Association between Chronic Interstitial Cystitis and Herpes Zoster

PD-L1 Expression in Nonbacterial Chronic Cystitis and Bladder Cancer

INTRODUCTION AND HYPOTHESIS

The objective was to assess PD-L1 expression in nonbacterial chronic cystitis (NCC) and bladder cancer (BC).

METHODS

The present study included 20 NCC and 20 BC patients. The degree of inflammation of the bladder wall was assessed on slides stained with H&E. Viral pathogens (herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and high-risk HPVs) were detected using real-time polymerase chain reaction analyses of the bladder specimens. Immunohistochemistry was performed to assess the PD-L1 expression in bladder tissue.

RESULTS

Expression of PD-L1 was detected in 40% of NCC patients and 85% of BC patients. Viral pathogens were found in 50% of NCC patients and 60% of BC patients, with EBV being the most common. In NCC patients the immune cell score correlated strongly with the degree of inflammatory infiltration of the bladder wall (r = 0.867, p < 0.001), the presence of lymphoid aggregates in the submucosa (r = 0.804, p < 0.001), koilocytosis (r = 0.620, p = 0.004), and the presence of viral pathogens (r = 0.784, p < 0.001). In BC patients the immune cell score correlated with the degree of inflammatory infiltration of the bladder wall (r = 0.534, p = 0.015) and the presence of viral pathogens (r = 0.626, p = 0.003), but not with the presence of lymphoid aggregates in the submucosa (r = 0.083, p = 0.729), and koilocytosis (r = 0.366, p = 0.112).

CONCLUSIONS

Expression of PD-L1 was detected in a cohort of NCC patients, although the PD-L1 positivity rate was lower than that in BC. Our results demonstrate that the degree of PD-L1 expression in bladder tissue is associated with the presence of viral infections and with the degree of inflammatory infiltration of the bladder wall in both NCC and BC.

Risk of Herpes Zoster in Patients with Pulmonary Tuberculosis-A Population-Based Cohort Study

BACKGROUND

Pulmonary tuberculosis (TB), a global health problem, is typically caused by the bacterium Mycobacterium tuberculosis. Herpes zoster (HZ) is caused by the reactivation of the varicella-zoster virus (VZV). The reactivation of VZV can be caused by stress. We investigated whether pulmonary TB increases the risk of HZ development.

METHODS

This study used data that sampled a population of 2 million people in 2000 from the National Health Insurance Research Database. This cohort study observed Taiwanese patients aged 20-100 years with pulmonary TB from 2000 to 2017 (tracked to 2018). Pulmonary TB was defined as having two or more outpatient diagnoses or at least one admission record. To address potential bias caused by confounding factors, the control cohort and pulmonary TB cohort were matched 1:1 by age, gender, index year, and comorbidities. Patients with HZ before the index date were excluded.

RESULTS

A total of 30,805 patients were in the pulmonary TB and control cohorts. The incidence rate of HZ in pulmonary TB and control cohorts were 12.00 and 9.66 per 1000 person-years, respectively. The risk of HZ in the pulmonary TB cohort (adjusted hazard ratios = 1.23; 95% confidence interval = 1.16-1.30) was significantly higher than that of in control cohort. Among patients without comorbidities, the patients with TB were 1.28-fold more likely to have HZ than those without TB.

CONCLUSION

Patients with TB should be well treated to avoid the potential risk of HZ occurrence. Although we identified the association between pulmonary TB and HZ, further studies are needed to confirm the result.

Etiological factors of voiding disorders in females

Background. Voiding disorders in females are a serious medical and social problem. Various urological, gynecological, and neurological factors contribute to the development of these disorders. Aim. To study etiological factors of voiding disorders in females. Materials and methods. A total of 52 women 19 to 81 years of age with various voiding disorders were inspected. Examination algorithm included collection of a comprehensive medical history, filling in voiding diaries, gynecological exam, various laboratory tests (including PCR-diagnostics of urethral scrapings; ELISA tests for IgM and IgG to herpes simplex virus types 1 and 2, Varicella Zoster virus, EpsteinBarr virus, cytomegalovirus; vaginal discharge culture for flora and sensitivity to antibiotics, with mandatory determination of the lactobacilli count) and diagnostic methods, as well as consultations by related specialists. Results. Chronic herpesvirus infection contributed to urinary dysfunction in 28 (53.8%) women, bacterial urinary tract infection in 15 (28.8%), bacterial vaginosis in 15 (28.8%), papillomavirus infection in 12 (23.1%), and interstitial cystitis in 10 (19.2%) patients. Thirty-five (76.9%) women had several simultaneous factors that contributed to the development of voiding disorders. Conclusion. The combination of disorders of the vaginal microflora with viral and/or bacterial infections most often contributes to the development of voiding disorders.

Chondromalacia patella increases the risk of herpes zoster: a population-based study

BACKGROUND

The reactivation of herpes zoster (HZ) is associated with disease stress. However, the relationship between chondromalacia patella (CMP) and HZ remains poorly understood. This study investigated the relationship between CMP and the risk of developing HZ.

METHODS

Data were collected from the Taiwan's National Health Insurance Research Database. Patients with CMP diagnosed between 2000 and 2017 were assigned to the case group; patients without CMP were randomly selected from the same database and paired with controls matched by age and sex. The primary outcome was a diagnosis of HZ. All patients were followed until their diagnosis of HZ, their withdrawal from the NHI program, their death, or the end of 2017, whichever was earliest. The risk of developing HZ was compared between the case and control groups.

RESULTS

In total, 22,710 patients with CMP and 90,840 matched controls were enrolled. The overall incidence rates of HZ in the CMP and control cohorts were 7.94 and 7.35 per 1,000 person-years, respectively. After potential confounders were controlled for, the case group exhibited a higher risk of HZ than did the control group [adjusted hazard ratio (aHR) = 1.06, p < 0.05]. In a stratification analysis by age, patients over 65 years old in the CMP group exhibited a higher risk of HZ than did those in the control group (aHR = 1.22, p < 0.01). In a stratification analysis by sex, women with CMP were at greater risk of developing HZ than women without CMP (aHR = 1.18, p < 0.01).

CONCLUSION

Patients with CMP, especially elder adults and women, exhibited a higher risk of HZ. The HZ risk of patients with CMP should thus be assessed, and the necessity of HZ vaccination should be informed.

The Risk of Herpes Zoster in Women with Polycystic Ovary Syndrome: A Retrospective Population-Based Study

Background: The association between polycystic ovary syndrome (PCOS) and the risk of herpes zoster (HZ) remains unclear. This study investigated the risk of HZ in women with PCOS. Methods: This study used data from the Longitudinal Generation Tracking Database (LGTD 2005) which contains the information of 2 million randomly selected from National Health Insurance beneficiaries. Patients who received a diagnosis of PCOS between 2000 and 2017 were included in the PCOS cohort. Patients who were not diagnosed as having PCOS were randomly selected from the LGTD 2005 and included in the control cohort. Patients who were aged <20 years and had a history of HZ before the index date were excluded. Patients who were in both the cohorts were matched at a ratio of 1:1 through propensity score matching based on age, comorbidities, and medication. The primary outcome was the diagnosis of HZ. Results: A total of 20,142 patients were included in each case and control cohorts. The incidence rates of HZ in the PCOS and control cohorts were 3.92 and 3.17 per 1000 person-years, respectively. The PCOS cohort had a significantly higher risk of HZ than did the control cohort (adjusted hazard ratios [aHR] = 1.26). Among the patients aged 30−39 years, those with PCOS had a significantly higher risk of HZ than did those without PCOS (aHR = 1.31). Among the patients without any comorbidities, those with PCOS had a significantly higher risk of HZ (aHR = 1.26) than did those without PCOS. Conclusion: PCOS is associated with the risk of HZ, especially in young women. The risk of HZ should be addressed while treating patients with PCOS. An HZ vaccine is recommended for these patients.

Association between de Quervain syndrome and herpes zoster: a population-based cohort study

OBJECTIVE

Both physical diseases such as infection and chronic pain and psychological disorders such as depression have been associated with herpes zoster (HZ) reactivation. However, the relationship between de Quervain syndrome (DQS), a painful tenosynovitis and HZ remains unclear. We investigated whether DQS increases the risk of HZ reactivation.

DESIGN

A retrospective population-based cohort study.

SETTING

Taiwan.

PARTICIPANTS

We used a subset of Taiwan's National Health Insurance Research Database, the Longitudinal Health Insurance Database which contains the registration files and original claims data of 1 million randomly selected individuals from the National Health Insurance programme. The case group in this study comprised patients newly diagnosed with DQS between 2000 and 2012. Individuals without DQS comprised the control group. Cases and controls were 1:1 matched by age, sex and index year (defined as the year of DQS diagnosis).

RESULTS

Approximately 55% of the participants were ≤49 years. Most participants were women (77%). The incidence rate of HZ in the DQS group was 8.39 per 1000 person years. After adjustments for age, sex and comorbidities, patients with DQS had a 1.30 times higher risk of HZ reactivation than the control group. Stratification analysis revealed taht DQS increases the HZ risk in individuals ≤64 years, women, and patients without comorbidities.

CONCLUSION

DQS is associated with an increased risk of HZ. Clinicians should be aware of this risk when dealing with patients with DQS, particularly in young adults.

Plantar fascial fibromatosis and herpes zoster

Purpose

Infection, chronic pain and depression are considered risk factors for herpes zoster (HZ). However, the correlation between plantar fascial fibromatosis (PFF) and HZ remains unknown. This study investigated HZ risk in patients with PFF.

Methods

Data was extracted from the Longitudinal Health Insurance Database 2000, which is a subsample of the Taiwan National Health Insurance (NHI) Research Database and contains 1 million NHI beneficiaries. Between 2000 and 2012, patients diagnosed as having PFF were included in the case cohort. Every case was age and sex-matched with individuals without PFF through 1:4 frequency matching (control cohort). The end of the follow-up was defined as December 31, 2013, the date of HZ diagnosis, death, emigration, or withdrawal from the NHI program.

Results

In total, 4,729 patients were diagnosed as having PFF and were matched with 18,916 individuals without PFF. Patients with PFF were 1.23 times more likely to develop HZ than were those without PFF. Among those aged ≥65 years, patients with PFF had a higher HZ risk than did those without PFF (adjusted hazard ratio [aHR] = 1.48). Men with PFF had a significantly higher risk of HZ than did men without PFF (aHR = 1.44).

Conclusion

Patients with PFF, particularly older and male patients, having a high HZ risk and may thus be vaccinated for HZ.

To Investigate the Risk of Herpes Zoster in Women With Endometriosis: A Taiwan National Population-Based Cohort Study

Background: The objective of this study is to investigate the occurrence of herpes zoster (HZ) in patients with endometriosis.

Methods: This retrospective population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. Between 2000 and 2012, women aged ≥20 years with newly diagnosed endometriosis were enrolled into the endometriosis group. Each patient with endometriosis was randomly matched to 4 controls according to age and index year. All the patients were traced from the index date to HZ diagnosis, loss to follow-up, death, or the end of December 2013.

Results: In total, 19,147 patients with newly diagnosed endometriosis and 76,588 participants without endometriosis were enrolled. The incidence of HZ was higher in endometriosis persons (5.36 per 1,000 person-years) than in matched controls (4.43 per 1,000 person-years) (p < 0.001). After adjustment for age and comorbidities, patients with endometriosis age ≤ 49 years (adjusted hazard ratio [aHR] = 1.17) (p < 0.001) and 50–64 years (aHR = 1.27) (p < 0.05) showed significantly higher risk of HZ than the corresponding controls. Among women without any comorbidities, patients with endometriosis were 1.22 times (p < 0.001) more likely to have HZ than those without endometriosis.

Conclusion: Taiwanese women with endometriosis may have a higher rate of HZ occurrence. Endometriosis seems to be a high burden for affected women. Therefore, we suggest that clinicians should be aware of HZ among women with endometriosis, although there may be ethnic differences.

Risk of herpes zoster infection in men with varicocele

PURPOSE

Several diseases have been identified as stressful factors for herpes zoster (HZ) infection. In this study, we investigated the risk of HZ infection in men with varicocele.

METHODS

We enlisted the data of patients with newly diagnosed varicocele between 2000 and 2012 from the Taiwanese National Health Insurance Research Database as case cohort. Four control patients were matched as per age and index year to a case patient. HZ diagnosis was the primary end point, and the follow-up period was considered as the time interval from the index date to the main outcome, withdrawal from the National Health Insurance program, or end of the study (31 December 2013).

RESULTS

In total, 8720 patients were recruited (1744 with varicocele and 6976 controls); the overall mean age was 36 years. Majority (85%) of the participants were 20-49 years old. HZ incidence was higher in patients with varicocele (5.60 per 1,000 person-years) than in the control group (4.01 per 1,000 person years). Patients with varicocele were 1.37 times more likely to develop HZ than the controls after adjustment. Compared with the control cohort, the adjusted hazards ratio (HR) of the varicocele cohort was higher in patients younger than 49 years old (adjusted HR = 1.60).

CONCLUSION

Men with varicocele had a higher risk of HZ development than those without varicocele, particularly those aged ≤49 years. Thus, stress from varicocele cannot be ignored in young men.

Herpes zoster in patients with sciatica

BACKGROUND

Several diseases are associated with herpes zoster (HZ). However, whether sciatica is a stressor leading to HZ development remains unclear. Here, we evaluated the occurrence of HZ in patients with sciatica.

METHODS

The sciatica cohort consisted of patients first diagnosed as having sciatica between 2000 and 2012. All patients with sciatica were randomly age, sex and index year matched with control individuals without sciatica. The primary outcome was diagnosis of HZ. All individuals were followed until HZ diagnosis, withdrawal from the insurance, death, or December 31, 2013, whichever occurred first. HZ risk in the two cohorts was further analyzed with age, sex and comorbidity stratification.

RESULTS

In total, 49,023 patients with sciatica and 49,023 matched controls were included. Female patients were more likely to have HZ development than were male patients [adjusted hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02-1.12]. After adjustments for all the covariates, HZ risk was significantly higher in the sciatica cohort than in the control cohort (adjusted HR = 1.19; 95% CI = 1.12-1.25).

CONCLUSION

Sciatica increased HZ risk. Thus, HZ risk should be addressed whenever physicians encounter patients with sciatica, HZ vaccination should be considered especially those aged over 50.

Association between lateral epicondylitis and the risk of herpes zoster development

BACKGROUND

Diseases burden is associated with herpes zoster (HZ) development. However, the relationship between lateral epicondylitis (LE) and HZ remains unknown.

AIM

This study investigated the association between LE and the risk of HZ development.

METHODS

In this study, we collected data from the National Health Insurance Research Database of Taiwan. Patients who were diagnosed as having LE for the first time between 2000 and 2012 were included in the LE cohort. Patients without LE were randomly selected from the same database for inclusion in the control cohort. The outcome of interest was the first diagnosis of HZ during the follow-up period.

RESULTS

The overall incidence rates of HZ in the LE and control cohort were 8.95 and 7.14 per 1,000 person-years, respectively. After adjustments were made, the LE cohort had a higher hazard ratio of HZ than the control cohort [adjusted hazard ratio (aHR) = 1.23]. The risk of HZ was significantly higher in those aged 50 to 64 years (aHR = 2.05) and in those over the age of 65 years (aHR = 2.50), compared with those aged ≤49 years. The risk of HZ was significantly higher in women (aHR = 1.17). The female patients with LE had a higher risk of HZ development than controls (aHR = 1.27).

CONCLUSION

Women with LE had a higher risk of HZ development. HZ vaccination may be needed for the female patients with LE.

Risk of Herpes Zoster in Patients with Adhesive Capsulitis of the Shoulder

Background: Physical diseases, such as infection, and emotional distress are associated with herpes zoster (HZ). However, the relationship between adhesive capsulitis of the shoulder (ACoS) and HZ remains unknown. Objective: This study investigated the risk of HZ development in patients with ACoS. Methods: We analyzed the Longitudinal Health Insurance Database, a subset of 1 million beneficiaries from the National Health Insurance Research Database. Patients newly diagnosed with ACoS during the 2000–2012 period were the case group. Each patient with ACoS was matched to a control, according to age and index year, through frequency matching. HZ was the primary event in this study. Results: A total of 60,478 patients were included and each group contained 30,239 patients. The risk of HZ infection in the case cohort was 1.28 times that of the control cohort. ACoS increased the risk of HZ infection in each age group, particularly among patients aged younger than 50 [adjusted hazard ratio (aHR) = 1.52, 95% confidence interval (CI): 1.31–1.75]. Relative to the control group, the hazard ratio of HZ for male patients (aHR = 1.40, 95% CI: 1.26–1.55) in the case group was higher than that for female patients (aHR = 1.22, 95% CI: 1.13–1.32). Conclusion: Patients with ACoS have a higher risk of HZ development, particularly among those aged younger than 50 years. The effect of ACoS on HZ development among young adults requires attention.