1
|
Nadeau Nguyen M, Dores GM, Nayernama A, Jones SC. Varicella zoster virus reactivation reported with isatuximab use. J Chemother 2024; 36:198-201. [PMID: 37800850 DOI: 10.1080/1120009x.2023.2266201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023]
Abstract
Isatuximab is a CD38-directed antibody indicated for the treatment of relapsed or refractory multiple myeloma. The Division of Pharmacovigilance at the U.S. Food and Drug Administration (FDA) reviewed case reports from postmarketing sources, including the FDA Adverse Event Reporting System (FAERS), PubMed, and Embase, to investigate a potential association between isatuximab and the risk of varicella zoster virus (VZV) reactivation. We identified 20 reports of which 15 met our case definition and causality criteria. All 15 patients (80% male, median age = 60 years) received isatuximab for a hematologic neoplasm; eight (53%) for previously untreated multiple myeloma. All cases described additional risk factors for VZV reactivation, including concomitant proteasome inhibitor and/or immunomodulatory drug (n = 10, 67%) use. Based on this postmarket analysis, the U.S. Prescribing Information for isatuximab was updated to include this new safety information, including recommendations for antiviral prophylaxis.
Collapse
Affiliation(s)
- Michelle Nadeau Nguyen
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Graça M Dores
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Afrouz Nayernama
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - S Christopher Jones
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
2
|
Wu W, Yang D, Sui D, Zhu M, Luo G, Yang Z, Wang Y, Luo H, Ling L, Zhang Z, Wu Y, Feng G, Li H. Efficacy and safety of Pien Tze Huang capsules in patients with herpes zoster: A multicenter, randomized, double-blinded, and placebo-controlled trial. Phytomedicine 2024; 127:155453. [PMID: 38452692 DOI: 10.1016/j.phymed.2024.155453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Herpes zoster (HZ) is a common medical condition accompanied by several distressing symptoms, including acute pain. Pien Tze Huang (PZH) is a well-known traditional Chinese medicine (TCM) with numerous pharmacological effects, including antiviral properties, neuroprotection, and immunity regulation. PURPOSE To investigate the efficacy and safety of PZH capsules in patients with HZ. STUDY DESIGN A multicenter, double-blinded, randomized, and placebo-controlled trial from 8 hospitals in 5 cities of China. METHODS Eligible participants were randomly assigned to the PZH capsule and placebo group at a 1:1 ratio. Treatment was conducted for 14 days with a window period of no more than 2 days. For the first 7 days, participants received antiviral drugs combined with PZH capsules (0.6 g/time, 3 times a day) or placebos. For the remaining 7 days, they were only treated with PZH capsules (0.6 g/time, 3 times a day) or placebos. RESULTS We included 222 patients in the full analysis set (FAS), and 187 patients in the per protocol set (PPS). The change of numeric rating scale pain scores from baseline to the seventh day (±1 day) after treatment in the PZH capsule group was statistically superior to the placebo group (FAS: 2.33 vs. 1.71, 97.5%CI: 0.03 ∼ 1.19; PPS: 2.29 vs. 1.51, 97.5%CI: 0.18 ∼ 1.38). In the PPS, there was a significant difference in the time (days) of pain relief between the placebo group and the PZH capsule group (Mean (SD): 5.71 (3.76) vs. 4.69 (3.57), p = 0.046). On the seventh day (±1 day) after treatment, the level of CD8+ cells in the PZH capsule group were higher than those of the placebo group (FAS: Mean (SD): 24.08 (6.81) vs. 21.93 (8.19), p = 0.007; PPS: Mean (SD): 24.26 (6.93) vs. 22.15 (8.51), p = 0.012). The level of cytotoxic lymphocyte cells found similar results on the seventh day (±1 day) (FAS: Mean (SD): 12.17 (4.65) vs. 10.55 (4.15), p = 0.018; PPS: Mean (SD): 12.25 (4.65) vs. 10.11 (3.93), p = 0.002). No serious adverse events were noted and PZH capsules were well tolerated. CONCLUSION PZH capsules confer therapeutic effects on HZ with the TCM symptom of stagnated heat of liver channel by substantially reducing the pain intensity, shortening the time of pain relief as well as regulating the immune function. On the basis of the efficacy and safety profiles, PZH capsules may be a promising complementary therapy for the treatment of HZ.
Collapse
Affiliation(s)
- Wenfeng Wu
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, PR China; Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, PR China
| | - Dingquan Yang
- Department of Dermatology, CHINA-JAPAN Friendship Hospital, Beijing, PR China
| | - Daoshun Sui
- Department of Dermatology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, PR China
| | - Minghua Zhu
- Department of Dermatology, The Guangdong Second Provincial Traditional Chinese Medicine Hospital, Guangzhou, PR China
| | - Guangpu Luo
- Department of Dermatology, The Dermatology Hospital of Southern Medical University, Guangzhou, PR China
| | - Zhonghui Yang
- Department of Dermatology, The Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, PR China
| | - Yongfeng Wang
- Department of Dermatology, The Affiliated Hospital of Shanxi University of Chinese Medicine, Xianyang, PR China
| | - Hong Luo
- Department of Dermatology, The First Hospital of Changsha, Changsha, PR China; Department of Dermatology, The Third People's Hospital of Shenzhen, Shenzhen, PR China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Zexin Zhang
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, PR China
| | - Yanmei Wu
- Guangzhou Evidence-Based Medicine Tech Co. Ltd, Guangzhou, PR China
| | - Guoming Feng
- Guangzhou Evidence-Based Medicine Tech Co. Ltd, Guangzhou, PR China
| | - Hongyi Li
- Department of Dermatology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, PR China.
| |
Collapse
|
3
|
周 颖, 赵 宁, 黄 竑, 李 庆, 郭 传, 郭 玉. [Left mandibular osteonecrosis following herpes zoster of the third branch of left trigeminal nerve: A case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:366-370. [PMID: 38595260 PMCID: PMC11004975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Indexed: 04/11/2024]
Abstract
Herpes zoster of trigeminal nerve was a common skin disease caused by varicella-zoster virus infection. Simple involvement of the third branch of trigeminal nerve was rare, and so were oral complications such as pulpitis, periodontitis, spontaneous tooth loss, bone necrosis, etc. This article presented a case of herpes zoster on the third branch of the left trigeminal nerve complicated with left mandibular osteonecrosis. We reported the case of a 64-year-old man with sudden pain in the left half of the tongue 1 month ago, and then herpes on the left facial skin appeared following with acute pain.The local hospital diagnosed it as herpes zoster and treated it with external medication. A few days later, he developed gum pain in the left mandibular posterior tooth area. He was admitted to Peking University School and Hospital of Stomatology one week ago with loose and dislodged left posterior tooth accompanied by left mandibular bone surface exposure. Clinical examination showed bilateral symmetry and no obvious restriction of mouth opening. Visible herpes zoster pigmentation and scarring on the left side of the face appeared. The left mandibular posterior tooth was missing, the exposed bone surface was about 1.5 cm×0.8 cm, and the surrounding gingiva was red and swollen, painful under pressure, with no discharge of pus. The remaining teeth in the mouth were all Ⅲ degree loosened. Imageological examination showed irregular low-density destruction of the left mandible bone, unclear boundary, and severe resorption of alveolar bone. The patient was diagnosed as left mandibular osteonecrosis. Under general anesthesia, left mandibular lesion exploration and curettage + left mandibular partial resection + adjacent flap transfer repair were performed. The patient was re-exmained 6 months after surgery, there was no redness, swelling or other abnormality in the gums and the herpes pigmentation on the left face was significantly reduced. Unfortunately, the patient had complications of postherpetic neuralgia. This case indicate that clinicians should improve their awareness of jaw necrosis, a serious oral complication of trigeminal zoster, and provide early treatment. After the inflammation was initially controlled, surgical treatment could be considered to remove the necrotic bone, curettage the inflammatory granulation tissue, and extraction of the focal teeth to avoid further deterioration of the disease.
Collapse
Affiliation(s)
- 颖 周
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 宁 赵
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 竑远 黄
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 庆祥 李
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 传瑸 郭
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 玉兴 郭
- />北京大学口腔医学院·口腔医院口腔颌面外科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| |
Collapse
|
4
|
Zhao C, Zhang T, Zhu Q, Chen Z, Ren H, Shrestha N, Meng L, Shen Y, Luo F. PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial. Clin Infect Dis 2024; 78:880-888. [PMID: 38015658 DOI: 10.1093/cid/ciad714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN. METHODS The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis. RESULTS A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons). CONCLUSIONS Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.
Collapse
Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingjie Zhang
- Department of Pain Management, Peking University People's Hospital, Beijing, China
| | - Qian Zhu
- Department of Pain Management, China-Japan Friendships Hospital, Beijing, China
| | - Zheng Chen
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Yagyu T, Yakami Y, Bando T. Acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster: a case report and review of the literature. J Med Case Rep 2024; 18:165. [PMID: 38584287 PMCID: PMC11000452 DOI: 10.1186/s13256-024-04487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/01/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Herpes zoster is a common disease that can affect men and women at any age. Sensory neuropathy is the most common complication while motor neuropathy of the abdominal muscles is rare complication appearing in ~ 0.7% of patients. Furthermore, visceral nerve involvement causing gastroparesis is an extremely rare postherpetic complication. We present an extremely rare case of acute gastric dilatation with segmented abdominal paresis as a rare manifestation of herpes zoster infection. CASE PRESENTATION A 91-year-old Asian man was admitted to hospital with 2-day history of vomiting and left abdominal protrusion. He was previously treated for a rash on the left abdominal wall as herpes zoster infection with oral valaciclovir 2 weeks prior. On physical examination, characteristic herpes zoster rash scars and an ipsilateral abdominal bulge were observed on the left side. Computed tomography revealed no abdominal wall defect, mass, or stenosis. Remarkable distension of the stomach, asymmetrical left flank wall bulge, and a thinner abdominal wall on the left compared with the right side were shown. He was diagnosed as acute gastric dilatation owing to gastroparesis and segmental paresis of the abdominal musculature associated with herpes zoster infection. The patient showed significant improvement in symptoms and abdominal paresis within a month of conservative treatment, including nasogastric tube decompression and mosapride administration. CONCLUSION Acute gastric dilatation with abdominal paresis is an extremely rare complication of herpes zoster infection, and to date there have been no reports in the literature. It alerts us that, when examining patients with abdominal bulge, we should be conscious of this rare pathology for the optical diagnosis, avoiding unnecessary invasive examination or surgical exploration.
Collapse
Affiliation(s)
- Toshihiko Yagyu
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan.
| | - Yoshikazu Yakami
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan
| | - Tomoki Bando
- Department of Gastroenterology, Higashi Osaka Hospital, 1-7-22, Chuo, Jyoto-Ku, Osaka, 536-0005, Japan
| |
Collapse
|
6
|
Huang K, Wang Y, Huang Y, Han S, Yang Y, Qu P, Liang B, Zhen Q, Chen W, Lin Y. Infection may play an important role in the pathogenesis of alveolar osteonecrosis following facial herpes zoster: a case report and literature review. BMC Oral Health 2024; 24:409. [PMID: 38566112 PMCID: PMC10985961 DOI: 10.1186/s12903-024-04202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Herpes zoster (HZ) is one of the most common skin diseases caused by viruses. Facial HZ develops when the varicella-zoster virus affects the trigeminal nerve, and alveolar osteonecrosis is a rare complication. However, the exact pathogenesis of postherpetic alveolar osteonecrosis remains unclear. CASE DESCRIPTION We encountered a patient who presented to the dermatology clinic with facial HZ and tooth exfoliation in the upper right jaw, and panoramic radiography revealed decreased bone density and poor alveolar socket healing in his right maxilla. Biopsy of the alveolar process revealed fragments of nonvital lamellar bone, which were devoid of osteoblasts and osteocytes and were surrounded by numerous neutrophils and bacterial aggregates. Thus, the diagnosis of alveolar osteonecrosis following facial HZ was confirmed. He then underwent resection of the osteonecrotic tissue. The pathological findings of postoperative tissue were similar to those of previous biopsies. Varicella-zoster virus and multiple types of bacteria were detected through next-generation sequencing, and the species of bacteria were consistent with the results of bacterial culture. Antibiotics and valaciclovir were administered during the perioperative period. The patient showed good recovery at the 9-month follow-up. CONCLUSIONS The coexistence of bacterial and viral infection may play an important role in the pathogenesis of alveolar osteonecrosis following HZ. To our knowledge, we are the first to directly explore microbial pathogens in a case of postherpetic alveolar osteonecrosis through next-generation sequencing and bacterial culture. We recommend that oral examinations be carefully conducted for patients who are diagnosed with facial HZ, even if their facial rashes have faded away. We suggest that a prolonged and full-dose antiviral therapy course may be beneficial for the treatment of facial HZ with intraoral lesions. The implementation of dental preventive measures should be considered for patients with facial HZ. The application of antibiotics and excision of necrotic bone may reduce the abundance of bacteria in lesions and improve wound healing.
Collapse
Affiliation(s)
- Kaikai Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Youyuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Yuhua Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Shanshan Han
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Yu Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Pinghua Qu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Baoying Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Qingyu Zhen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Wenting Chen
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Ying Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
| |
Collapse
|
7
|
Chopra Y, Hong C, Schechter T, Ali M, Chiang KY, Wall D, Krueger J. Intractable abdominal pain as the sole symptom of Varicella Zoster reactivation after allogeneic stem cell transplantation: brief case report and review of the literature. Pediatr Hematol Oncol 2024; 41:224-228. [PMID: 37898904 DOI: 10.1080/08880018.2023.2271974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
After primary infection, Varicella Zoster (VZV) persists in sensory dorsal root ganglia and may be reactivated in periods of diminished T-cell immunity. Varicella Zoster reactivation post allogenic stem cell transplantation (HSCT) can be challenging to diagnose as it does not always present with characteristic skin lesions. We describe a pediatric patient who presented with isolated severe abdominal pain with no other symptoms. Cutaneous lesions appeared only 10 days later resulting in delayed diagnosis and treatment. He was successfully treated with intravenous acyclovir and recovered after a prolonged hospital stay with post-herpetic neuralgia. Abdominal pain in children post HSCT has a broad differential and VZV reactivation should be considered even in absence of cutaneous lesions. Early diagnosis and treatment are essential to reduce VZV-related morbidity and mortality. In this article we present a case report and review clinical presentation and outcome of similar cases in the literature.
Collapse
Affiliation(s)
- Yogi Chopra
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Carly Hong
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Tal Schechter
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Muhammad Ali
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Kuang-Yueh Chiang
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Donna Wall
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Joerg Krueger
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Gong Y, Shi ZN, Yu J, He XF, Meng XH, Wu QX, Zhu Y. The genus Scorzonera L. (Asteraceae): A comprehensive review on traditional uses, phytochemistry, pharmacology, toxicology, chemotaxonomy, and other applications. J Ethnopharmacol 2024; 320:116787. [PMID: 37390877 DOI: 10.1016/j.jep.2023.116787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The genus Scorzonera L. comprises of approximately 175 species, which are mainly distributed in temperate and arid regions of Central Europe, Central Asia, and Africa. Twenty-nine Scorzonera traditional ethnomedicines have been used for treating colds and fevers, pulmonary diseases, asthma, dyspepsia, malignant stomach neoplasia, liver disorder, jaundice, kidney diseases, mastitis, women's vaginitis, herpes zoster, poisonous ulcers, rheumatic pain, diabetic, atherosclerosis, headache, hypertension, dysentery, pregnant vomiting, snakebites, etc. AIM OF THE REVIEW: This review aims to systematically evaluate the genus Scorzonera over its ethnomedicinal uses, phytochemistry, pharmacology, and toxicology, discuss the relationship between traditional uses, phytochemistry and pharmacological properties, and put forward some suggestions to promote further development and utilization of Scorzonera. MATERIALS AND METHODS This review is based on published scientific research works obtained from the following databases: Elsevier, Web of Science, PubMed, Springer, Wiley, Taylor & Francis, Google Scholar, CNKI, Baidu Scholar, ResearchGate, and others (the Flora of China, 1997 edition; Chinese herbal books, PhD dissertation and Master thesis in Chinese). RESULTS The genus 81 Scorzonera plants have been studied for their traditional usage, phytochemistry, and pharmacology. Altogether 421 chemical constituents are isolated from the 54 species of Scorzonera, which include sesquiterpenoids, monoterpenes, diterpenes, triterpenoids, steroids, quinic acid derivatives, flavonoids, cumarinoids, lignanoids, phenylpropanoids, stilbene derivatives, benzylphthalides, kava lactones, phenolics, aliphatic acids, phthalic acids, alkanes, vitamins, sugars, alkaloids, and other constitutes. Besides those listed above, there are also volatile oils, polysaccharides, tannins, amino acids, enzymes, and inorganic elements. The extracts and compounds extracted from 55 Scorzonera species exhibit extensive pharmacological activities, such as anti-inflammatory, antinociceptive, wound healing, anti-cancer, hepatoprotective, anti-microbial, anti-ulcerogenic, antidiarrheal, antidiabetic, hypolipidemic, antioxidant, repairing cerebral ischemia, antidepressant, immunomodulatory activities, enzyme inhibitory effects, etc. Clinical applications strongly indicate that certain species are effective in treating herpes zoster and pregnancy resistance. Certain species are studied over applicationssuch as pharmacokinetic and histological distribution, and toxicity, the product extraction process, quick-freezing processing technology, synthesized metabolites, etc. Chemotaxonomy is also discussed on Scorzonera. CONCLUSION This review provides information on traditional usage, phytochemistry, pharmacology, toxicology, chemotaxonomy, other applications aspects, and future prospects of the genus Scorzonera. However, only around one third of Scorzonera species have been studied so far. This review may be used as the basis for future endeavors, including further biological and chemical investigations, and efforts of seeking more applications.
Collapse
Affiliation(s)
- Yuan Gong
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Engineering, Lanzhou University, Lanzhou, 730000, Gansu, PR China; School of Chemical Engineering, Lanzhou University of Arts and Science, Lanzhou, 730000, Gansu, PR China
| | - Zhuan-Ning Shi
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Engineering, Lanzhou University, Lanzhou, 730000, Gansu, PR China
| | - Jun Yu
- Marvell Semiconductor, Inc., Westborough, MA, 01532, USA
| | - Xiao-Feng He
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Engineering, Lanzhou University, Lanzhou, 730000, Gansu, PR China
| | - Xian-Hua Meng
- Key Laboratory for Tibet Plateau Phytochemistry of Qinghai Province, College of Pharmacy, Qinghai, Nationnalites University, Xining, 810007, Qinghai, PR China
| | - Quan-Xiang Wu
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Engineering, Lanzhou University, Lanzhou, 730000, Gansu, PR China
| | - Ying Zhu
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Engineering, Lanzhou University, Lanzhou, 730000, Gansu, PR China.
| |
Collapse
|
9
|
Abu Rached N, Gambichler T, Ocker L, Schultheis B, Susok L, Schmidt W, Bechara FG. Upadacitinib treatment associated with varicella zoster infection complicated by haemophagocytic lymphohistiocytosis in a patient with severe hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:e139-e141. [PMID: 37641970 DOI: 10.1111/jdv.19483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Beate Schultheis
- Department of Hematology and Oncology with Palliative Care, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Wolfgang Schmidt
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
10
|
Iseki M, Yamamoto T, Ogawa Y, Majima Y, Abe Y, Watanabe D, Amaya F, Hasegawa T, Inafuku K, Kosugi T, Nomura Y, Deguchi T, Hamada T, Shimizu K, Arai S, Takahashi M, Hamada I, Ishikawa Y, Kawashima M. Efficacy and safety of intravenous fosphenytoin for patients with acute herpes zoster-associated pain: A placebo-controlled randomized trial. J Dermatol 2024; 51:234-242. [PMID: 38149403 DOI: 10.1111/1346-8138.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023]
Abstract
Acute zoster-associated pain develops in most patients with herpes zoster. Nonopioid analgesics are usually used to treat acute zoster-associated pain but are frequently ineffective. We administered intravenous fosphenytoin, the prodrug of phenytoin, to patients with acute zoster-associated pain to examine its analgesic efficacy and safety. At 13 medical institutions in Japan, we conducted a phase II, double-blind, placebo-controlled, randomized trial of intravenous fosphenytoin in Japanese inpatients with acute zoster-associated pain for whom nonopioid analgesics had shown an insufficient analgesic effect. The patients were randomly assigned (1:1:1) to receive a single intravenous dose of fosphenytoin at 18 mg/kg (high dose), a single intravenous dose of fosphenytoin at 12 mg/kg (low dose), or placebo. The primary endpoint was the mean change per hour (slope) in the numerical rating scale score from the baseline score until 120 min after dosing. Seventeen patients were randomly assigned to the low-dose fosphenytoin group (n = 6, median age 62.5 years, range 39-75 years), high-dose fosphenytoin group (n = 5, median age 69.0 years, range 22-75 years), and placebo group (n = 5, median age 52.0 years, range 38-72 years). One patient was excluded because of investigational drug dilution failure. This study was discontinued because of the influences of coronavirus disease 2019. The slope was significantly lower in the high- and low-dose fosphenytoin groups than in the placebo group (P < 0.001 and P = 0.016, respectively). Responsiveness to intravenous fosphenytoin (≥2-point reduction in the numerical rating scale score from baseline to 120 min after dosing) was inferred at plasma total phenytoin concentrations of 10-15 μg/mL. Treatment-emergent adverse events caused no safety concerns in the clinical setting and intravenous fosphenytoin was well tolerated. Intravenous fosphenytoin appears to be an effective and promising alternative treatment for acute zoster-associated pain. Trial Registration: ClinicalTrials.gov NCT04139330.
Collapse
Affiliation(s)
- Masako Iseki
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takenobu Yamamoto
- Department of Dermatology, Kawasaki Medical School General Medical Center, Okayama, Okayama, Japan
| | - Youichi Ogawa
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yuta Majima
- Department of Dermatology, Shizuoka City Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Yoichiro Abe
- Department of Pain Clinic, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan
| | - Daisuke Watanabe
- Department of Dermatology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshio Hasegawa
- Department of Dermatology and Allergology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Kazuhiro Inafuku
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Chiba, Japan
| | - Toshifumi Kosugi
- Department of Palliative Care, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yukiko Nomura
- Department of Dermatology, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Tokiko Deguchi
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | | | - Saori Arai
- Nobelpharma Co., Ltd., Chuo-ku, Tokyo, Japan
| | | | | | | | | |
Collapse
|
11
|
Banerjee R, Sharma V, Patel R, Jena A, Pal P, Raghunathan N, Kumar A, Sood A, Puri AS, Goswami B, Desai D, Mekala D, Ramesh GN, Rao GV, Peddi K, Philip M, Tandon M, Bhatia S, Godbole S, Bhatia S, Ghoshal UC, Dutta U, Midha V, Prasad VGM, Reddy DN. Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice. Indian J Gastroenterol 2024; 43:22-35. [PMID: 38347433 DOI: 10.1007/s12664-023-01507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/13/2023] [Indexed: 03/10/2024]
Abstract
Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.
Collapse
Affiliation(s)
- Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India.
| | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India
| | - Rajendra Patel
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Anuraag Jena
- IMS and SUM Hospital, K8, Kalinga Nagar, Bhubaneswar, 751 003, India
| | - Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Nalini Raghunathan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Ajay Kumar
- BLK Institute of Digestive Science, BLK-Max Super Speciality Hospital, Pusa Road, New Delhi, 110 005, India
| | - Ajit Sood
- Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana, 141 001, India
| | - Amarender S Puri
- Medanta Hospital, CH Baktawar Singh Road, Medicity, Islampur Colony, Sector 38, Gurugram, 122 001, India
| | | | - Devendra Desai
- Hinduja Hospital, 8-12, Swatantryaveer Savarkar Road, Mahim West, Mahim, Mumbai, 400 016, India
| | - Dhanush Mekala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - G N Ramesh
- Aster Hospital, Kuttisahib Road Cheranelloor, South Chittoor, Kochi, 682 027, India
| | - G V Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Kiran Peddi
- Yashoda Hospitals, 6-3-905, Raj Bhavan Road, Matha Nagar, Somajiguda, Hyderabad, 500 082, India
| | - Mathew Philip
- Lisie Institute of Gastroenterology, Cochin, Lisie Hospital Road, North Kaloor, Kaloor, Ernakulam, 682 018, India
| | - Manu Tandon
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Shobna Bhatia
- National Institute of Medical Sciences, Kalwad Kalan and Khurd, Jaipur, 303 121, India
| | - Shubhankar Godbole
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Sumit Bhatia
- Paras Hospitals, Sec-43, Sushant Lok, Gurugram, 122 002, India
| | - Uday C Ghoshal
- Apollo Institute of Gastrosciences and Liver, Apollo Multispecialty Hospitals, 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, 700 054, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India
| | - Vandana Midha
- Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana, 141 001, India
| | | | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| |
Collapse
|
12
|
Weinmann S, Rawlings A, Koppolu P, Rosales AG, Prado YK, Schmidt MA. Herpes zoster diagnosis and treatment in relation to incident dementia: A population-based retrospective matched cohort study. PLoS One 2024; 19:e0296957. [PMID: 38271405 PMCID: PMC10810473 DOI: 10.1371/journal.pone.0296957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Evidence suggests that some infectious diseases, such as herpes zoster (HZ), are associated with elevated risk of subsequent dementia, while certain anti-viral medications are associated with lower risk. We sought to evaluate associations between HZ diagnosis and treatment with incident dementia in a large, retrospective matched cohort. METHODS Using ICD-9 and ICD-10 diagnosis codes in electronic medical records, we identified members of Kaiser Permanente Northwest age 50 and older from 2000-2019 with a HZ diagnosis during this period. A comparison group without HZ diagnosis was individually matched 3:1 on age at HZ diagnosis date (index date), sex, and membership length prior to index date. We excluded subjects with dementia diagnosed before the index date. Antiherpetic medication was identified using pharmacy fills 1 month before to 12 months after the index date. We employed survival analysis to examine the associations between dementia and HZ diagnosis and antiherpetic medication, adjusting multivariable models for demographic and clinical factors. We stratified on age and sex and conducted a sensitivity analysis with a 5-year lag period. RESULT The study included 101,328 persons, 25,332 with HZ. Over a median follow-up of 4.8 years, 6,000 developed dementia. HZ diagnosis was not associated with higher hazard of dementia (hazard ratio (HR) = 0.99, 95% CI 0.93-1.05) in the primary analysis. Among persons with HZ diagnoses, the HR for receipt of any antiherpetic medication was 0.79 (95% CI 0.70-0.90) in univariate analysis and 0.88 (95% CI 0.77-1.00) after adjustment for demographic and clinical factors. Dementia was not associated with trends in duration of medication use or cumulative dose. CONCLUSIONS We found little evidence for an association between HZ diagnosis and dementia overall. Antiherpetic medication prescribed around the time of HZ diagnosis was statistically associated with lower risk of subsequent dementia in some but not all analyses and subgroups.
Collapse
Affiliation(s)
- Sheila Weinmann
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - Andreea Rawlings
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - Padma Koppolu
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - A. Gabriela Rosales
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - Yolanda K. Prado
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| | - Mark A. Schmidt
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, United States of America
| |
Collapse
|
13
|
Ono H, Yamaguchi R, Anzawa K, Shimizu A. Detection of varicella-zoster virus in two dermatomes of herpes zoster duplex bilateralis in an immunocompetent host. J Dermatol 2024; 51:98-100. [PMID: 37718543 DOI: 10.1111/1346-8138.16963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
An 85-year-old woman with no history of herpes zoster (HZ) presented with a primary lesion of erythema and blistering on her left thigh and a secondary similar lesion on her right chest which had appeared at 4 and 3 days before presentation, respectively. Tzanck smears for both lesions were positive, revealing multinucleated giant cells. Immunochromatography to detect varicella-zoster virus (VZV) antigen (DermaQuick®VZV) showed positive on the left thigh at initial onset but negative on the right chest at subsequent onset. The latter repeatedly tested negative for VZV by DermaQuick®VZV. A skin biopsy of the subsequent onset area revealed giant cells, and inclusion bodies were observed in the epidermis. Immunohistochemical staining with anti-VZV antibody and polymerase chain reaction to detect VZV DNA were positive. The patient was diagnosed with HZ duplex bilateralis and treated with acyclovir. The right thoracic region of the posterior part of the lesion became negative for DermaQuick®VZV. It is thought that expression of viral antigens was suppressed in the right thoracic region, i.e., the late-onset area.
Collapse
Affiliation(s)
- Hiroto Ono
- Department of Dermatology, Kanazawa Medical University, Uchinada, Japan
| | - Reimon Yamaguchi
- Department of Dermatology, Kanazawa Medical University, Uchinada, Japan
| | - Kazushi Anzawa
- Department of Dermatology, Kanazawa Medical University, Uchinada, Japan
| | - Akira Shimizu
- Department of Dermatology, Kanazawa Medical University, Uchinada, Japan
| |
Collapse
|
14
|
Isagulyan ED, Semenov DE, Polushkin AA, Asriants SV, Sergeenko EV, Aslakhanova KS, Tomsky AA. [Electrical dorsal root ganglion stimulation (DRGS) for the treatment of refractory postherpetic neuralgia]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:21-27. [PMID: 38334727 DOI: 10.17116/neiro20248801121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Postherpetic neuralgia (PHN) is a rare complication of herpes zoster characterized by prolonged and excruciating pain. Traditional treatments for PHN, such as analgesics, anticonvulsants and antidepressants, do not always bring the desired result. One promising alternative that is attracting the attention of the scientific community is dorsal root ganglion stimulation (DRGS). This method focuses on targeted and precise targeting of the source of pain, providing a new level of effectiveness in the treatment of PHN. OBJECTIVE A retrospective analysis of the technique and results of implantation of a permanent device for stimulating the spinal ganglia in patients with refractory PHN at the Burdenko Neurosurgical Center. MATERIAL AND METHODS The study was conducted in 7 patients (5 men, 2 women) with refractory PHN in the period from 2018 to 2020. The age of the patients ranged from 57 to 84 years (average age 74±8.4). All patients were implanted with Boston systems (Precision or Spectra versions). Stimulation parameters: pulse width - 120-210 μs, frequency - 30-130 Hz, amplitude at the lower limit of the appearance of paresthesia with the possibility of increasing with increased pain up to 5 mA. The position of the electrode depended on the location of the pain. All systems were implanted under X-ray guidance. RESULTS The duration of follow-up observation was more than 2.5 years. The average pain intensity one year after treatment was 3.42±2.45 points on the visual analogue scale (VAS) (a 62.3% decrease in intensity compared to baseline). In 3 (42.8%) patients, the result was characterized by us as «excellent» (intensity according to VAS decreased by 75% or more), in 1 (14.2%) - as «good» (intensity according to VAS decreased by 50-74%), in 1 (14.2%) - as «moderate» (VAS intensity decreased by 25-49% and in 2 (28.5%) as «unsatisfactory» (VAS intensity decreased by less than 25%, or postoperative complications occurred). CONCLUSION Given the complicated nature of PHN, the use of dorsal ganglion stimulation appears to be a promising and innovative treatment approach. Further research is needed to introduce this technique into clinical practice for the treatment of patients suffering from PHN.
Collapse
Affiliation(s)
| | - D E Semenov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | | | - A A Tomsky
- Burdenko Neurosurgical Center, Moscow, Russia
| |
Collapse
|
15
|
Wu J, Cai Y, Jiang N, Qian Y, Lyu R, You Q, Zhang F, Tao H, Zhu H, Nawaz W, Chen D, Wu Z. Pralatrexate inhibited the replication of varicella zoster virus and vesicular stomatitis virus: An old dog with new tricks. Antiviral Res 2024; 221:105787. [PMID: 38145756 DOI: 10.1016/j.antiviral.2023.105787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
Varicella zoster virus (VZV) is associated with herpes zoster (HZ) or herpes zoster ophthalmicus (HZO). All antiviral agents currently licensed for the management of VZV replication via modulating different mechanisms, and the resistance is on the rise. There is a need to develop new antiviral agents with distinct mechanisms of action and adequate safety profiles. Pralatrexate (PDX) is a fourth-generation anti-folate agent with an inhibitory activity on folate (FA) metabolism and has been used as an anti-tumor drug. We observed that PDX possessed potent inhibitory activity against VZV infection. In this study, we reported the antiviral effects and the underlying mechanism of PDX against VZV infection. The results showed that PDX not only inhibited VZV replication in vitro and in mice corneal tissues but also reduced the inflammatory response and apoptosis induced by viral infection. Furthermore, PDX treatment showed a similar anti-VSV inhibitory effect in both in vitro and in vivo models. Mechanistically, PDX inhibited viral replication by interrupting the substrate supply for de novo purine and thymidine synthesis. In conclusion, this study discovered the potent antiviral activity of PDX with a novel mechanism and presented a new strategy for VZV treatment that targets a cellular metabolic mechanism essential for viral replication. The present study provided a new insight into the development of broad-spectrum antiviral agents.
Collapse
Affiliation(s)
- Jing Wu
- Medical School of Nanjing University, Nanjing, China
| | - Yurong Cai
- School of Life Science, Ningxia University, Yinchuan, China
| | - Na Jiang
- Medical School of Nanjing University, Nanjing, China
| | - Yajie Qian
- Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruining Lyu
- Medical School of Nanjing University, Nanjing, China
| | - Qiao You
- Medical School of Nanjing University, Nanjing, China
| | - Fang Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongji Tao
- Medical School of Nanjing University, Nanjing, China
| | - Haotian Zhu
- Medical School of Nanjing University, Nanjing, China
| | - Waqas Nawaz
- Hȏpital Maisonneuve-Rosemont, School of Medicine, University of Montreal, Canada
| | - Deyan Chen
- Medical School of Nanjing University, Nanjing, China.
| | - Zhiwei Wu
- Medical School of Nanjing University, Nanjing, China; Northern Jiangsu People's Hospital, Affiliated Teaching Hospital of Medical School, Nanjing University, Yangzhou, China; State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, China; School of Life Science, Ningxia University, Yinchuan, China.
| |
Collapse
|
16
|
Miller C, Taylor-Salmon E, Emuren L, Landry M, Gershon A, Miller G. Progressive shingles in a toddler due to reactivation of Varicella Zoster vaccine virus four days after infection with SARS-CoV-2; a case report. BMC Infect Dis 2023; 23:854. [PMID: 38057696 PMCID: PMC10698951 DOI: 10.1186/s12879-023-08809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) is the clinical syndrome associated with reactivation of latent varicella-zoster virus (VZV). Several factors have been implicated to promote VZV reactivation; these include immunosuppression, older age, mechanical trauma, physiologic stress, lymphopenia, and more recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Recent reports suggest an increase in the number of HZ cases in the general population during the global COVID-19 pandemic. However, it is unknown what proportion of HZ during the pandemic is due to reactivation of wild-type or vaccine-strain VZV. CASE Here we report the first known case of HZ concomitant with SARS-CoV2 infection in a 20-month-old female who was treated with a single dose of dexamethasone, due to reactivation of the vaccine-type strain of VZV after presenting with a worsening vesicular rash. CONCLUSION In this case, we were able to show vaccine-strain VZV reactivation in the context of a mild acute symptomatic COVID-19 infection in a toddler. Being able to recognize HZ quickly and effectively in a pediatric patient can help stave off the significant morbidity and mortality associated with disease process.
Collapse
Affiliation(s)
- Christine Miller
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Emma Taylor-Salmon
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Leonard Emuren
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA
| | - Marie Landry
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Anne Gershon
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - George Miller
- Department of Pediatrics, Section of Infectious Diseases and Global Health, Yale University School of Medicine, 464 Congress Ave, New Haven, CT, 06519, USA.
| |
Collapse
|
17
|
Jiang X, Li Y, Chen N, Zhou M, He L. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2023; 12:CD005582. [PMID: 38050854 PMCID: PMC10696631 DOI: 10.1002/14651858.cd005582.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a common, serious, painful complication of herpes zoster. Corticosteroids have anti-inflammatory properties, and might be beneficial. This is an update of a review first published in 2008, and previously updated in 2013. OBJECTIVES To assess the effects (benefits and harms) of corticosteroids in preventing postherpetic neuralgia. SEARCH METHODS We updated the searches for randomised controlled trials (RCTs) of corticosteroids for preventing postherpetic neuralgia in the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, and two trials registers (June 2022). We also reviewed the bibliographies of identified trials, contacted authors, and approached pharmaceutical companies to identify additional published or unpublished data. SELECTION CRITERIA We included all RCTs involving corticosteroids given by oral, intramuscular, or intravenous routes for people of all ages, with herpes zoster of all degrees of severity within seven days after onset, compared with no treatment or placebo, but not with other treatments. DATA COLLECTION AND ANALYSIS Two review authors independently identified potential articles, extracted data, assessed the risk of bias of each trial, and the certainty of the evidence. Disagreement was resolved by discussion among the co-authors. We followed standard Cochrane methodology. MAIN RESULTS We identified five trials with a total of 787 participants that met our inclusion criteria. No new studies were identified for this update. All were randomised, double-blind, placebo-controlled parallel-group studies. The evidence is very uncertain about the effects of corticosteroids given orally during an acute herpes zoster infection in preventing postherpetic neuralgia six months after the onset of herpes (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.45 to 1.99; 2 trials, 114 participants; very low-certainty evidence (downgraded for serious risk of bias and very serious imprecision)). The three other trials that fulfilled our inclusion criteria were not included in the meta-analysis because they did not provide separate information on the number of participants with PHN at six months. Adverse events during or within two weeks after stopping treatment were reported in all five included trials. There were no observed differences in serious (RR 1.65, 95% CI 0.51 to 5.29; 5 trials, 755 participants; very low-certainty evidence (downgraded for serious risk of bias and very serious imprecision)), or non-serious adverse events (RR 1.30, 95% CI 0.90 to 1.87; 5 trials, 755 participants; low-certainty evidence (downgraded for serious risk of bias and serious imprecision)) between the corticosteroid and placebo groups. One of these trials was at high risk of bias because of incomplete outcome data, two were at unclear risk of bias, and the other was at low risk of bias. The review was first published in 2008; no new RCTs were identified for inclusion in subsequent updates in 2010, 2013, and 2023. AUTHORS' CONCLUSIONS Based on the current available evidence, we are uncertain about the effects of corticosteroids given orally during an acute herpes zoster infection on preventing postherpetic neuralgia. Corticosteroids given orally or intramuscularly may result in little to no difference in the risk of adverse events in people with acute herpes zoster. Some researchers have recommended using corticosteroids to relieve the zoster-associated pain in the acute phase of the disease. If further research is designed to evaluate the efficacy of corticosteroids for herpes zoster, long-term follow-up should be included to observe their effect on the transition from acute pain to postherpetic neuralgia. Future trials should include measurements of function and quality of life, as well as updated measures of pain.
Collapse
Affiliation(s)
- Xin Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
18
|
Guiraud V, Thévenet H, Boutolleau D. Detection of varicella zoster virus DNA in blood from immunocompromised patients during the week preceding the onset of herpes zoster rash. J Clin Virol 2023; 169:105609. [PMID: 37839137 DOI: 10.1016/j.jcv.2023.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess whether varicella zoster virus (VZV) DNA can be detected in blood before herpes zoster (HZ) rash onset. METHOD Monocentric retrospective study from January 2019 to March 2023 including patients with HZ and stored blood samples performed during the week preceding the onset of HZ rash. Blood samples were retrospectively analyzed for VZV DNA by quantitative PCR. RESULTS Among the 138 patients with HZ during the study period, stored blood samples performed during the week preceding the onset of HZ rash were available for 13 of them. Twelve (92 %) patients were immunosuppressed, mostly due to solid organ transplantation (38 %), solid malignancy (31 %) or autoimmune disease (23 %). During the week preceding HZ onset, VZV DNA was detected in blood from 10 (77 %) patients, with a median value of 3.6 log (copies/mL) (IQR 3.3-3.9). At the time of HZ onset, all VZV PCR performed in available blood samples were positive. CONCLUSION Our findings demonstrates that VZV DNA can be commonly detected in blood from immunocompromised patients during the prodromal phase of HZ. Early screening of VZV DNA in blood from high-risk immunocompromised patients might improve HZ therapeutic management.
Collapse
Affiliation(s)
- Vincent Guiraud
- Centre National de Référence Herpèsvirus (Laboratoire Associé), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France; Sorbonne Université, INSERM, UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.
| | - Henri Thévenet
- Centre National de Référence Herpèsvirus (Laboratoire Associé), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - David Boutolleau
- Centre National de Référence Herpèsvirus (Laboratoire Associé), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris, France; Sorbonne Université, INSERM, UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France
| |
Collapse
|
19
|
Sollie M, Thomsen JB, Sørensen JA. Autologous Fat Grafting Is Not Superior to Placebo as Treatment of Postherpetic Neuralgia: A Double-Blind Randomized Clinical Trial. Plast Reconstr Surg 2023; 152:1053e-1062e. [PMID: 36988642 DOI: 10.1097/prs.0000000000010462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a chronic pain syndrome occurring after a herpes zoster outbreak. While there is no effective treatment available today, autologous fat grafting has shown promise. This randomized controlled trial investigated the effectiveness of fat grafting as treatment for PHN compared with a sham treatment. METHODS A total of 46 participants with PHN were included. After liposuction under general anesthesia, participants were randomly assigned to receive either autologous fat grafting or saline injection to the area of pain. The primary outcomes were the average and maximum degree of pain measured on an 11-point numeric rating scale. Secondary outcomes were quality and degree of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey). RESULTS Forty-two participants completed follow-up of 6 months. For maximal degree of pain, a reduction of -1.1 ± 0.6 and -1.0 ± 0.5 mean change (±SE) on the numeric rating scale was observed in the intervention and control groups, respectively. For average degree of pain, the reduction was -1.2 ± 0.5 and -1.3 ± 0.4 in the intervention and control groups, respectively. The authors did not observe any significant changes in the neuropathic pain and quality-of-life parameters. For all measured outcomes, the differences between the groups were not statistically significant. CONCLUSIONS The authors did not find autologous fat grafting superior to a placebo when treating PHN of the skin. Given their results, they cannot recommend the routine use of this method to treat these pains. CLINICAL RELEVANCE STATEMENT Since autologous fat grafting was not proven to be more effective than a placebo in treating PHN, alternative treatment options should be explored. It is also essential to emphasize the importance of prophylactic vaccination against herpes zoster. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
Collapse
Affiliation(s)
- Martin Sollie
- From the Research Unit for Plastic Surgery
- Open Patient Data Explorative Network, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark
| | - Jørn B Thomsen
- From the Research Unit for Plastic Surgery
- Department of Clinical Research, University of Southern Denmark
| | - Jens A Sørensen
- From the Research Unit for Plastic Surgery
- Department of Clinical Research, University of Southern Denmark
| |
Collapse
|
20
|
Hong X, Ji Y, Chen M, Su F, Zhu Y, Ge Y. Varicella Zoster viral encephalitis without herpes: diagnosis by metagenomic next-generation sequencing of cerebrospinal fluid. Future Microbiol 2023; 18:1217-1223. [PMID: 37882765 DOI: 10.2217/fmb-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Acute Varicella Zoster viral encephalitis in immunocompetent adult patients without cutaneous herpes has rarely been reported. A 24-year-old female was hospitalized for a headache with a fever but without other obvious symptoms. Multiple routine examinations showed no abnormalities. Lumbar puncture indicated intracranial hypertension. The examination of cerebrospinal fluid by metagenomic next-generation sequencing demonstrated acute Varicella Zoster viral encephalitis. The patient's condition improved by treatment with acyclovir for antiviral therapy and mannitol dehydration to lower cranial pressure. Central Varicella Zoster viral infection should be emphasized as it is easily misdiagnosed and rare in clinical settings. Metagenomic next-generation sequencing of cerebrospinal fluid has significant advantages in the diagnosis of Varicella Zoster viral encephalitis.
Collapse
Affiliation(s)
- Xin Hong
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
| | - Youqi Ji
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- School of Medical Technology & Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Mengyuan Chen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- School of Medical Technology & Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Fang Su
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yongze Zhu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yumei Ge
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
- School of Medical Technology & Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Biomarkers & In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang, 310053, China
| |
Collapse
|
21
|
Berman MA, Rupp RE. Disseminated vaccine-induced varicella infection in a kidney transplant recipient. Am J Transplant 2023; 23:1806-1810. [PMID: 37286085 DOI: 10.1016/j.ajt.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
A 33-year-old kidney transplant (KT) recipient presented with a disseminated pruritic, painful, vesicular rash and hepatitis 3 weeks after receiving a varicella vaccine (VAR). A skin lesion biopsy sent to the Centers for Disease Control and Prevention for genotyping confirmed vaccine-strain varicella-zoster virus (VZV) (Oka strain; vOka). The patient was successfully treated with intravenous acyclovir during a prolonged hospital stay. This case supports the contraindication of VAR in adult KT recipients and highlights the potential for severe illness when used in this population. Optimally, VZV-seronegative KT candidates should receive VAR before starting immunosuppressive medications. If this opportunity is missed, the recombinant varicella-zoster vaccine might be considered following transplantation as it is already recommended to prevent herpes zoster in VZV-seropositive immunocompromised adults. Further study is needed as data are limited on the safety and efficacy of recombinant varicella-zoster vaccine for primary varicella prevention in VZV-seronegative immunocompromised adults.
Collapse
Affiliation(s)
- Megan A Berman
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA; Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA.
| | - Richard E Rupp
- Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA; Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
22
|
Lee YH, Song GG. Efficacy and safety of tacrolimus versus mycophenolate mofetil as induction treatment and low-dose tacrolimus as treatment for lupus nephritis: a meta-analysis. Z Rheumatol 2023; 82:754-762. [PMID: 36607421 DOI: 10.1007/s00393-022-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy and safety of tacrolimus and mycophenolate mofetil (MMF) as induction therapy and low-dose tacrolimus as treatment for lupus nephritis (LN). METHODS Meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety of tacrolimus and MMF as induction therapy for LN. We systematically reviewed RCTs and prospective cohort studies with a tacrolimus dose of 3 mg daily and performed a meta-analysis of the efficacy and safety of tacrolimus as an induction treatment for LN in comparison to MMF. RESULTS The inclusion criteria were satisfied by eight studies (five RCTs and three prospective cohort studies) with a total of 408 individuals (289 for tacrolimus vs. MMF and 119 for low-dose tacrolimus). Tacrolimus and MMF had similar complete remission rates (odds ratio [OR] 1.028; 95% confidence interval [CI] 0.589-1.796; p = 0.922). The partial remission rate did not differ between the tacrolimus and MMF groups (OR 1.400; 95% CI 0.741-2.646; p = 0.300). Tacrolimus and MMF showed no differences in proteinuria, serum albumin, serum creatinine, creatinine clearance, renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), or extra-renal SLEDAI. The incidence of infection, severe infection, leukopenia, and hyperglycemia did not differ between the tacrolimus and MMF groups. However, herpes zoster infection was significantly less common in the tacrolimus group (OR 0.137; 95% CI 0.034-0.546; p = 0.005), whereas serum creatinine elevation was significantly higher in the tacrolimus group than in the MMF group (OR 8.148; 95% CI 1.369-48.50; p = 0.021). At 3 mg/d, tacrolimus was shown to be safe, well tolerated, and offered therapeutic benefits in all investigations. CONCLUSION Tacrolimus was comparable to MMF in terms of effectiveness and safety as an induction therapy for LN, with the exception of a reduced risk of herpes zoster infection and a rise in serum creatinine. In individuals with LN, 3 mg/d tacrolimus was proven to be efficacious and safe.
Collapse
Affiliation(s)
- Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seoul 02841, Seongbuk-gu, Korea (Republic of).
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seoul 02841, Seongbuk-gu, Korea (Republic of)
| |
Collapse
|
23
|
Wang X, Chen H, Song F, Zuo K, Chen X, Zhang X, Liang L, Ta Q, Zhang L, Li J. Resveratrol: a potential medication for the prevention and treatment of varicella zoster virus-induced ischemic stroke. Eur J Med Res 2023; 28:400. [PMID: 37794518 PMCID: PMC10552394 DOI: 10.1186/s40001-023-01291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Infection rate of varicella zoster virus (VZV) is 95% in humans, and VZV infection is strongly associated with ischemic stroke (IS). However, the underlying molecular mechanisms of VZV-induced IS are still unclear, and there are no effective agents to treat and prevent VZV-induced IS. OBJECTIVE By integrating bioinformatics, this study explored the interactions between VZV and IS and potential medication to treat and prevent VZV-induced IS. METHODS In this study, the VZV and IS datasets from the GEO database were used to specify the common genes. Then, bioinformatics analysis including Gene Ontology, Kyoto Encyclopedia Genes Genomes and Protein-Protein Interaction network analysis was performed. Further, the hub genes, transcription factor (TF) gene interactions, TF-miRNA co-regulatory network and potential drug were obtained. Finally, validation was performed using molecular docking and molecular dynamics simulations. RESULTS The potential molecular mechanisms of VZV-induced IS were studied using multiple bioinformatics tools. Ten hub genes were COL1A2, DCN, PDGFRB, ACTA2, etc. TF genes and miRNAs included JUN, FOS, CREB, BRCA1, PPARG, STAT3, miR-29, etc. A series of mechanism may be involved, such as inflammation, oxidative stress, blood-brain barrier disruption, foam cell generation and among others. Finally, we proposed resveratrol as a potential therapeutic medicine for the prevention and treatment of VZV-induced IS. Molecular docking and molecular dynamics results showed that resveratrol and hub genes exhibited strong binding score. CONCLUSIONS Resveratrol could be an alternative for the prevention and treatment of VZV-IS. More in vivo and in vitro studies are needed in the future to fully explore the molecular mechanisms between VZV and IS and for medication development.
Collapse
Affiliation(s)
- Xu Wang
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin, China
| | - Hao Chen
- Department of Neurovascular Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Feiyu Song
- Jilin Connell Pharmaceutical Co., Ltd, JilinJilin, 132013, China
| | - Kuiyang Zuo
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Xin Chen
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Xu Zhang
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Lanqian Liang
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China
| | - Qiyi Ta
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin, China
| | - Lin Zhang
- China-Japan Union Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Jinhua Li
- School of Public Health, Jilin University, Changchun, 130021, Jilin, China.
| |
Collapse
|
24
|
de Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga MEDS, Canteiro Cruz E. Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev 2023; 10:CD008858. [PMID: 37781954 PMCID: PMC10542961 DOI: 10.1002/14651858.cd008858.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the virus that causes varicella (chickenpox). After resolution of the varicella episode, the virus can remain latent in the sensitive dorsal ganglia of the spine. Years later, with declining immunity, the varicella zoster virus (VZV) can reactivate and cause herpes zoster, an extremely painful condition that can last many weeks or months and significantly compromise the quality of life of the affected person. The natural process of ageing is associated with a reduction in cellular immunity, and this predisposes older adults to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. Two types of herpes zoster vaccines are currently available. One of them is the single-dose live attenuated zoster vaccine (LZV), which contains the same live attenuated virus used in the chickenpox vaccine, but it has over 14-fold more plaque-forming units of the attenuated virus per dose. The other is the recombinant zoster vaccine (RZV) which does not contain the live attenuated virus, but rather a small fraction of the virus that cannot replicate but can boost immunogenicity. The recommended schedule for the RZV is two doses two months apart. This is an update of a Cochrane Review first published in 2010, and updated in 2012, 2016, and 2019. OBJECTIVES To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults. SEARCH METHODS For this 2022 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2022, Issue 10), MEDLINE (1948 to October 2022), Embase (2010 to October 2022), CINAHL (1981 to October 2022), LILACS (1982 to October 2022), and three trial registries. SELECTION CRITERIA We included studies involving healthy older adults (mean age 60 years or older). We included randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine (any dose and potency) versus any other type of intervention (e.g. varicella vaccine, antiviral medication), placebo, or no intervention (no vaccine). Outcomes were cumulative incidence of herpes zoster, adverse events (death, serious adverse events, systemic reactions, or local reaction occurring at any time after vaccination), and dropouts. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included two new studies involving 1736 participants in this update. The review now includes a total of 26 studies involving 90,259 healthy older adults with a mean age of 63.7 years. Only three studies assessed the cumulative incidence of herpes zoster in groups that received vaccines versus placebo. Most studies were conducted in high-income countries in Europe and North America and included healthy Caucasians (understood to be white participants) aged 60 years or over with no immunosuppressive comorbidities. Two studies were conducted in Japan and one study was conducted in the Republic of Korea. Sixteen studies used LZV. Ten studies tested an RZV. The overall certainty of the evidence was moderate, which indicates that the intervention probably works. Most data for the primary outcome (cumulative incidence of herpes zoster) and secondary outcomes (adverse events and dropouts) came from studies that had a low risk of bias and included a large number of participants. The cumulative incidence of herpes zoster at up to three years of follow-up was lower in participants who received the LZV (one dose subcutaneously) than in those who received placebo (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.43 to 0.56; risk difference (RD) 2%; number needed to treat for an additional beneficial outcome (NNTB) 50; moderate-certainty evidence) in the largest study, which included 38,546 participants. There were no differences between the vaccinated and placebo groups for serious adverse events (RR 1.08, 95% CI 0.95 to 1.21) or deaths (RR 1.01, 95% CI 0.92 to 1.11; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of one or more adverse events (RR 1.71, 95% CI 1.38 to 2.11; RD 23%; number needed to treat for an additional harmful outcome (NNTH) 4.3) and injection site adverse events (RR 3.73, 95% CI 1.93 to 7.21; RD 28%; NNTH 3.6; moderate-certainty evidence) of mild to moderate intensity. These data came from four studies with 6980 participants aged 60 years or older. Two studies (29,311 participants for safety evaluation and 22,022 participants for efficacy evaluation) compared RZV (two doses intramuscularly, two months apart) versus placebo. Participants who received the new vaccine had a lower cumulative incidence of herpes zoster at 3.2 years follow-up (RR 0.08, 95% CI 0.03 to 0.23; RD 3%; NNTB 33; moderate-certainty evidence), probably indicating a favourable profile of the intervention. There were no differences between the vaccinated and placebo groups in cumulative incidence of serious adverse events (RR 0.97, 95% CI 0.91 to 1.03) or deaths (RR 0.94, 95% CI 0.84 to 1.04; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of adverse events, any systemic symptom (RR 2.23, 95% CI 2.12 to 2.34; RD 33%; NNTH 3.0), and any local symptom (RR 6.89, 95% CI 6.37 to 7.45; RD 67%; NNTH 1.5). Although most participants reported that their symptoms were of mild to moderate intensity, the risk of dropouts (participants not returning for the second dose, two months after the first dose) was higher in the vaccine group than in the placebo group (RR 1.25, 95% CI 1.13 to 1.39; RD 1%; NNTH 100, moderate-certainty evidence). Only one study reported funding from a non-commercial source (a university research foundation). All other included studies received funding from pharmaceutical companies. We did not conduct subgroup and sensitivity analyses AUTHORS' CONCLUSIONS: LZV (single dose) and RZV (two doses) are probably effective in preventing shingles disease for at least three years. To date, there are no data to recommend revaccination after receiving the basic schedule for each type of vaccine. Both vaccines produce systemic and injection site adverse events of mild to moderate intensity. The conclusions did not change in relation to the previous version of the systematic review.
Collapse
Affiliation(s)
| | - Anna Mz Gagliardi
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Brenda Ng Andriolo
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Maria Regina Torloni
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Regis B Andriolo
- Department of Public Health, Universidade do Estado do Pará, Belém, Brazil
| | - Maria Eduarda Dos Santos Puga
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Eduardo Canteiro Cruz
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
25
|
Li P, Li J, Huang H, Chen X, Lin Y, He G, Xu D. The effect of varicella-zoster virus reactivation on the long-term outcomes of patients undergoing allogeneic hematopoietic stem cell transplantation. J Health Popul Nutr 2023; 42:105. [PMID: 37784192 PMCID: PMC10544620 DOI: 10.1186/s41043-023-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/11/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND A virus infection may lead the body to produce more immune cells of particular types or stimulate the production of new ones, both of which may have anti-leukemic effects. There has been no research on whether immune cells stimulated by varicella-zoster virus (VZV) infection have anti-leukemic effects. The objective of this investigation is to assess the impact of VZV infection on patients' long-term survival following allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS This retrospective study investigated the association between varicella-zoster virus (VZV) reactivation and outcomes in 219 individuals who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the Sun Yat-sen University's First Affiliated Hospital. According to being diagnosed with VZV infection or not, these patients were grouped into two groups. The comparison of cumulative incidence of relapse, non-recurrent mortality, and overall survival (OS) was conducted between the two groups. RESULTS Analyzing multivariate data, VZV reactivation was linked to lower relapse incidence in the group containing all individuals (hazard ratio [HR] = 0.27; 95% confidence interval [CI], 0.12-0.64), patients suffering from acute myeloid leukaemia (HR = 0.10; 95% CI, 0.01-0.83), and patients suffering from acute lymphoblastic leukaemia (HR = 0.25; 95% CI, 0.08-0.77). Moreover, VZV reactivation was linked with decreased non-relapse mortality in all individuals (HR = 0.20; 95% CI, 0.05-0.79), but no statistical significance was found for any disease subgroup. Further, VZV reactivation was an independent predictor for improved OS in the group containing all individuals (HR = 0.10; 95% CI, 0.03-0.29), patients suffering from acute myeloid leukaemia (HR = 0.09; 95% CI, 0.01-0.66), and patients suffering from acute lymphoblastic leukaemia (HR = 0.16; 95% CI, 0.04-0.68). CONCLUSION This is the first study to show that VZV reactivation following allo-HSCT is an independent predictor for lower relapse rates and improved OS, providing novel therapeutic approaches to improve patients' long-term survival following allo-HSCT.
Collapse
Affiliation(s)
- Ping Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jingxia Li
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Haoyuan Huang
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiongnong Chen
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yue Lin
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Ganlin He
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Duorong Xu
- Department of Haematology, The First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| |
Collapse
|
26
|
Peksöz U, Öner Ü, Çelik M. The effectiveness of the erector spinae plane block using methylprednisolone and bupivacaine in post-herpetic neuralgia: Case series. Agri 2023; 35:273-277. [PMID: 37886862 DOI: 10.14744/agri.2021.43926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Post-herpetic neuralgia (PHN) is the most common chronic complication of herpes zoster and the most common pain syndrome associated with infections. There are medical and interventional treatment options in PHN, and some patients may be resistant to the preferred medical treatments. This situation negatively affects the quality of life of the patient. Interventional treatments come to the fore, especially in patients in whom medical treatments are not sufficient, and systemic side effects such as hepatotoxicity and nephrotoxicity occur. Erector spinal plane block (ESPB) is a recently described ultrasound-guided regional anesthesia technique. It is especially used to prevent post-operative pain due to trunk surgeries. In this study, ESPB was administered with methylprednisolone and bupivacaine in five patients who developed PHN after thoracic herpes zoster and did not have an expected response to three-month medical treatments. Pain severity was assessed using the Numerical Pain Rating Scale. We want to emphasize that ESPB, which is applied with steroids and anesthetics, is a speedy and longacting treatment option that increases the quality of life of the patient, has low side effects, and is a cost-effective treatment option.
Collapse
Affiliation(s)
- Uğur Peksöz
- Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ümran Öner
- Department of Dermatology, Health Science University, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
| | - Mine Çelik
- Department of Anesthesiology and Reanimation, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| |
Collapse
|
27
|
Jeyaraj R, Alexander E, Cutino-Moguel T, Li S, Kainth R. Postexposure prophylaxis for varicella/shingles: a review of the UKHSA guidelines. Arch Dis Child Educ Pract Ed 2023; 108:355-359. [PMID: 37236770 DOI: 10.1136/archdischild-2022-324738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Rebecca Jeyaraj
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eliza Alexander
- Virology Department, Division of Infection, Barts Health NHS Trust, London, UK
| | | | - Susan Li
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Ranjev Kainth
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
28
|
Chu WK, Lin KY, Sun HY, Chen YC, Cheng A. Herpes zoster aseptic meningitis and Ramsay Hunt syndrome in an immunocompetent young adult post mild COVID-19 - A coincidence? J Microbiol Immunol Infect 2023; 56:1114-1115. [PMID: 37147243 PMCID: PMC10155042 DOI: 10.1016/j.jmii.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/08/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Wen-Kai Chu
- National Taiwan University Hospital and the National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- National Taiwan University Hospital and the National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- National Taiwan University Hospital and the National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Yee-Chun Chen
- National Taiwan University Hospital and the National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Aristine Cheng
- National Taiwan University Hospital and the National Taiwan University, College of Medicine, Taipei, Taiwan.
| |
Collapse
|
29
|
Bieńkowski C, Talarek E, Pokorska-Śpiewak M. The clinical course of herpes zoster is similar in immunocompetent and immunocompromised paediatric patients. J Paediatr Child Health 2023; 59:1112-1114. [PMID: 37357994 DOI: 10.1111/jpc.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/07/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
AIM We aimed to compare the clinical manifestation of HZ in immunocompetent and immunocompromised children. METHODS Medical charts of all consecutive children hospitalized and/or consulted in the Regional Hospital for Infectious Diseases in Warsaw due to HZ were retrospectively analysed. Age, history of varicella, time interval between varicella and HZ, underlying diseases, immunosuppresive therapy, dermatome involvement and HZ complications were analyzed in both groups. RESULTS In total 152 children were included in the analysis, 56 (36.84%) of them were hospitalsed, whereas 96 (63.16%) were consulted and discharged home due to good general condition. The median age was 10 years (IQR 5.75-12), there were 73 (48.03%) boys and 79 (51.97%) girls. In 16/152 (10.5%) one or more complications occurred, including: skin bacterial superinfection (16/17, 94.2%), sepsis (1/17, 5.9%), meningitis (1/17, 5.9%). Thoracic dermatomes were the most commonly affected (81/152, 53.29%). Most of the children didn't have any immunodeficiencies 118/152 (77.6%), and 34/152 (22.4%) of them were immunocompromised (and had been treated with intravenous acyclovir). The clinical picture of the disease was similar in both groups (Table 1). However, immunocompromised children more often had sacral dermatomes affected (5/35, 14.3% vs. 1/117, 0.9%, p < 0.001), and less often thoracic dermatomes were involved in this group (12/35, 34.3% vs. 69/117, 59%, p = 0.0102). CONCLUSIONS To conclude, herpes zoster occurs in both immunocompetent and immunocompromised children. Clinical manifestations are similar. Serious complications, although uncommon, affect not only immunocompromised patients but also otherwise healthy children.
Collapse
Affiliation(s)
- Carlo Bieńkowski
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Ward XI of the Regional Hospital for Infectious Diseases, Warsaw, Poland
| | - Ewa Talarek
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Ward XI of the Regional Hospital for Infectious Diseases, Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- Ward XI of the Regional Hospital for Infectious Diseases, Warsaw, Poland
| |
Collapse
|
30
|
Kim IH, Mupparapu A, Yablonski JN, Mupparapu M. A Patient with Herpes Zoster of the Maxillary Division of Trigeminal Nerve Presents for Oral Evaluation and Toothache. Dent Clin North Am 2023; 67:687-690. [PMID: 37714625 DOI: 10.1016/j.cden.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Herpes zoster (HZ) is an acute and painful neurocutaneous infection caused by the reactivation of a latent varicella-zoster virus in the dorsal root or cranial nerve ganglia. It is characterized by 3 stages: prodromal, acute, and chronic. During the prodromal stage, reactivation in the maxillary branch of the trigeminal nerve closely mimics odontalgia, and HZ should be in the differential diagnosis. Patients with HZ develop painful lesions following the affected dermatome. Laboratory testing confirms the diagnosis; treatment is with antiviral agents. Early detection and treatment shorten the course of the infection and lessen the severity of the associated postherpetic neuralgia.
Collapse
Affiliation(s)
- Irene H Kim
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | | | - Jana N Yablonski
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Mel Mupparapu
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
| |
Collapse
|
31
|
Hanada K, Osaki Y, Fujita K, Fukumoto T, Fukushima K, Kito H, Izumi Y. Segmental Zoster Paresis Accompanied by Horner's Syndrome. Intern Med 2023; 62:2743-2746. [PMID: 37722924 PMCID: PMC10569921 DOI: 10.2169/internalmedicine.0578-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/27/2022] [Indexed: 09/20/2023] Open
Abstract
We herein report a 90-year-old immunocompromised woman who developed right upper limb weakness and right ptosis with a miotic pupil 1 week after oral therapy for zoster on the right T2 dermatome. The right pupil was dilated with instillation of 1% apraclonidine, indicating Horner's syndrome. The patient was treated with intravenous acyclovir and methylprednisolone. Focal weakness related to zoster, generally known as segmental zoster paresis, improved over five months, but Horner's syndrome remained. We suggest that aggressive intravenous treatment should be considered for rare cases of zoster that occur with a combination of these two neurological conditions.
Collapse
Affiliation(s)
- Kenta Hanada
- Naka Municipal Kaminaka Hospital, Japan
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| | - Yusuke Osaki
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| | - Koji Fujita
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| | - Tatsuya Fukumoto
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| | - Koji Fukushima
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| | | | - Yuishin Izumi
- Department of Neurology, University of Tokushima Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
32
|
Yoshida A, Hayashi S, Komatsuzaki Y, Igawa K. Zoster-associated pain relief on the left trigeminal nerve V1, accompanied by improvement of the syndrome of inappropriate secretion of antidiuretic hormone. J Dermatol 2023; 50:e276-e277. [PMID: 36949651 DOI: 10.1111/1346-8138.16783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Ai Yoshida
- Department of Dermatology, Dokkyo Medical University School of Medicine, Tochigi, Japan
- Department of Dermatology, Kamitsuga General Hospital, Tochigi, Japan
| | - Shujiro Hayashi
- Department of Dermatology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yuki Komatsuzaki
- Department of Dermatology, Dokkyo Medical University School of Medicine, Tochigi, Japan
- Department of Dermatology, Kamitsuga General Hospital, Tochigi, Japan
| | - Ken Igawa
- Department of Dermatology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| |
Collapse
|
33
|
Wang Y, Deng H, Chen T, Li P, Zhao W, Wang L, Zhu C, Wang H, Hou S. Effect of antivirals plus low-dose, short-term glucocorticoids on post-herpetic neuralgia. Eur J Dermatol 2023; 33:413-418. [PMID: 37823492 DOI: 10.1684/ejd.2023.4515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). It is unclear whether short-term and low-dose glucocorticoids combined with antivirals can reduce the incidence of PHN. OBJECTIVES To investigate the effects of antivirals plus low-dose, short-term glucocorticoids on PHN. MATERIALS & METHODS A total of 394 patients with HZ were divided into glucocorticoid and non-glucocorticoid groups, and the incidence of PHN was studied retrospectively. Forty patients with HZ were randomized into the glucocorticoid (n=20) and non-glucocorticoid (n=20) groups. The levels of protein 100-B (S100B) and neuron-specific enolase (NSE) in the blood and the viral load in the skin lesions were measured before and after seven days of treatment. Patient condition and pain were assessed using the HZ and visual analogue scale pain scores. RESULTS The incidence of PHN in the glucocorticoid and non-glucocorticoid groups was 20.89% and 30.51%, respectively. In patients with onset time >seven days before treatment, the incidence of PHN was 19.81% and 40.16%, respectively. In the glucocorticoid group, after treatment, the mean serum NSE level of the glucocorticoid group decreased from 15.8 ng/mL to 14.0 ng/mL, while the mean serum S100B level decreased from 1486.3 ng/mL to 1453.7 ng/mL. There was no intergroup difference in the reduction rate of viral load. The mean condition score and pain score were significantly lower in the glucocorticoid group. CONCLUSION Antiviral therapy plus low-dose, short-term glucocorticoids can improve the condition of patients with HZ and partly reduce the incidence of PHN.
Collapse
Affiliation(s)
- Yu Wang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Han Deng
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Tudi Chen
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Pinglu Li
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Wanxing Zhao
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Lu Wang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Congzhong Zhu
- Obstetrics and Gynecology Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Huiping Wang
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| | - Shuping Hou
- Department of Dermatovenereology, Tianjin Medical University General Hospital/ Tianjin Institute of Sexually Transmitted Disease, Tianjin 300052, China
| |
Collapse
|
34
|
Uda K, Okubo Y, Tsuge M, Tsukahara H, Miyairi I. Impacts of routine varicella vaccination program and COVID-19 pandemic on varicella and herpes zoster incidence and health resource use among children in Japan. Vaccine 2023; 41:4958-4966. [PMID: 37400282 DOI: 10.1016/j.vaccine.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan. MATERIALS AND METHODS We conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005-2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization. RESULTS After the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9-56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1-53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2-57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5-67.1]), antiviral use (65.7 % reduction [59.7-70.8]), and healthcare costs (49.1 % [95 %CI, 32.7-61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014. CONCLUSIONS Varicella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.
Collapse
Affiliation(s)
- Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Mitsuru Tsuge
- Department of Pediatric Acute Diseases, Academic Field of Medicine, Dentistry, and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, TN, USA
| |
Collapse
|
35
|
Şimşek F, Eren A, Kızıldağ N. Varicella zoster virus Vasculopathy as a Rare Cause of Stroke. Rev Soc Bras Med Trop 2023; 56:e02152023. [PMID: 37493749 PMCID: PMC10367210 DOI: 10.1590/0037-8682-0215-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Fatma Şimşek
- Ataturk University, Faculty of Medicine, Department of Neurology, Erzurum, Turkey.Ataturk UniversityFaculty of MedicineDepartment of NeurologyErzurumTurkey
| | - Alper Eren
- Ataturk University, Faculty of Medicine, Department of Neurology, Erzurum, Turkey.Ataturk UniversityFaculty of MedicineDepartment of NeurologyErzurumTurkey
| | - Nazım Kızıldağ
- Ataturk University, Faculty of Medicine, Department of Neurology, Erzurum, Turkey.Ataturk UniversityFaculty of MedicineDepartment of NeurologyErzurumTurkey
| |
Collapse
|
36
|
Li S, Xiao Z, Wang D, Yang K, Cao X, Wang G, Guo Z, Tong J, Fei W, Gong Y, Zhang Z. Clinical efficacy of LED golden light combined with acyclovir in the treatment of herpes zoster: a single-center prospective study. Lasers Med Sci 2023; 38:157. [PMID: 37407742 DOI: 10.1007/s10103-023-03817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
This study aimed to explore the safety and clinical efficacy of light emitting diode (LED) golden light combined with acyclovir in treating herpes zoster (HZ). According to the random number table, 54 inpatients with HZ were divided into control group, golden-light group, and red-light group, with 18 cases in each group. The control group received acyclovir intravenous drip, while the patients in the red-light group received acyclovir intravenous drip and red-light LED phototherapy, and the golden-light group received acyclovir intravenous drip and golden-light LED phototherapy. Primary assessments included herpes stopping time, incrustation time, decrustation time, pain visual analog scale scores (VAS), and incidence of postherpetic neuralgia (PHN) on the 30th and 90th days. Golden-light group and red-light group showed a shorter herpes stopping time, incrustation time, and decrustation time (P < 0.05) compared to the control group (P < 0.05), while the golden-light group showed a shorter incrustation time and decrustation time than the red light group (all P < 0.05). After treatment VAS scores, the golden-light group showed a significant improvement compared to the control group. The golden-light group showed a better PHN incidence than the control group at 30 days follow-up. Compared with the comprehensive curative effect, the total effective rates of the golden-light group, red-light group, and control group were 88.89%, 77.78%, and 72.22%, respectively, and the efficacy of the golden-light group was better than that of the control group and red-light group. Golden light combined with acyclovir can shorten the course of HZ, relieve pain, and reduce the occurrence of PHN, and the effect is better than that of the red-light group and the control group.
Collapse
Affiliation(s)
- Shiyang Li
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zixuan Xiao
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Duyang Wang
- Nanchang University National Institute of LED On Silicon Substrute, Nanchang, Jiangxi, China
| | - Kainan Yang
- Nanchang University National Institute of LED On Silicon Substrute, Nanchang, Jiangxi, China
| | - Xianwei Cao
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Guangxu Wang
- Nanchang University National Institute of LED On Silicon Substrute, Nanchang, Jiangxi, China.
| | - Zhuxiu Guo
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianbo Tong
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenmin Fei
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yangyang Gong
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhibin Zhang
- Department of Dermatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| |
Collapse
|
37
|
Ishino Y, Fukasawa H, Kitamoto S, Nakagami D, Kaneko M, Yasuda H, Furuya R. A survival case of visceral disseminated varicella zoster virus infection in a patient with systemic lupus erythematosus. BMC Nephrol 2023; 24:164. [PMID: 37291486 PMCID: PMC10251651 DOI: 10.1186/s12882-023-03223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE). CASE PRESENTATION A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged. CONCLUSIONS Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.
Collapse
Affiliation(s)
- Yuri Ishino
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Hirotaka Fukasawa
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan.
| | - Shuhei Kitamoto
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Daisuke Nakagami
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Mai Kaneko
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ryuichi Furuya
- Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| |
Collapse
|
38
|
Zeng J, Yang Y. Diagnosis and treatment of varicella-zoster virus infection with herpetic visceral neuralgia without rash: A case report. Medicine (Baltimore) 2023; 102:e33766. [PMID: 37233427 PMCID: PMC10219750 DOI: 10.1097/md.0000000000033766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
RATIONALE Herpes zoster (HZ) is an infection caused by the varicella-zoster virus reactivation, often leading to peripheral nervous system infection and pain. This case report aimed to present 2 patients with damaged sensory nerves originating from the visceral neurons of the lateral horn of the spinal cord. PATIENT CONCERNS Two patients presented intractable, severe lower back pain and abdominal pain, but without rash or herpes. A female patient was admitted 2 months after symptom onset. She was presented with paroxysmal, acupuncture-like pain in the right upper quadrant and around the umbilicus without apparent incentives. A male patient was presented with recurrent episodes of paroxysmal and spastic colic in the left waist and left middle abdomen for 3 days. Abdominal examination showed no tumors or organic lesions in their intra-abdominal tissues or organs. DIAGNOSES After excluding organic lesions on the waist and in abdominal organs, patients were diagnosed with herpetic visceral neuralgia without rash. INTERVENTION The treatment for herpes zoster neuralgia or postherpetic neuralgia was applied for 3 to 4 weeks. OUTCOME Antibacterial and anti-inflammatory analgesics were not effective in either patient. The therapeutic effects of herpes zoster neuralgia or postherpetic neuralgia treatment were satisfactory. LESSONS Herpetic visceral neuralgia can be easily misdiagnosed due to the absence of a rash or herpes, resulting in delayed treatment. When patients have severe, intractable pain but no rash or herpes, and the biochemical and imaging examinations are normal, the treatment method for HZ neuralgia can be used. If the treatment is effective, HZ neuralgia is diagnosed. If not, shingles neuralgia can be ruled out. Further investigations are required to elucidate the mechanisms of pathophysiological changes in varicella-zoster virus-induced peripheral HZ neuralgia or visceral neuralgia without herpes.
Collapse
Affiliation(s)
- Jin Zeng
- Department of Anesthesiology, First Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Yuanyuan Yang
- First Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| |
Collapse
|
39
|
Dash S, Behera B, Thakur V. Zosteriform erythematous rash. Eur J Intern Med 2023; 110:93-94. [PMID: 36585322 DOI: 10.1016/j.ejim.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Siddhartha Dash
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India 751019
| | - Biswanath Behera
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India 751019
| | - Vishal Thakur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India 751019.
| |
Collapse
|
40
|
Kanugo A, Deshpande A, Sharma R. Formulation Optimization and Evaluation of Nanocochleate Gel of Famciclovir for the Treatment of Herpes Zoster. Recent Pat Nanotechnol 2023; 17:259-269. [PMID: 35733311 DOI: 10.2174/1872210516666220622115553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Herpes zoster is a viral infection triggered due to the reactivation of the varicella- zoster virus in the posterior dorsal root ganglion. Herpes zoster infections occur mostly in the facial, cervical and thoracic regions of the body, beginning with pain and resulting in the vesicular eruption. Recently, this infection was observed during the COVID-19 pandemic and also after the induction of mRNA-based vaccine for coronavirus at an extended level. Nanocochleates are cylindrical (cigarshape) microstructure lipid-based versatile carriers for drug delivery systems. Famciclovir is an antiviral agent employed for the treatment of Herpes zoster infections. OBJECTIVE The current research patent aims to develop a novel nanocochleate gel of Famciclovir for the treatment of herpes zoster infections with higher efficacy. METHODS The interaction studies using FTIR were carried out and indicated no such interactions between the drug and lipids. The nanocochleates were developed using hydrogel, trapping, liposome before cochleate dialysis, direct calcium dialysis and binary aqueous-aqueous emulsion methods, respectively. The 32 Box-Behnken design was applied by considering the concentration of lipids (phosphatidylcholine and cholesterol) and speed of rotation as independent factors, whereas particle size and entrapment efficiency as dependable factors. RESULTS The developed nanocochleates were estimated for the particle size (276.3 nm), zeta potential (-16.7 mV), polydispersity index (0.241), entrapment efficiency (73.87±0.19%) and in vitro diffusion release (>98.8% in 10 h). The optimized batch was further converted into the topical gel using carbopol 940 as a gelling agent. The prepared gel was smooth, rapidly spreadable with a viscosity (5998.72 cp), drug content (95.3%) and remained stable during stability studies. CONCLUSION A novel nanocochleate gel of Famciclovir was successfully developed for the treatment of infections associated with Herpes Zoster with sustained release action.
Collapse
Affiliation(s)
- Abhishek Kanugo
- Department of Pharmaceutics, SVKM NMIMS School of Pharmacy and Technology Management, Shirpur, Dhule 425405, India
| | - Ashwini Deshpande
- Department of Pharmaceutics, SVKM NMIMS School of Pharmacy and Technology Management, Jadcherla, Mahabubnagar 509301, India
| | - Rahul Sharma
- Department of Pharmaceutics, SVKM NMIMS School of Pharmacy and Technology Management, Shirpur, Dhule 425405, India
| |
Collapse
|
41
|
Li Z, Wu J, Huang S, Pan Z, Huang J. Screening of Key Part in IFN Pathway for Herpes Zoster: Evidence from Bioinformatics Analysis. Comb Chem High Throughput Screen 2023; 26:719-727. [PMID: 35538831 DOI: 10.2174/1386207325666220509182242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Herpes zoster is one of the most common diseases in middle and old ages, and the incidence rate is constantly increasing. Long-term, severe neuropathological pain continues to afflict the patients, causing trouble and even the inability to live a normal life. Since the occurrence and development of herpes zoster are related to many mechanisms, there is no uniform conclusion and specific treatment method, and only a limited number of people are currently vaccinated against HZ. OBJECTIVE This study aimed at exploring the potential mechanism or biomarkers for Herpes zoster. METHODS In this study, a data set GSE165112 containing 12 samples was downloaded, out of which, 6 samples were treated with interferon, and 6 samples were not treated. Differentially expressed genes (DEG) analysis, KEGG, GO enrichment analysis, and GSEA were carried out. RESULTS A total of 264 DEGs were identified, including 32 uP-regulated DEGs and 232 downregulated DEGs. DEGs are mainly enriched in immune response, inflammatory response, chemotaxis, etc. Four key pathways were found to be related to HZ, including IL2-STAT5 signaling, inflammatory response, TNF-a signaling via NF-κB, and IFN-α. Moreover, ten hub genes were also identified. CONCLUSION This study shows that exploring DEGs and pathways through bioinformatics analysis is of great significance for understanding the molecular mechanism of HZ, especially the defect of the IFN pathway. It may be helpful in improving the treatment for HZ.
Collapse
Affiliation(s)
- Zimeng Li
- Acupuncture and Moxibustion School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Shijie Huang
- Acupuncture and Moxibustion School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Zhengqi Pan
- Acupuncture and Moxibustion School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| | - Jing Huang
- Eye college of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China
| |
Collapse
|
42
|
Kelley A. Herpes zoster: A primary care approach to diagnosis and treatment. JAAPA 2022; 35:13-18. [PMID: 36346926 DOI: 10.1097/01.jaa.0000892712.73041.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT Herpes zoster, or shingles, caused by a reactivation of the chickenpox virus, can occur in patients of any age, but is more common in older adults. Patient history is critical in reaching a diagnosis, not only to manage the outbreak effectively, but also to prevent severe complications such as dissemination of the virus into the central nervous system. This article describes recent changes in diagnostic testing, treatment, prevention, and practice guidelines as well as the approach clinicians should take when evaluating patients with herpes zoster and assessing risk for complications.
Collapse
Affiliation(s)
- Angela Kelley
- Angela Kelley is director of didactic education and an assistant professor in the PA program at Gannon University's Ruskin (Fla.) Campus. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
43
|
Oe H, Watanabe M, Sasaki M, Miyamoto Y, Okada N, Matsuyama T, Ohta B. Varicella-zoster virus meningitis coincident with bacteremia caused by liver abscess: a case report. J Neurovirol 2022; 28:606-608. [PMID: 36112241 DOI: 10.1007/s13365-022-01086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 01/13/2023]
Abstract
Varicella-zoster virus (VZV) meningitis is sometimes associated with herpes zoster, which is also associated with various other infectious diseases. However, there are limited case reports of VZV meningitis with concomitant infectious diseases. Herein, we report a unique case of VZV meningitis concomitant with a pyogenic liver abscess. VZV meningitis was associated with herpes zoster ophthalmicus, Klebsiella pneumoniae bacteremia, and liver abscess. When VZV meningitis is suspected, clinicians should be aware of its relatively rare epidemiology, nonspecific presentation, and many background risks shared with other infections and should never omit thorough examinations to rule out other infectious causes.
Collapse
Affiliation(s)
- Hikaru Oe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Makoto Sasaki
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
44
|
Marra Y, Lalji F. Prevention of Herpes Zoster: A Focus on the Effectiveness and Safety of Herpes Zoster Vaccines. Viruses 2022; 14:v14122667. [PMID: 36560671 PMCID: PMC9782228 DOI: 10.3390/v14122667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Infection with varicella zoster virus typically occurs in children and it can cause primary varicella infection or "chickenpox", or it can reactivate later in life and cause herpes zoster or "shingles". Herpes zoster mainly occurs in older adults, causing a reduction in activities of daily living, impacting quality of life, and may lead to serious complications, including chronic pain. Two vaccines are marketed to prevent herpes zoster: the live zoster vaccine and the non-live, recombinant zoster vaccine. The pre-licensure clinical trials show the efficacy of the live zoster vaccine to be between 50 and 70% and for the recombinant vaccine to be higher at 90 to 97%. Real-world effectiveness studies, with a follow-up of approximately 10 years, were reviewed in this article. These data corroborated the efficacy studies, with vaccine effectiveness being 46% and 85% for the live and recombinant vaccines, respectively. Safety data from the effectiveness studies show similar results to the clinical trials with mostly local injection-site reactions and mild systemic reactions seen with both vaccines, although in larger proportions with the recombinant vaccine. Rare adverse events, occurring less than 1% of the time, have been seen with both vaccine types and include disseminated herpes zoster with the live zoster vaccine and Guillain-Barré syndrome with the recombinant vaccine. The wider use of preventative measures with vaccines will reduce the herpes zoster burden of illness seen in older adults.
Collapse
Affiliation(s)
- Yasmin Marra
- Faculty of Arts and Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Fawziah Lalji
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: ; Tel.: +1-604-8227-898
| |
Collapse
|
45
|
Deng YX, Hu J, Li HM. [Efficacy and safety of different doses of antiviral agents in the treatment of herpes zoster: a meta-analysis]. Zhonghua Yi Xue Za Zhi 2022; 102:3192-3200. [PMID: 36319173 DOI: 10.3760/cma.j.cn112137-20220603-01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To systematically evaluate the efficacy and safety of different doses of antiviral drugs in the treatment of herpes zoster. Methods: PubMed, EMBASE, Cochrane Library, VIP, CNKI and WanFang database up to April 9, 2022 were searched. Two reviewers selected the studies according to inclusion and exclusion criteria, and the Cochrane bias risk assessment tool was used for quality evaluation. Data were analyzed by Revman 5.4 software for meta-analysis. The qualitative data used relative risk (RR) as the effect index, and the quantitative data used mean difference (MD) as the effect index. The point estimates and 95%CI of each effect were given. Results: Fourteen randomized controlled trials with 1 831 patients were included in the study. Compared with the 200 mg acyclovir with five times a day, the 800 mg can improve the effective rate, shorten the blister stopping time (MD=-1.29, 95%CI:-1.62- -0.96, P<0.001), relieve the pain faster (MD=-2.73, 95%CI:-4.37- -1.09, P=0.001), shorten the scabbing time (MD=-2.42, 95%CI:-2.96- -1.89, P<0.001) without increasing the adverse reaction rate (RR=1.64, 95%CI:0.80-3.36, P=0.17); Compared with the 300 mg valaciclovir with twice daily, the 900-1 000 mg valaciclovir with three times a day can improve the effective rate(RR=1.17, 95%CI:1.04-1.32, P=0.007), shorten the blister stopping time (MD=-1.53, 95%CI:-2.54- -0.51, P=0.003), relieve the pain faster (MD=-1.04, 95%CI:-1.30- -0.77, P<0.001), shorten the scabbing time (MD=-1.78, 95%CI:-2.80- -0.76, P<0.001), reduce the incidence of postherpetic neuralgia(RR=0.28, 95%CI:0.15-0.52, P<0.001) without increasing the adverse reaction rate (RR=1.47, 95%CI:0.93-2.32, P=0.10); In immunocompromised patients, compared with 1 000 mg valaciclovir with three times a day, 2 000 mg cannot significantly improve the treatment efficacy. There was no significant difference among the efficacy of 250 mg, 500 mg and 750 mg famciclovir, three times a day, in the treatment of herpes zoster. Conclusion: The 800 mg acyclovir with five times a day; 900-1 000 mg valaciclovir and 250 mg famciclovir with three times a day, are better choices in the treatment of herpes zoster.
Collapse
Affiliation(s)
- Y X Deng
- Department of Dermatology, Peking University People 's Hospital, Beijing 100044, China
| | - J Hu
- Department of Dermatology, Peking University People 's Hospital, Beijing 100044, China
| | - H M Li
- Department of Dermatology, Peking University People 's Hospital, Beijing 100044, China
| |
Collapse
|
46
|
Akpandak I, Miller DC, Sun Y, Arnold BF, Kelly JD, Acharya NR. Assessment of Herpes Zoster Risk Among Recipients of COVID-19 Vaccine. JAMA Netw Open 2022; 5:e2242240. [PMID: 36383382 PMCID: PMC9669817 DOI: 10.1001/jamanetworkopen.2022.42240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Importance Herpes zoster infection after COVID-19 vaccination has been reported in numerous case studies. It is not known whether these cases represent increased reporting or a true increase in risk. Objective To assess whether COVID-19 vaccination is associated with an increased risk of herpes zoster infection. Design, Setting, and Participants This cohort study used a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination or up to the date of the second vaccine dose with a control interval remote from COVID-19 vaccination (defined as 60-90 days after the last recorded vaccination date for each individual, allowing for a 30-day washout period between control and risk intervals). A supplemental cohort analysis was used to compare the risk of herpes zoster after COVID-19 vaccination with the risk of herpes zoster after influenza vaccination among 2 historical cohorts who received an influenza vaccine in the prepandemic period (January 1, 2018, to December 31, 2019) or the early pandemic period (March 1, 2020, to November 30, 2020). Data were obtained from Optum Labs Data Warehouse, a US national deidentified claims-based database. A total of 2 039 854 individuals who received any dose of a COVID-19 vaccine with emergency use authorization (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], or Ad26.COV2.S [Johnson & Johnson]) from December 11, 2020, through June 30, 2021, were eligible for inclusion. Individuals included in the SCRI analysis were a subset of the COVID-19-vaccinated cohort who had herpes zoster during either a risk or control interval. Exposures Any dose of a COVID-19 vaccine. Main Outcomes and Measures Incident herpes zoster, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and a prescription of a new antiviral medication or a dose increase in antiviral medication within 5 days of diagnosis. Results Among 2 039 854 individuals who received any dose of a COVID-19 vaccine during the study period, the mean (SD) age was 43.2 (16.3) years; 1 031 149 individuals (50.6%) were female, and 1 344 318 (65.9%) were White. Of those, 1451 patients (mean [SD] age, 51.6 [12.6] years; 845 [58.2%] female) with a herpes zoster diagnosis were included in the primary SCRI analysis. In the SCRI analysis, COVID-19 vaccination was not associated with an increased risk of herpes zoster after adjustment (incidence rate ratio, 0.91; 95% CI, 0.82-1.01; P = .08). In the supplementary cohort analysis, COVID-19 vaccination was not associated with a higher risk of herpes zoster compared with influenza vaccination in the prepandemic period (first dose of COVID-19 vaccine: hazard ratio [HR], 0.78 [95% CI, 0.70-0.86; P < .001]; second dose of COVID-19 vaccine: HR, 0.79 [95% CI, 0.71-0.88; P < .001]) or the early pandemic period (first dose of COVID-19 vaccine: HR, 0.89 [95% CI, 0.80-1.00; P = .05]; second dose: HR, 0.91 [95% CI, 0.81-1.02; P = .09]). Conclusions and Relevance In this study, there was no association found between COVID-19 vaccination and an increased risk of herpes zoster infection, which may help to address concerns about the safety profile of the COVID-19 vaccines among patients and clinicians.
Collapse
Affiliation(s)
- Idara Akpandak
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - D. Claire Miller
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Yuwei Sun
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Benjamin F. Arnold
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - J. Daniel Kelly
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco
| | - Nisha R. Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco
- Department of Ophthalmology, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| |
Collapse
|
47
|
Li J, Huang Y, Lin J. [Efficacy analysis of lidocaine plaster combined with gabapentin in the treatment of herpes zoster neuralgia]. Zhonghua Yi Xue Za Zhi 2022; 102:3186-3191. [PMID: 36319172 DOI: 10.3760/cma.j.cn112137-20220419-00852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To evaluate the efficacy and safety of lidocaine plaster combined with gabapentin in the treatment of herpes zoster neuralgia (HZN). Methods: A total of 93 patients diagnosed with HZN from June 4, 2021 to January 5, 2022 in the Department of Pain Clinic of Nanjing Drum Tower Hospital were selected, and their gender was not limited. They were divided into 3 groups by random number table method: group A (n=32) prescribed gabapentin alone, group B (n=30) lidocaine plaster alone, and group C (n=31) lidocaine plaster combined with gabapentin. After excluding patients who did not meet the criteria, there were 28 cases in group A, 28 cases in group B, and 29 cases in group C. The visual analogue scale (VAS), the short-form McGill pain questionnaire (SF-MPQ) score, and drug dosage and adverse reaction in each group at pre-treatment (T0), post-treatment in one week (T1), in two weeks (T2), in four weeks (T4), and in 12 weeks (T12) were recorded and evaluated; Pittsburgh Sleep Quality Index (PSQI) score and Medical Outcomes Study short-form 36 (SF-36) score at T0, T4, and T12 were recorded. Adverse reactions and drug dosage in each group were documented. Repeated measures ANOVA was used to compare the curative effects of the three groups at different time points before and after treatment. Results: The ages of the three groups of patients were (67.8±10.0), (60.9±11.4) and (63.5±12.5) years old respectively (P=0.318), and the proportions of men were 46.4 % (13 cases), 35.7% (10 cases) and 44.8 % (13 cases), respectively (P=0.472). After treatment, the VAS scores and SF-MPQ scores of patients in the three groups were decreased at each time point compared with those before treatment (all P<0.05), the VAS and SF-MPQ scores of patients in group C at T12 time point were 1.2±0.4 and 5.2±2.4 respectively, which were lower than those of patients in groups A and B (both P<0.05). The dosages of gabapentin and lidocaine plaster in group C were lower than those in groups A and B at each time point after treatment (all P<0.05). The PSQI scores of patients in the three groups at T4 and T12 were lower than those before treatment (all P<0.05). The PSQI scores of patients in group C at T4 and T12 were 5.7±1.2 and 4.5±1.2, which were lower than those of patients in groups A and B. (all P<0.05), The SF-36 scores of patients in three groups at T4 and T12 were higher than those before treatment (all P<0.05), and the SF-36 scores of group C at T4 and T12 were 91.7±8.5, 93.1±6.3, which were higher than that of patients in groups A and B (both P<0.05). The incidence of adverse reactions in the three groups were 35.7% (9 cases), 10.7% (3 cases), and 13.8% (4 cases) respectively (P<0.05), the adverse reactions in groups B and C were less than those in group A (P<0.05), and there was no statistical difference between groups B and C (P>0.05). Conclusion: Lidocaine plaster combined with gabapentin has better analgesic effect in the treatment of HZN, with less incidence of adverse reactions, and can reduce the dosage of systemic drugs, improve patients' sleep and quality of life, and thus could provide a safe and effective method for the treatment of HZN.
Collapse
Affiliation(s)
- J Li
- Department of Pain Clinic, Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008, China
| | - Y Huang
- Department of Pain Clinic, Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008, China
| | - J Lin
- Department of Pain Clinic, Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008, China
| |
Collapse
|
48
|
Sutra P, Pokawattana I. Retinal vasculopathy following varicella zoster virus infection. Curr Opin Ophthalmol 2022; 33:557-563. [PMID: 36165416 DOI: 10.1097/icu.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed. RECENT FINDINGS Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed. SUMMARY VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.
Collapse
Affiliation(s)
- Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | |
Collapse
|
49
|
Martinez-Reviejo R, Tejada S, Adebanjo GAR, Chello C, Machado MC, Parisella FR, Campins M, Tammaro A, Rello J. Varicella-Zoster virus reactivation following severe acute respiratory syndrome coronavirus 2 vaccination or infection: New insights. Eur J Intern Med 2022; 104:73-79. [PMID: 35931613 PMCID: PMC9340059 DOI: 10.1016/j.ejim.2022.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Varicella zoster virus (VZV) reactivation has been reported following vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the real extent remains unknown. METHODS We conducted a systematic review to summarize evidence of VZV reactivation or infection following SARS-CoV-2 vaccination. Episodes after coronavirus disease-2019 (COVID-19) were also identified. Related articles were identified in PubMed and EMBASE databases till December 31, 2021 using the terms "varicella zoster" and "COVID-19″. PROSPERO Register Number: CRD42021289399. RESULTS The search revealed 314 articles, of which 55 met the inclusion criteria. VZV manifestations were documented in 179 (82.1%) subjects following SARS-CoV-2 vaccination and in 39 (17.9%) patients with COVID-19. Among the vaccinated, median (IQR) age was 56.5 (42-70) years, and 56.8% were female. Twenty-one (16.8%) were immunosuppressed. The median (IQR) latency time after vaccination was 6 (3-10) days, and 84.4% received mRNA vaccines. VZV reactivation occurred following a first dose (68.2%), a second dose (12.8%) or a booster (0.6%). The most important VZV manifestation was dermatome herpes zoster rash, which accounted for 86.4% of events in vaccinated subjects. Twenty patients (11.3%) presented serious VZV events after vaccination, with Herpes Zoster ophthalmicus (5.6%) and post-herpetic neuralgia (3.4%) predominating. No VZV pneumonia or deaths were recorded. Antiviral prescriptions were made in 96.2% of vaccinated subjects. No significant differences between vaccinated and infected subjects were found. CONCLUSION This study indicates that the occurrence of VZV reactivation is clinically relevant. However, our findings suggest that COVID-19 vaccination is safe, and remains strongly recommended.
Collapse
Affiliation(s)
- Raquel Martinez-Reviejo
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Sofia Tejada
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | | | - Camilla Chello
- NESMOS Department of Dermatology, Sapienza University of Rome, Rome, Italy
| | | | | | - Magda Campins
- Department of Epidemiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Antonella Tammaro
- NESMOS Department of Dermatology, Sapienza University of Rome, Rome, Italy
| | - Jordi Rello
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Clinical Research, Department of Anesthesia, CHRU Nîmes, Nîmes, France.
| |
Collapse
|
50
|
Itoh K, Mitsuke Y, Wakahara M, Yoshioka T, Otsuki N, Suzuki Y, Kiriba C, Kuwata A, Sakamaki I, Iwasaki H, Tsutani H. Aseptic Meningitis after Amenamevir Treatment for Herpes Zoster in the First Branch of the Trigeminal Nerve. Intern Med 2022; 61:2809-2811. [PMID: 35228415 PMCID: PMC9556230 DOI: 10.2169/internalmedicine.8581-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Amenamevir has been approved for the treatment of herpes zoster (HZ); however, its therapeutic efficacy against central nervous system (CNS) infection may be insufficient due to its low spinal fluid permeability. We herein report a case of aseptic meningitis in a 91-year-old Japanese man treated with amenamevir for HZ in the trigeminal nerve region. Several cases of CNS infection have been reported in patients receiving amenamevir treatment for HZ. Patients with CNS complications often have skin rashes near the trigeminal region. Thus, we should be alert for signs of CNS infection when administering amenamevir to patients with such rashes.
Collapse
Affiliation(s)
- Kazuhiro Itoh
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
- Department of Infectious Diseases, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yasuhiko Mitsuke
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| | - Mami Wakahara
- Department of Dermatology, National Hospital Organization Awara Hospital, Japan
| | - Tatsuya Yoshioka
- Department of Ophthalmology, National Hospital Organization Awara Hospital, Japan
| | - Nozomi Otsuki
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| | - Yusuke Suzuki
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| | - Chiyo Kiriba
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| | - Atsushi Kuwata
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| | - Ippei Sakamaki
- Department of Infectious Diseases, Faculty of Medical Sciences, University of Fukui, Japan
| | - Hiromichi Iwasaki
- Department of Infectious Diseases, Faculty of Medical Sciences, University of Fukui, Japan
- Division of Infection Control and Prevention, University of Fukui Hospital, Japan
| | - Hiroshi Tsutani
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Japan
| |
Collapse
|