Incidence of complications of herpes zoster in individuals on immunosuppressive therapy: a register-based population study

2022 ◽  
Author(s):  
Sylvain Chawki ◽  
Ana-Maria Vilcu ◽  
Cindy Etienne ◽  
Flora Finet ◽  
Thierry Blanchon ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Immunosuppressive Therapy ◽  
Population Study

scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

Herpes Zoster in the Age of Focused Immunosuppressive Therapy

JAMA ◽  
2009 ◽  
Vol 301 (7) ◽  
pp. 774 ◽  
Author(s):  
Richard J. Whitley
Keyword(s):  
Herpes Zoster ◽  
Immunosuppressive Therapy

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project

2016 ◽  
Vol 44 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Heena Sheth ◽  
Larry Moreland ◽  
Hilary Peterson ◽  
Rohit Aggarwal
Keyword(s):  
Rheumatoid Arthritis ◽  
Quality Improvement ◽  
Herpes Zoster ◽  
Immunosuppressive Therapy ◽  
Eligible Patient ◽  
Quality Improvement Project ◽  
Post Intervention ◽  
Improvement Project ◽  
Intervention Phase ◽  
Vaccination Rates

Objective.To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy.Methods.This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test.Results.We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002).Conclusion.Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician’s time, and has the potential for self-sustainability and generalizability.

scholarly journals Herpes Zoster Infections in SLE in a University Hospital in Saudi Arabia: Risk Factors and Outcomes

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Afsar Sayeeda ◽  
Hussain Al Arfaj ◽  
Najma Khalil ◽  
A. S. Al Arfaj
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Immunosuppressive Therapy ◽  
Statistical Significance ◽  
Oral Prednisolone ◽  
Pulse Therapy ◽  
University Hospital ◽  
Retrospective Case ◽  
Similar Time ◽  
Increased Risk

Patients with SLE carry an increased risk of infection that account for 11–23% of all hospitalized patients and 50% of all SLE patients develop major infections during the course of their disease. Globally Herpes Zoster has been reported as the most frequent viral infection in SLE patients. We determined the clinical spectrum, disease sequelae and the risk factors associated with the development of Herpes Zoster in patients with SLE and their outcomes. Retrospective case control study of Herpes Zoster infections was done in SLE patients between 1982 and 2006. Cases were matched 1:2 to controls for age, race, sex and duration of follow up. Clinical features of the cases from the time of lupus diagnosis to the time of Zoster were compared to their respective controls over similar time periods. Thirty two SLE cases were compared to sixty four controls. Cases were more likely to have received cyclophosphamide () and intravenous methylprednisolone pulse therapy (), MMF (), had leucopenia () and hemolytic anemia (). More cases than controls had lupus nephritis, cerebritis, thrombocytopenia but the differences did not reach statistical significance. The mean oral prednisolone dose and proportion of patients receiving immunosuppressives including pulse methylprednisolone therapy, IV Cyclophosphamide and mycophenolate was significantly higher in patients with active SLE compared to patients with SLE in remission at the time of Herpes Zoster (). Disseminated Zoster developed in patients with active SLE (7/9) compared to patients with SLE in remission (0/23). None of the patients had postherpetic neuralgia or bacterial super infection. Immunosuppressive medications were discontinued at the time of diagnosis of Zoster in 19 of 32 patients and all patients received antiviral medications.There were no permanent neurologic deficits or deaths. We conclude that Herpes Zoster infections occur at increased frequency among patients with SLE and carry significant morbidity. Immunosuppressive therapy and severe manifestations of lupus may be risk factors for the development of Herpes Zoster although not necessarily at the time of disease flare or immunosuppressive therapy. Our study suggests that although Herpes Zoster occurs frequently in patients with SLE, it has a relatively benign course.

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