-8. [PMID: 19815828 DOI: 10.1161/strokeaha.109.562017] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design. Method- A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate. RESULTS Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control (P<0.001). The adjusted hazard ratios of stroke after herpes zoster and herpes zoster ophthalmicus during the 1-year follow-up period were 1.31 and 4.28, respectively. CONCLUSIONS The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, the Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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21
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Helgason S, Sigurdsson JA, Gudmundsson S. The clinical course of herpes zoster: A prospective study in primary care. Eur J Gen Pract 2009. [DOI: 10.3109/13814789609161651] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? THE LANCET. INFECTIOUS DISEASES 2004; 4:26-33. [PMID: 14720565 DOI: 10.1016/s1473-3099(03)00857-0] [Citation(s) in RCA: 378] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reactivation of latent varicella zoster virus as herpes zoster is thought to result from waning of specific cell-mediated immunity, but little is known about its determinants in individuals with no underlying immunosuppression. We systematically reviewed studies of zoster epidemiology in adults and analysed data from a large morbidity study to identify factors that might be modulated to reduce the risk of zoster. Annual zoster incidence in population-based studies varied from 3.6-14.2/10(3) in the oldest individuals. Risk factors identified in analytical studies that could explain this variation included age, sex, ethnicity, genetic susceptibility, exogenous boosting of immunity from varicella contacts, underlying cell-mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. Our review highlights the lack of information about risk factors for zoster. We suggest areas of research that could lead to interventions to limit the incidence of zoster. Such research might also help to identify risk factors for age-related immune decline.
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Affiliation(s)
- Sara L Thomas
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
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Termorshuizen F, Hogewoning AA, Bouwes Bavinck JN, Goettsch WG, de Fijter JW, van Loveren H. Skin infections in renal transplant recipients and the relation with solar ultraviolet radiation. Clin Transplant 2003; 17:522-7. [PMID: 14756268 DOI: 10.1046/j.0902-0063.2003.00099.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ultraviolet radiation (UVR) is an important risk factor for skin cancer in transplant recipients. In view of the potential suppressive effect of UVR on host resistance it was examined whether exposure to UVR was also associated with the occurrence of various skin infections. METHODS In a cohort of renal transplant recipients (n = 137), lifetime exposure was assessed by means of a retrospective questionnaire on cumulative sunlight exposure. Diagnosed skin infections since renal transplantation were extracted from the patient's medical charts. Season of diagnosis was regarded as indicative of short-term exposure. RESULTS In comparison with winter a high rate of herpes simplex infections was found in spring [rate ratio (RR) = 4.09, 95% confidence interval (CI) 1.2-14.5], and high rates of herpes zoster infections (RR = 1.6, 95% CI: 0.8-3.5) and fungal/yeast infections in summer (RR = 2.1, 95% CI: 1.3-3.4). A higher lifetime exposure (RR = 2.31, 95% CI: 1.04-5.1) and a greater cumulative number of reported sunburns (RR = 2.3, 95% CI: 1.1-5.1) were independently associated with a higher risk of bacterial infections. CONCLUSIONS The seasonal association with the occurrence of clinical herpes infections indicates an effect of short-term UVR. Our data suggest that the number of sunburn episodes in the past is also relevant for the susceptibility to certain skin infections.
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Affiliation(s)
- F Termorshuizen
- Laboratory for Toxicology, Pathology and Genetics, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Wassilew SW, Wutzler P. Oral brivudin in comparison with acyclovir for improved therapy of herpes zoster in immunocompetent patients: results of a randomized, double-blind, multicentered study. Antiviral Res 2003; 59:49-56. [PMID: 12834860 DOI: 10.1016/s0166-3542(03)00065-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Brivudin [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a nucleoside analogue with a high and selective antiviral activity against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The double-blind, randomized study presented here compared efficacy and safety of oral brivudin 1 x 125 mg and acyclovir 5 x 800 mg, both for 7 days, in 1227 immunocompetent patients with herpes zoster. Main results were as follows: brivudin was superior to acyclovir in accelerating the "time to last formation of new vesicles" (primary parameter; risk ratio(ITT): 1.13, P=0.014). Equivalent effects of brivudin and acyclovir were observed for the secondary parameters "time to first crust" (RR(ITT): 0.93, P=0.004), "time to full crusting" (risk ratio(ITT): 1.03, P<0.001), and "time to loss of crusts" (RR(ITT): 0.95, P=0.002). The incidence of potentially treatment-related adverse events was similar under brivudin (7.7%) and acyclovir (10.0%). In conclusion, brivudin proved to be more effective than acyclovir in terminating vesicle formation, the parameter which reflects the end of viral replication, thus confirming, in the clinical setting, the greater in vitro antiviral activity of brivudin. Compared with acyclovir, brivudin provides a similar safety profile and a significant improvement in efficacy.
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Affiliation(s)
- Sawko W Wassilew
- Dermatological Department, Klinikum Krefeld, Lutherplatz 40, D-47805, Krefeld, Germany.
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25
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Gross G, Schöfer H, Wassilew S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP, Wutzler P, Doerr HW. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol 2003; 26:277-89; discussion 291-3. [PMID: 12637076 DOI: 10.1016/s1386-6532(03)00005-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Varicella zoster virus (VZV) causes varicella (chickenpox), remains dormant in dorsal root and cranial nerve ganglia and can be reactivated as a consequence of declining VZV-specific cellular immunity leading to herpes zoster (shingles). Patients older than 50 years of age affected by herpes zoster may suffer a significant decrease of quality of life. These patients and immunocompromised individuals are at increased risks for severe complications, involving the eye, the peripheral and the central nervous system (prolonged pain, postherpetic neuralgia). Such complications occur with and without cutaneous symptoms. The German Dermatology Society (DDG) has released guidelines in order to guarantee updated management to anyone affected by herpes zoster. Diagnosis is primarily clinical. The gold standard of laboratory diagnosis comprises PCR and direct identification of VZV in cell cultures. Detection of IgM- and IgA-anti VZV antibodies may be helpful in immunocompromised patients. Therapy has become very effective in the last years. Systemic antiviral therapy is able to shorten the healing process of acute herpes zoster, to prevent or to alleviate pain and other acute and chronic complications, particularly, when given within 48 h to a maximum of 72 h after onset of the rash. Systemic antiviral therapy is urgently indicated in patients beyond the age of 50 years and in patients at any age with herpes zoster in the head and neck area, especially in patients with zoster ophthalmicus. Further urgent indications are severe herpes zoster on the trunk and on the extremities, herpes zoster in immunosuppressed patients and in patients with severe atopic dermatitis and severe ekzema. Only relative indications for antiviral therapy exist in patients younger than 50 years with zoster on the trunk and on the extremities. In Germany acyclovir, valacyclovir, famciclovir and brivudin are approved for the systemic antiviral treatment of herpes zoster. These compounds are all well tolerated by the patients and do not differ with regard to efficacy and safety. Brivudin has a markedly higher anti-VZV potency than oral acyclovir, valacyclovir and famciclovir and thus offers a simpler dosing regimen. It must be given only once daily during 7 days in comparison to three and five times dosing per day of valacyclovir, famciclovir and acyclovir, respectively. Brivudin is an antiviral agent with no nephrotoxic properties, which is an advantage when compared to acyclovir. The most important aim of therapy of herpes zoster is to achieve painlessness. Appropriately dosed analgesics in combination with a neuroactive agent (i.e. amitriptylin) are very helpful when given together with antiviral therapy. The additive therapy with corticosteroids may shorten the degree and duration of acute zoster pain, but has no essential effect on the development of postherpetic neuralgia, which is a very difficult condition to treat. Thus early presentation to a pain therapist is recommended in specific cases.
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Affiliation(s)
- G Gross
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Rostock, Augustenstr. 80-84, D-18055, Rostock, Germany.
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Ostermann ME, Gyawali P, Snowden SA, Eastwood JB, Streather CP. A 67-year-old kidney transplant patient with headache of uncertain origin. Nephrol Dial Transplant 2002; 17:508-10. [PMID: 11865103 DOI: 10.1093/ndt/17.3.508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chidiac C, Bruxelle J, Daures JP, Hoang-Xuan T, Morel P, Leplège A, El Hasnaoui A, de Labareyre C. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis 2001; 33:62-9. [PMID: 11389496 DOI: 10.1086/320884] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2000] [Revised: 11/16/2000] [Indexed: 11/04/2022] Open
Abstract
There have been many epidemiological studies of chickenpox but only a few of herpes zoster. We report data from an observational study, conducted in France during a 1-year period, of 9038 patients who presented with acute herpes zoster (n = 8103) or postherpetic neuralgia (PHN; n = 935) at the office practices of 4635 general practitioners or dermatologists. The incidence of herpes zoster in France was found to be similar to that in the literature: from 1.4 to 4.8 cases per 1000 population per year. The patient profiles and clinical patterns were delineated, as well as the management decisions made according to the type of treating physician. The impact of herpes zoster on quality of life was evaluated on the basis of the Medical Outcome Study Short Form 36 (MOS SF 36) scale, which is widely used for assessing quality of life in the field of health. This study provides reference data on the substantial deterioration in quality of life associated with herpes zoster and PHN.
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Affiliation(s)
- C Chidiac
- Department of Infectious and Tropical Diseases-AIDS Reference Center, University Claude Bernard, Lyon, France.
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Affiliation(s)
- L P Ang
- Singapore National Eye Centre, Singapore
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Abstract
Herpes zoster is cause of considerable morbidity, especially among elderly patients, with a suggestion of a slight increase in incidence among female patients. Substantial research on the biology of the varicella zoster virus has led to advances in our knowledge of the pathophysiology of the disease along with more successful therapy for the acute episodes of herpes zoster. Ophthalmic zoster is more common than zoster in other cranial nerves and is associated with pronounced suffering. This article reviews the epidemiology, biology, and latency of herpes zoster, discusses the pathophysiology of the disease, and describes treatment options with antivirals and corticosteroids. The pathophysiology and treatment options for postherpetic neuralgia are also addressed. The varicella vaccine is now available, and initial results suggest that this may lessen the effect of herpes zoster in the future.
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Affiliation(s)
- T J Liesegang
- Department of Ophthalmology, Mayo Clinic Jacksonville, FL 32224, USA
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Arndt V, Vine MF, Weigle K. Environmental chemical exposures and risk of herpes zoster. ENVIRONMENTAL HEALTH PERSPECTIVES 1999; 107:835-41. [PMID: 10504152 PMCID: PMC1566619 DOI: 10.1289/ehp.99107835] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study investigated whether residence in Aberdeen, North Carolina, the location of the Aberdeen pesticides dumps site (a national priority list Superfund site containing organochlorine pesticides, volatile organic compounds, and metals), is associated with immune suppression as indicated by a higher incidence of herpes zoster and recent occurrences of other common infectious diseases. Study participants included 1,642 residents, 18-64 years of age, who responded to a telephone survey concerning potential occupational and recreational exposures to pesticides and other chemicals, lifetime history of herpes zoster (shingles), and the recent occurrence of other common infectious diseases. Stratified and logistic regression analyses were used to compare the cumulative incidence of herpes zoster among Aberdeen residents and residents of nearby communities. There was little evidence of an overall increased risk of herpes zoster among Aberdeen residents during the period 1951-1994 [relative risk (RR), 1.3; 95% confidence interval (CI), 0.8-2.1]. However, an elevated risk of herpes zoster was noted consistently among Aberdeen residents of younger ages as compared to residents of the nearby communities. The RR was 2.0 (CI, 1.0-4.0) among those 18-40 years of age and was not affected by controlling for potential confounders. The RR of herpes zoster was also consistently elevated in all age groups for the period before 1985. No differences were noted between residents of Aberdeen and those of the nearby communities with respect to the recent occurrence of other common infectious diseases. These results support the plausibility of an association between exposure to the Aberdeen pesticides dumps site and immune suppression and the potential use of herpes zoster as a marker of immune suppression in studies of environmental chemical exposures.
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Affiliation(s)
- V Arndt
- Department of Epidemiology, University of Ulm, Ulm, Germany
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di Luzio Paparatti U, Arpinelli F, Visonà G. Herpes zoster and its complications in Italy: an observational survey. J Infect 1999; 38:116-20. [PMID: 10342652 DOI: 10.1016/s0163-4453(99)90079-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To estimate the rate of Herpes zoster and its complications in Italy. METHODS this is an observational, retrospective study carried out by Dermatologists, Geriatric Doctors and General Practitioners. Details on demography, clinical and therapeutic aspects were reported on record forms. The rate of Herpes zoster was only calculated for patients aged 15 years or more, attending General Practitioners because this was the only group where the number of patients at risk was known. The hypothesis that the rate of complications depends on sex, age and number of affected dermatomes was explored through univariate (Chi-square tests) and multivariate (logistic regression) analysis. RESULTS the number of cases of Herpes zoster examined by General Practitioners was 4.1 persons aged 15 years or more/1000/year. Usually, only one dermatome was affected, most frequently the thoracic one. Overall the rate of complications was 26.1% The rate of complications is significantly higher (P = 0.001) in patients with two or more affected dermatomes, it is positively correlated to age while difference by sex is not significant (P = 0.297). Practically all patients received treatment for their disease. CONCLUSIONS this is the first epidemiological study on Herpes zoster that has been conducted in Italy. It indicates that annually there are about 200 000 people aged 15 years and over suffering from Herpes zoster in Italy, with a considerable number of cases of post herpetic neuralgia.
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Carlton S, Evans T, Tyring SK. New antiviral agents for dermatologic disease. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1998; 17:243-55. [PMID: 9859911 DOI: 10.1016/s1085-5629(98)80020-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The topic of antiviral agents for dermatologic disease is an area that is rapidly changing and expanding as our knowledge of herpes viruses, HIV, and human papilloma viruses continues to expand. New drugs are continuing to make therapy for these viruses more efficacious day by day. This review will discuss the recent advances in antiviral therapy, new therapies currently being developed or studied, and the future of antiviral vaccines.
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Affiliation(s)
- S Carlton
- Department of Dermatology, University of Texas Medical Branch, Galveston 77555, USA
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Abstract
Postherpetic neuralgia (PHN) is a neuropathic pain disorder that occurs most often in the elderly. This painful condition is uniquely suited for clinical research, resulting in an emerging understanding of the pathophysiology of the persistent pain. Until recently, only the tricyclic antidepressants proved effective for PHN. Controlled trials of a wide variety of therapeutic strategies are in progress or have been recently completed.
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Affiliation(s)
- R S Cluff
- Department of Neurology, Pain Clinical Research Center, University of California, San Francisco 94115, USA
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Abstract
OBJECTIVES To follow the clinical course of herpes zoster and to determine the incidence, frequency of complications and association with malignancy in children and adolescents. DESIGN Prospective cohort study in a primary health care setting in Iceland. The main outcome measures were age and sex distribution of patients and discomfort or pain 1, 3 and 12 months after the rash and general health before and 3 to 6 years after the zoster episode. RESULTS During observation of the target population for a period of 75750 person years, 121 episodes of acute zoster developed (incidence 1.6/1000/year) in 118 patients. End points were gained for all 118 patients after 554 person years of follow-up. Systemic acyclovir was never used. No patient developed postherpetic neuralgia, moderate or severe pain or any pain lasting longer than 1 month from start of the rash (95% confidence interval, 0 to 0.03). Potential immunomodulating conditions were diagnosed in 3 patients (2.5%) within 3 months of contracting zoster. Only 5 (4%) had a history of severe diseases. CONCLUSIONS The probability of postherpetic neuralgia in children and adolescents is extremely low. Zoster is seldom associated with undiagnosed malignancy in the primary care setting.
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Affiliation(s)
- G Petursson
- Department of Family Medicine, University of Iceland, Reykjavik
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35
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Kakourou T, Theodoridou M, Mostrou G, Syriopoulou V, Papadogeorgaki H, Constantopoulos A. Herpes zoster in children. J Am Acad Dermatol 1998; 39:207-10. [PMID: 9704830 DOI: 10.1016/s0190-9622(98)70076-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical studies of series of children with herpes zoster (HZ) are rather limited. OBJECTIVE The purpose of this study was to evaluate the epidemiologic conditions, clinical manifestations, therapy, and outcome of HZ in children. METHODS Twenty-one patients with HZ have been studied. Five patients who had herpes simplex virus infection were excluded. The laboratory diagnosis was made by fluorescent techniques. Acyclovir was administered systematically for 2 more days after no new lesions had developed. RESULTS Thirteen patients (group A) were immunocompromised; eight patients (group B) were otherwise healthy. Two patients from group B had intrauterine varicella; the other six patients had had varicella under the age of 4 years. Three patients were recently exposed to varicella. The duration of HZ was significantly longer in group A than in group B, but the outcome was good in all patients. CONCLUSION Herpes simplex virus infection may simulate the pattern of HZ; varicella in early childhood is a risk factor for HZ in otherwise healthy children; exposure of a child to varicella may cause reactivation of latent HZ virus; and acyclovir therapy within 3 days of exanthem onset prevents significant morbidity and death in immunocompromised children with HZ.
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Affiliation(s)
- T Kakourou
- First Department of Pediatrics, Athens University, Greece
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36
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Goh CL, Khoo L. A retrospective study on the clinical outcome of herpes zoster in patients treated with acyclovir or valaciclovir vs. patients not treated with antiviral. Int J Dermatol 1998; 37:544-6. [PMID: 9679698 DOI: 10.1046/j.1365-4362.1998.00472.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C L Goh
- Institute of Dermatology, Singapore, National Skin Centre, Singapore
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37
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Torrens J, Nathwani D, MacDonald T, Davey PG. Acute Herpes zoster in Tayside: demographic and treatment details in immunocompetent patients 1989-1992. J Infect 1998; 36:209-14. [PMID: 9570656 DOI: 10.1016/s0163-4453(98)80015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical records of 105 patients admitted to Tayside hospitals with acute Herpes zoster without underlying immunosuppression were examined retrospectively for the period 1984-1992. In this elderly population (median age: 79 years) there was a female preponderance (70.5%), most admissions were for trigeminal zoster (49.5%) and length of stay ranged from 1-70 days (median: 11 days), indicating significant morbidity. There was a wide variation in both pre-admission and inpatient treatment; 53.3% of patients did not receive any anti-viral therapy prior to admission, and prescribing patterns for in-patients revealed marked differences, according to the dermatome affected. Idoxuridine 5% solution was prescribed by 15.24% of General Practitioners. Given the significant morbidity and associated costs of Herpes zoster, and that existing anti-viral agents exert maximal benefit when administered early in the course of the disease, recommendations are made with respect to appropriate therapy, and auditing current management of this serious illness, which is expected to increase in prevalence as the population ages.
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Affiliation(s)
- J Torrens
- Infection and Immunodeficiency Unit, Kings Cross Hospital, Dundee Teaching Hospitals NHS Trust, Dundee, UK
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Affiliation(s)
- G P Garnett
- Wellcome Centre for the Epidemiology of Infectious Disease, University of Oxford, Department of Zoology, South Parks Road, Oxford OX1 3PS, UK
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Affiliation(s)
- R G Kost
- Medical Virology Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
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Abstract
Three cases of orbital inflammatory disease caused by herpes zoster are described. This extremely rare complication occurred between 5 days and 14 days following the skin eruption and slowly resolved with or without treatment. Biopsy of a chronic inflammatory lesion on the cheek of one patient demonstrated a sterile vasculitis and granulomatous liponecrosis, a process which may underlie the orbital disease in these patients.
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Affiliation(s)
- S J Vardy
- Orbital and Adnexal Service, Moorfields Eye Hospital, London, UK
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Abstract
A current review of ophthalmic zoster is presented including its virology, immunology, epidemiology and pathogenesis. We give our findings in 1356 patients referred to the Zoster Clinic at Moorfields Eye Hospital, London. The treatment of the disease and its ocular complications is discussed.
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Affiliation(s)
- R J Marsh
- Department of Clinical Ophthalmology, Moorfields Eye Hospital, London, UK
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Abstract
We describe a 77-year-old women with cutaneous herpes zoster in the area of the right T9-T11 dermatomes complicated by abdominal muscle paralysis. Four months after onset of paralysis, stimulation of appropriate intercostal nerves failed to evoke responses from the corresponding segments of the rectus abdominis muscle. Three months later EMG of these muscle segments revealed profuse denervation activity and spontaneous long-lasting burst of high frequency discharges. Magnetic stimulation applied transcranially and peripherally at T10 evoked responses from the left, but not from the right paralytic rectus abdominis muscle. Electric stimulation of right T10 elicited a markedly delayed, prolonged and polyphasic response in the transverse abdominis muscle and EMG revealed polyphasia and increased motor unit potential duration in muscle segments underlying herpes zoster eruption. One and a half years after onset, the paralysis of the rectus abdominis muscle was still present. A survey of the literature concerning this rare type of zoster paralysis is presented.
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Affiliation(s)
- P Gottschau
- Medical Department, Roskilde County Hospital, Køge, Denmark
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