1
|
Itagaki H, Suzuki J, Imai H, Endo T, Endo S, Kaku M. A retrospective observational study on disseminated herpes zoster in immunocompetent patients. J Infect Chemother 2024:S1341-321X(24)00187-9. [PMID: 39002859 DOI: 10.1016/j.jiac.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/18/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Disseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies. METHODS We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients. RESULTS Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower. CONCLUSIONS This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.
Collapse
Affiliation(s)
- Hideya Itagaki
- Division of Infectious Diseases and Infection Control, Department of Social and Community Medicine, Graduate School of Medicine, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan; Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan.
| | - Jun Suzuki
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan
| | - Haruka Imai
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan
| | - Tomoyuki Endo
- Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Shiro Endo
- Division of Infectious Diseases and Infection Control, Department of Social and Community Medicine, Graduate School of Medicine, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan; Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan; Division of Crisis Management Network for Infectious Diseases, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8536, Japan
| | - Mitsuo Kaku
- Division of Infectious Diseases and Infection Control, Department of Social and Community Medicine, Graduate School of Medicine, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan; Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan; Division of Crisis Management Network for Infectious Diseases, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8536, Japan
| |
Collapse
|
2
|
Yogi TN, Bhusal A, Subedi S, Katwal S, Acharya K. Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights. Ann Med Surg (Lond) 2023; 85:6231-6236. [PMID: 38098591 PMCID: PMC10718367 DOI: 10.1097/ms9.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and Importance Herpes zoster (HZ), a reactivated varicella zoster virus infection arising from dormant viral latency after initial chickenpox, manifests as localized skin rashes along dermatomes. Multidermatomal involvement, especially in immunocompetent individuals, is rare. The potential link between psychological stress and HZ reactivation remains underexplored. The authors present a case of multidermatomal HZ triggered by psychological stress in a young immunocompetent adult. Case presentation A 26-year-old male presented with vesicular lesions spanning C5, C8, T1, and T2 dermatomes, triggered by psychological stress. The disease exhibited a unique midline-crossing presentation. The Varicella zoster virus IgM test result was positive. Treatment included acyclovir, pain management, and stress reduction strategies, yielding complete resolution within 3 weeks. Clinical discussions The case highlights a distinctive multidermatomal HZ presentation, defying conventional dermatomal restrictions. Psychological stress potentially influenced viral reactivation. Immunocompetence and stress interplay merit further exploration. Multidermatomal HZ necessitates prompt clinical recognition and comprehensive evaluation. Antiviral therapy and integrated stress management may contribute to successful outcomes. Conclusion This case underscores the rare occurrence of multidermatomal HZ in an immunocompetent young adult triggered by psychological stress. The atypical presentation and potential role of stress in viral reactivation emphasize the complex interaction between the nervous and immune systems. Integrated clinical management, stress reduction strategies, and antiviral therapy were effective in resolving the condition. Further research is warranted to elucidate the mechanisms underlying stress-induced viral reactivation and its clinical implications.
Collapse
Affiliation(s)
| | - Amrit Bhusal
- Department of Dermatology and Venerology, BP Koirala Institute of Health Sciences (BPKIHS)
| | - Suman Subedi
- Department of Dermatology and Venerology, BP Koirala Institute of Health Sciences (BPKIHS)
| | | | - Kshitiz Acharya
- Department of Dermatology and Venereology, Tribhuvan University Institute of Medicine
| |
Collapse
|