Herpes-zoster-Update – was gibt es Neues?

2021 ◽  
Vol 47 (11) ◽  
pp. 498-509
Author(s):  
Cornelia S.L. Müller ◽  
Patric Bialas ◽  
Sören L. Becker
Keyword(s):  
Herpes Zoster ◽  
Skin Lesions ◽  
Inactivated Vaccine ◽  
Limited Extent ◽  
Everyday Clinical Practice ◽  
Varicella Zoster ◽  
Experienced Pain ◽  
Increased Risk ◽  
Patient Groups ◽  
Pain Therapists

AbstractShingles are triggered by the reactivation of an infection with the varicella zoster virus (VZV) and are characterized by specific vesicular skin lesions. Mostly, elderly patients are affected. Depending on the affected dermatome, some serious complications can be observed. The introduction of a vaccine against shingles in Germany offers a great potential for reducing the frequency and severity of this disease. There are both a live vaccine, which is no longer recommended, and an inactivated vaccine, which, however, is still not sufficiently recommended to the authorized patient groups and is also only available to a limited extent due to delivery bottlenecks. HZ neuralgia is a serious complication of the disease that requires rapid and effective therapy and should be handed over to experienced pain therapists rather too early than too late. Unfortunately, in everyday clinical practice only a few people are familiar with VZV vasculopathy, which is associated with a significantly increased risk of cerebral insults.

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 with Cutaneous Dissemination in a Patient 21 Years after Splenectomy for Idiopathic Thrombocytopenic Purpura

2012 ◽  
Vol 16 (5) ◽  
pp. 368-371 ◽  
Author(s):  
Rachel A. Moquete ◽  
Barry Hartman ◽  
Richard D. Granstein
Keyword(s):  
Herpes Zoster ◽  
Herpes Simplex ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Good Health ◽  
Immunocompetent Patient ◽  
Thrombocytopenic Purpura ◽  
Virus Family ◽  
Varicella Zoster ◽  
Increased Risk ◽  
History Of

Background: Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination. Objective: We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy. Conclusions: This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ. Renseignements de base: Le virus varicelle-zona est un virus de la famille des Herpesviridae qui cause la varicelle durant une primo-infection, et l'herpès zoster (zona) (HZ) en cas de réactivation. Les patients qui sont immunocompromis ont souvent des présentations atypiques de HZ et affichent des complications telles que la participation et la dissémination multicutanées. Objectif: Nous exposons un cas de zona disséminé chez un patient immunocompétent ayant subi une splénectomie pour traiter un purpura thrombocytopénique idiopathique (PTI). Notre patiente âgée de 46 ans présentait une éruption vésiculo-papuleuse douloureuse localisée dans une zone dermatome avec environ 80 autres lésions diffuses réparties sur son corps. Elle était en bonne santé mais avait subi une splénectomie pour traiter un PTI 21 ans plus tôt et présentait des antécédents d'épisodes récurrents d'herpès labial. Ce dernier a abouti 'a un diagnostic provisoire d'une infection généralisée par le virus herpès simplex. Cependant, les résultats des analyses de laboratoire ont confirmé un diagnostic d'herpès zoster (zona) disséminé. Une investigation de l'état immunitaire de la patiente n'a pas révélé d'anomalies autres que la splénectomie que la patiente a subie antérieurement. Conclusions: Ce cas vient s'ajouter aux deux cas de patients signalés qui ont développé un HZ disséminé plusieurs années après avoir subi une splénectomie. Notre cas sert à rappeler que les patients présentant des antécédents de splénectomie semblent être exposés à un risque accru de dissémination cutanée sous forme de HZ.

scholarly journals Herpes Zoster in Kidney Transplant Recipients: A Series of Three Cases

2020 ◽  
Vol 10 (3) ◽  
pp. 139-146 ◽  
Author(s):  
Ramy M. Hanna ◽  
Farid Abd-El-Malak ◽  
Ammar Alnaser ◽  
Rumi Cader ◽  
Julie M. Yabu
Keyword(s):  
Herpes Zoster ◽  
Kidney Transplant ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Varicella Zoster ◽  
Organ Rejection ◽  
Increased Risk ◽  
Disseminated Disease

Kidney transplant recipients require lifelong immunosuppression to prevent organ rejection. The need for this intervention, however, leads to decreased cellular immunity and, in turn, increased risk of developing herpes zoster (HZ) from reactivation of latent varicella zoster virus. HZ commonly presents as a painful rash in a dermatome presentation followed by post-herpetic neuralgia. In immunosuppressed individuals, the presentation can be atypical and vary in severity depending on degree of immunosuppression and host immune response. We present the clinical course of 3 kidney transplant recipients who developed HZ after transplantation at different times post-transplant with varying clinical manifestations. The balance between maintaining immunosuppression and preventing or subsequently treating disseminated disease is discussed.

scholarly journals Reactivation of Varicella Zoster Virus after Vaccination for SARS-CoV-2

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 572
Author(s):  
Mina Psichogiou ◽  
Michael Samarkos ◽  
Nikolaos Mikos ◽  
Angelos Hatzakis
Keyword(s):  
Adverse Event ◽  
Herpes Zoster ◽  
T Cell ◽  
Varicella Zoster Virus ◽  
Time Window ◽  
Vaccine Safety ◽  
Cell Mediated Immunity ◽  
Varicella Zoster ◽  
Increased Risk ◽  
Immunocompetent Patients

Seven immunocompetent patients aged > 50 years old presented with herpes zoster (HZ) infection in a median of 9 days (range 7–20) after vaccination against SARS-CoV-2. The occurrence of HZ within the time window 1–21 days after vaccination defined for increased risk and the reported T cell-mediated immunity involvement suggest that COVID-19 vaccination is a probable cause of HZ. These cases support the importance of continuing assessment of vaccine safety during the ongoing massive vaccination for the COVID-19 pandemic and encourage reporting and communication of any vaccination-associated adverse event.

scholarly journals Clinical Study on Outcome of Treatment for Herpes Zoster

2021 ◽  
Author(s):  
Kishan Rasubhai Ninama ◽  
Rashmi Samir Mahajan ◽  
Atmakalyani Rashmi Shah ◽  
Apexa Prakash Jain
Keyword(s):  
Herpes Zoster ◽  
Lupus Erythematosus ◽  
De Novo ◽  
Clinical Manifestations ◽  
Pemphigus Vulgaris ◽  
Clinical History ◽  
Skin Lesions ◽  
Enzyme Linked Immunosorbent Assay ◽  
Oral Acyclovir ◽  
Varicella Zoster

Introduction: Herpes Zoster (HZ) is caused by reactivation of Varicella Zoster Virus (VZV). It is characterised by occurrence of grouped vesicles on erythematous base which involves the entire dermatome innervated by a single spinal or cranial sensory ganglion and is associated with radicular pain. Antivirals (Acyclovir, Famciclovir and Valacyclovir) started within 72 hours of onset of lesions are the agents of choice. Aim: To study the clinical manifestations, comorbidities, efficacy and safety of Acyclovir, complications and sequelae associated with HZ. Materials and Methods: A 3-year longitudinal cohort study was conducted in 212 adult patients (>18 years of age) suffering with HZ in the Department of Dermatology, Dhiraj General Hospital, Pipariya, Gujarat, India. In this study 212 patients with HZ were prescribed oral Acyclovir in a dose of 800 mg 5 times a day for 7 days. All patients were analysed in terms of clinical manifestations, pre-existing co-morbidities and incidence of complications. The clinical history and findings were recorded in a prestructured proforma. All patients were subjected to cytological examination (Tzanck smear) and Human immunodeficiency viruses (HIV) testing Enzyme-Linked Immunosorbent Assay (ELISA). Diagnosis was made primarily on the basis of clinical findings and presence of multinucleated giant cells in Tzanck smear. All the patients were treated with Oral Acyclovir. Cases were followed-up fortnightly for six weeks and evaluated for relief of symptoms, treatment outcome and complications/sequelae. Results: Two hundred and twelve cases were studied. One hundred and forty-two cases were in the 4th and 5th decades of life. Sixty-three cases had comorbidities like diabetes mellitus in 31, autoimmune diseases like pemphigus vulgaris, systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease in 19 and AIDS in 8 cases. Five cases had malignancy/lymphomas and were receiving chemotherapy for the same. In the majority, HZ occurred de novo without any comorbidities. The most common dermatomes involved were cervical and thoracic. Out of 212 cases Oral Acyclovir 800 mg was well tolerated by 74. Most common complication was Postherpetic Neuralgia (PHN), seen in 80 cases. Conclusion: The treatment of HZ with Oral Acyclovir 800 mg 5 times a day for 7 days is efficacious for healing of skin lesions and also reduces the chances of PHN if instituted within 72 hours.

scholarly journals Clinical study of herpes zoster in 109 patients in central referral hospital, Gangtok

2019 ◽  
Vol 5 (4) ◽  
pp. 849
Author(s):  
Rukma L. Sharma ◽  
Rekha Sharma
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Age Group ◽  
Female Ratio ◽  
Varicella Zoster ◽  
Single Nerve ◽  
Male Female Ratio ◽  
The Common

<p class="abstract"><strong>Background:</strong> Herpes zoster results from the reactivation of varicella-zoster virus lying dormant in the dorsal root ganglia following an earlier primary infection (chickenpox), usually in childhood. The reactivation occurs due to multifactorial causes leading to decreased immunity.</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 109 cases of herpes zoster. Patient’s particulars were noted. A detailed history was recorded; morphology, the site and side of skin lesions were recorded. Any other associated diseases were noted.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 109 patients 66 were male and 43 were female. The total of 53 (48.6%) patients were under the age of 40 years and 56 (51.4%) patients above 40 years. Bhutias were affected in highest number (18.4%) followed by Sharma community (15.6%). The ophthalmic division of trigeminal nerve was the most commonly affected single nerve with 13.8% followed by T10 and T7 dermatome at 9.17% and 7.3% respectively. Thoracic nerves the most commonly involved thoracic nerves with 44 cases. Single dermatomal eruptions were found in 55 patients. The dissemination of herpes zoster was although very rare but was present in three patients. Type 2 diabetes mellitus was the common associated systemic illness with 10.09% of patients.</p><p class="abstract"><strong>Conclusions:</strong> From this study it was revealed that both young adults and older age group people were affected almost equally. The male: female ratio was 1.5:1 with Bhutia community being mostly affected. Thoracic dermatome was the most common dermatome involved and in half the patients some form of associated disease noted.</p>

Delayed Varicella Zoster Virus (VZV) Infection Following Hematopoietic Cell Transplantation (HCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3366-3366
Author(s):  
Liton Francisco ◽  
Mary Harton ◽  
Can-Lan Sun ◽  
Andrea R. Carter ◽  
John Zaia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Mycophenolate Mofetil ◽  
Herpes Zoster ◽  
Immunosuppressive Agents ◽  
Unrelated Donor ◽  
Varicella Zoster ◽  
Increased Risk ◽  
Autologous Hct ◽  
Varicella Zoster Infection

Abstract Patients undergoing HCT are at an increased risk of developing primary and reactivated VZV infection, with the majority of reactivations occurring within the first year post-HCT. Short term use of acyclovir as prophylaxis has been shown to be effective in reducing VZV risk, however prolonged use of acyclovir as prophylaxis is controversial, and the long term incidence of delayed VZV infection, and hence the recommended duration of antiviral prophylaxis is not clear. To assess the incidence and risk factors associated with delayed VZV infection (occurring one or more years after HCT), we conducted a retrospective chart review of 1578 consecutive patients undergoing HCT at City of Hope Cancer Center between 1976 and 1998, and surviving one or more years after HCT. Diagnosis of VZV was based on the clinic note dictated by the physician, with validation using appropriate laboratory tests in those individuals diagnosed with VZV. Information on pre-transplant therapeutic exposures and post-transplant health complications was obtained via medical record abstraction. The median age at HCT was 35 years (range, 0.6–71.5), median length of follow-up 6.4 years, and the cohort included 934 males (59.2%). In total, 178 patients (11.3%) developed VZV infection after surviving at least one year after HCT (19 patients (1.2%) had primary VZV (chickenpox), 138 patients (8.7%) localized herpes zoster, and 21 patients (1.3%) disseminated herpes zoster). The overall cumulative incidence was 13.9% (95% Confidence Interval [CI], 11.6–16.2%) at 15 years from HCT for the first reported VZV infection developing one or more years after HCT. (autologous HCT: 10.2% [7.2–13.3%] at 10 years); allogeneic sibling donor HCT survivors: 14.2% [11.6–16.8%]; unrelated donor HCT: 21.5% [12.3–30.7%]). Multivariate analysis of the allogeneic transplant cohort showed that prophylaxis/treatment of GvHD with prednisone (Relative risk (RR), 2.14; 95% CI, 1.27 to 3.61) and Mycophenolate Mofetil (RR, 1.93; 95% CI, 1.08 to 3.45) were associated with increased risk. No risk factors were identified for the development of VZV among autologous HCT recipients by multivariate analysis. VZV infection is a frequent and significant source of morbidity after HCT (bacterial superinfection, scarring, post-herpetic neuralgia), and can be potentially fatal if disseminated. This study describes the magnitude of risk of delayed VZV infection in autologous and allogeneic HCT recipients and identifies the use of immunosuppressive agents such as Prednisone and Mycophenolate Mofetil as risk factors, suggesting the possible use of acyclovir as prophylaxis during prolonged periods of immune suppression. Incidence of Delayed Varicella Zoster in 1+ Year Survivors of HCT Incidence of Delayed Varicella Zoster in 1+ Year Survivors of HCT Delayed Varicella Zoster Infection in 1+ Year Survivors of HCT (by Type of Transplant) Delayed Varicella Zoster Infection in 1+ Year Survivors of HCT (by Type of Transplant)

Herpes Zoster and Postherpetic Neuralgia

2018 ◽  
pp. 93-98
Author(s):  
Jianguo Cheng
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Intercostal Nerve ◽  
Intrathecal Therapy ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Epidural Injections ◽  
History Of

Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV) that causes chicken pox. VZV remains dormant in the dorsal root and cranial ganglia and can reactivate later in a person’s life and cause herpes zoster, which appears predominantly in older adults, but may also occur in those that are immunocompromised. Postherpetic neuralgia (PHN) is defined as pain in the affected dermatome that is still present 1 month after development of the vesicles. Adults older than 50 should receive the herpes zoster vaccine as part of routine medical care. Shingrix is a new vaccine recently approved and recommended by the FDA, which is a non-live, subunit vaccine. In contrast to Zostavax, Shingrix is 97% effective against shingles and 91% effective against PHN for people 50 and older. The diagnosis of herpes zoster can be made on the basis of characteristic skin lesions and pain and itching in the involved dermatome. During the acute phase, an antiviral given within 72 hours of onset helps reduce pain and complications and shorten the course of the disease. The diagnosis of PHN is based on a history of herpes zoster, typical dermatomal distribution of the pain, and hyperalgesia and/or allodynia on physical examination. First-line pharmacotherapy includes gabapentin or pregabalin, tricyclic antidepressants, and SNRIs. Combination therapies are often necessary. Interventional options such as epidural injections, paravertebral blocks, selective nerve root blocks, sympathetic nerve blocks, intercostal nerve blocks, trigeminal nerve blocks, spinal cord or dorsal root ganglion stimulation, and intrathecal therapy may be considered in refractory cases.

scholarly journals Herpes Zoster Vaccination in SLE: A Pilot Study of Immunogenicity

2013 ◽  
Vol 40 (11) ◽  
pp. 1875-1880 ◽  
Author(s):  
Joel M. Guthridge ◽  
Abigail Cogman ◽  
Joan T. Merrill ◽  
Susan Macwana ◽  
Krista M. Bean ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Pilot Study ◽  
Adverse Events ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Open Label ◽  
Serious Adverse Events ◽  
Varicella Zoster ◽  
Link Type ◽  
Increased Risk

Objective.Patients with systemic lupus erythematosus (SLE) are at increased risk of herpes zoster (HZ). Although a vaccine for HZ has been approved by the US Food and Drug Administration, its use in immunocompromised individuals remains controversial because it is a live-attenuated virus vaccine. We performed a pilot study of the immunogenicity of the HZ vaccine (Zostavax) in patients with SLE.Methods.Ten patients with SLE and 10 control subjects ≥ age 50 years participated in this open-label vaccination study. All were seropositive for varicella zoster virus (VZV). Patients with SLE were excluded for SLE Disease Activity Index (SLEDAI) > 4, or use of mycophenolate mofetil, cyclophosphamide, biologics, or > 10 mg prednisone daily. Followup visits occurred at 2, 6, and 12 weeks. Clinical outcomes included the development of adverse events, particularly HZ or vesicular lesions, and SLE flare. Immunogenicity was assessed with VZV-specific interferon-γ-producing enzyme-linked immunospot (ELISPOT) assays and with antibody concentrations.Results.All subjects were women. Patients with SLE were slightly older than controls (60.5 vs 55.3 yrs, p < 0.05). Median baseline SLEDAI was 0 (range 0–2) for patients with SLE. No episodes of HZ, vesicular rash, serious adverse events, or SLE flares occurred. Three injection site reactions occurred in each group: mild erythema or tenderness. The proportion of subjects with a > 50% increase in ELISPOT results following vaccination was comparable between both groups, although absolute SLE responses were lower than controls. Antibody titers increased only among controls following vaccination (p < 0.05).Conclusion.The HZ vaccination yielded a measurable immune response in this cohort of patients with mild SLE taking mild-moderate immunosuppressive medications. No herpetiform lesions or SLE flares were seen in this small cohort of patients. ClinicalTrials.gov ID:NCT01474720.

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