scholarly journals Chronic and Recurrent Herpes Zoster Ophthalmicus

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 999
Author(s):  
Soo Min Lee ◽  
Jisang Han ◽  
Chan Min Yang ◽  
Chul Young Choi ◽  
Ramin Khoramnia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Chronic Disease ◽  
Recurrence Rate ◽  
Cox Regression ◽  
Significant Rise ◽  
Herpes Zoster Ophthalmicus ◽  
Long Term Treatment ◽  
Recurrent Herpes ◽  
Stromal Keratitis

Background and Objectives: This study sought to investigate the natural course, the chronicity and recurrence rate, and the risk factors of chronic and recurrent herpes zoster ophthalmicus (HZO). We also evaluated the effects of long-term treatment for HZO. Materials and Methods: Patients diagnosed and treated for HZO were included in the retrospective medical chart review. Multivariable-adjusted logistic and Cox regression models were used to show risk factors for chronic and recurrent HZO along with hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among a total 130 of HZO patients, 31 patients (23.85%) had chronic disease and 19 patients (14.62%) had recurrent disease. The rate of chronic disease was higher in HZO with conjunctivitis, epithelial keratitis, and stromal keratitis. The recurrence rate increased in patients with chronic HZO (HR: 34.4, 95% CI: 3.6–324.6), epithelial keratitis (HR: 5.5, 95% CI: 1.3–30.0), stromal keratitis (HR: 18.8, 95% CI: 3.0–120.8), and increased intraocular pressure (IOP) (HR: 7.3, 95% CI: 1.6–33.2). Length of systemic antiviral therapy and anti-inflammatory eyedrop treatment were not associated with recurrent HZO (p = 0.847 and p = 0.660, respectively). The most common ocular manifestation for recurrent HZO was stromal keratitis. Conclusions: This study demonstrated a considerable frequency of chronic and recurrent HZO. Chronic HZO in the form of epithelial or stromal keratitis with increased IOP provoked a significant rise in the risk of recurrence.

scholarly journals Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S413-S413 ◽  
Author(s):  
Laurie Aukes ◽  
Joan Bartlett ◽  
Bruce Fireman ◽  
John Hansen ◽  
Edwin Lewis ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Cox Regression ◽  
Age Groups ◽  
Weighted Average ◽  
Care Seeking ◽  
Zoster Vaccine ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Grant Recipient ◽  
Restricted Stock

Abstract Background Herpes zoster ophthalmicus (HZO), caused by reactivation of varicella-zoster virus in or around the eye, can be severe and often results in care-seeking that may be less discretionary than for uncomplicated herpes zoster (HZ). We compared the vaccine effectiveness (VE) of live zoster vaccine against HZO with the VE against HZ overall. Methods Kaiser Permanente Northern California (KPNC) members enter the ongoing cohort study when age-eligible for zoster vaccine starting in 2007. Incident HZ was defined as a new diagnosis of HZ with an antiviral prescription or a positive varicella viral test. Among those, an HZO case was defined as having an HZO diagnosis during an ophthalmology visit within 30 days of the initial HZ diagnosis. VE by age at vaccination and time since vaccination was estimated using Cox regression adjusted for age, race, sex and time-varying measures of healthcare use, comorbidities and immunocompromise status. Average VE over the first 5 years following vaccination was calculated as a weighted average of annual VE estimates. Results During 2007–2014, ~1.3 million individuals ≥50 years of age entered the study population and 29% were vaccinated. Among 48,889 incident HZ cases, 2,858 (6%) had HZO, 87% of whom were unvaccinated. For all ages combined, VE against HZO was 72% (95% CI, 64%-79%) in year 1, similar to 68% (95% CI, 65%-70%) against HZ. VE fell in years 2, 3, 4, and 5 to 47%, 45%, 42% and 27% for HZO and to 47%, 39%, 41% and 37% for HZ. For age groups 60 – 69 and 70 – 79, where we have the most data, initial VE and waning were similar for HZO and HZ. Numbers of HZO cases for 50–59 year olds were too small to evaluate at this time. Average VE against HZO over the first 5 years following vaccination was 52% (95% CI, 42%–60%) for ages 60–69, 51% (95% CI, 39%–61%) for ages 70-79, and 39% (95% CI, 14%-57%) for ages 80+; similarly, 5-year average VE against HZ was 49%, 46%, and 44% for these 3 age groups. Conclusion VE against HZO was similar to VE against HZ regardless of age at vaccination or time since vaccination. Effectiveness of live zoster vaccine in preventing HZO was highest in year one with subsequent waning. Disclosures E. Earley, Merck & Co.: Research Contractor, Salary; M. Marks, Merck and Co. Inc.: Employee, Restricted Stock and Salary; P. Saddier, Merck & Co., Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co.: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Science: Investigator, Grant recipient Pfizer: Investigator, Grant recipient

scholarly journals Recurrent Herpes Zoster Ophthalmicus Preceded by Anabolic Steroids and High-Dose L-Arginine

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Stephen A. LoBue ◽  
Adam Goldman ◽  
Richard A. Giovane ◽  
Stacy M. Carlson ◽  
Michael Bivona ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Amino Acid ◽  
Anabolic Steroids ◽  
High Dose ◽  
Cell Mediated Immunity ◽  
Amino Acid Supplementation ◽  
Herpes Zoster Ophthalmicus ◽  
Acid Supplementation ◽  
Recurrent Herpes ◽  
Arginine Supplementation

Purpose. To report a case of a 34-year-old male with recurrent herpes zoster ophthalmicus (HZO) preceded by a 6-week cycle of anabolic steroids and high-dose amino acid supplementation. Case Presentation. A 34-year-old man presented to our institution for left eye pain for one week associated with a vesicular rash in the V1 dermatome, respecting the midline. The patient had no significant past medical or past ocular history, including systemic immunosuppressive agents or HIV. However, prior to the onset of his symptoms the patient had completed a 6-week course of anabolic steroids including trenbolone, deca-durabolin, and testosterone as well as high-dose arginine supplementation averaging more than 40 grams a day. The best-corrected vision was 20/25 OS with slit-lamp examination remarkable for punctate staining and pseudodendrites at 6 o’clock, outside the visual axis. The patient was treated with oral acyclovir 800 mg five times a day for seven days along with prednisolone QID and moxifloxacin QID which was tapered over a month. Four months after resolution, the patient developed a recurrent HZO keratitis preceded by another cycle of anabolic steroids and amino acid supplementation. Conclusion. In vitro L-arginine supplementation has been associated with the proliferation and virulence of a variety of herpes viruses. Anabolic steroids have also been demonstrated by various studies to negatively affect cell-mediated immunity necessary to prevent viral infection. Thus, it is possible that anabolic steroids in conjunction with increased L-arginine intake may have precipitated a recurrent HZO in a previously healthy, immunocompetent individual.

scholarly journals Recurrent herpes zoster ophthalmicus in a young, healthy individual taking high doses of l-Arginine

2019 ◽  
Vol 16 ◽  
pp. 100547 ◽  
Author(s):  
Stephen A. LoBue ◽  
Prashant Tailor ◽  
Stacy M. Carlson ◽  
Fukutaro Mano ◽  
Richard A. Giovane ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Healthy Individual ◽  
Herpes Zoster Ophthalmicus ◽  
Recurrent Herpes ◽  
High Doses

scholarly journals Recurrence Rate of Herpes Zoster and Its Risk Factors: a Population-based Cohort Study

2019 ◽  
Vol 34 (2) ◽  
Author(s):  
You Jeong Kim ◽  
Chang Nam Lee ◽  
Mi So Lee ◽  
Ji Hyun Lee ◽  
Jun Young Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Herpes Zoster ◽  
Recurrence Rate ◽  
Population Based

scholarly journals POS0772 PREVALENCE AND RISK FACTORS FOR HERPES ZOSTER REACTIVATION IN 1542 PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 640.1-640
Author(s):  
C. C. Mok ◽  
L. Y. Ho ◽  
S. M. Tse ◽  
K. L. Chan ◽  
C. H. To
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Regression Analysis ◽  
Herpes Zoster ◽  
Rheumatic Diseases ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Objectives:To study the prevalence and risk factors of herpes zoster (HZ) infection in patients with rheumatic diseases.Methods:Medical records of patients with rheumatic diseases who attended our out-patient rheumatology clinics between 2019 March and 2019 August were retrospectively reviewed. Patients who were using biological or targeted DMARDs were excluded. Episodes of HZ infection since disease diagnosis were identified and the prevalence over time was calculated. Laboratory parameters (total white cell count, neutrophil-to-lymphocyte ratio, serum albumin, globulin & creatinine), history of diabetes mellitus and the highest doses of immunosuppressive medications within 6 months of the first episode of HZ infection were compared with those within 6 months of last follow-up in patients who did not have HZ infection. Cox regression analysis was performed to identify factors associated with the first HZ infection in all patients.Results:1542 patients were studied (88% women, age 46.4±15.0 years). The underlying diseases were systemic lupus erythematosus (SLE) (38%), rheumatoid arthritis (26%) and other rheumatic diseases (36%). After a total follow-up of 11,515 patient-years since diagnosis (7.5±7.0 years), 122 (7.9%) patients developed 146 episodes of HZ infection, giving an overall prevalence of 1.27/100-patient years. The prevalence rates of HZ in SLE, RA and non-SLE/RA patients were 1.70, 0.64 and 0.76 per 100 patient-years, respectively. Patients who experienced HZ reactivation were younger (41.6±14.7 vs 46.8±15.0 years; p<0.001), more likely to have SLE (74% vs 35%; p<0.001) and diabetes mellitus (17% vs 7.3%; p=0.01), and had a significantly lower albumin (38.6±5.6 vs 41.3±3.5; p<0.001) and higher neutrophil-to-lymphocyte ratio (4.9±6.2 vs 2.8±2.6; p<0.001). More patients with HZ reactivation were treated with prednisolone (54% vs 22%; p<0.001), azathioprine (20% vs 8%; p<0.001), mycophenolate mofetil [MMF] (21% vs 12%; p=0.006), cyclophosphamide [CYC] (4.9% vs 0.1%; p<0.001) and hydroxychloroquine (48% vs 34%; p=0.002) in the preceding 6 months compared with those who did not have HZ infection. Among those using immunosuppressive drugs, the doses of MMF (1.42±0.64 vs 1.02±0.31g; p=0.005) and prednisolone (15.6±15.9 vs 5.5±4.5mg; p<0.001) were significantly higher in those with HZ infection. The cumulative risk of having HZ reactivation in SLE patients at 24 and 48 months since diagnosis was 5.9% and 8.6%, respectively, which was significantly higher than that in non-SLE patients (1.9% and 2.5%, respectively; p<0.001 by log rank test). Cox regression analysis revealed that having a diagnosis of SLE (HR 1.97 [1.17-3.31]), albumin level (HR 0.93 [0.90-0.97] per g/L; p=0.001), serum creatinine (HR 0.995 [0.990-1.00] per umol/L), higher neutrophil/lymphocyte ratio (HR 1.08 [1.05-1.11]) and the use of CYC (HR 6.69 [2.56-17.5]) and prednisolone (HR 1.61 [1.02-2.45]) in the preceding 6 months were independently associated with the development of HZ infection.Conclusion:Reactivation of HZ is fairly common in patients with rheumatic diseases. Underlying SLE, prednisolone/cyclophosphamide therapy and the neutrophil/lymphocyte ratio, but not age, sex or other laboratory parameters, are the major risk factors for HZ reactivation.Disclosure of Interests:None declared

scholarly journals Epidemiological characteristics of patients with severe COVID-19 infection in Wuhan, China: evidence from a retrospective observational study

2020 ◽  
Author(s):  
Fang Wang ◽  
Jinhong Cao ◽  
Yong Yu ◽  
Jianbo Ding ◽  
Ehab S Eshak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Disease ◽  
Critical Illness ◽  
Critically Ill ◽  
Cox Regression ◽  
Advanced Age ◽  
Male Sex ◽  
Susceptible Populations ◽  
Epidemiological Characteristics

Abstract Background The new coronavirus (COVID-19) rapidly resulted in a pandemic. We report the characteristics of patients with severe or critical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan city, China, and the risk factors related to infection severity and death. Methods We extracted the demographic and clinical data of 7283 patients with severe COVID-19 infection from designated Wuhan hospitals as of 25 February 2020. Factors associated with COVID-19 critical illness and mortality were analysed using logistic- and Cox-regression analyses. Results We studied 6269 patients with severe COVID-19 illness and 1014 critically ill patients. The median (IQR) age was 64 (53–71) years; 51.2% were male, 38.9% were retirees and 7.4% had self-reported histories of chronic disease. Up to the end of the study, 1180 patients (16.2%) recovered and were discharged, 649 (8.9%) died and the remainder were still receiving treatment. The number of daily confirmed critical cases peaked between 23 January and 1 February 2020. Patients with advanced age [odds ratio (OR), 1.03; 95% confidence intervals (CIs), 1.03–1.04], male sex (OR, 1.57; 95% CI, 1.33–1.86) and pre-existing diabetes (OR, 2.11), hypertension (OR, 2.72), cardiovascular disease (OR, 2.15) or respiratory disease (OR, 3.50) were more likely to be critically ill. Compared with those who recovered and were discharged, patients who died were older [hazard ratio (HR), 1.04; 95% CI, 1.03–1.05], more likely to be male (HR, 1.74; 95% CI, 1.44–2.11) and more likely to have hypertension (HR, 5.58), cardiovascular disease (HR, 1.83) or diabetes (HR, 1.67). Conclusion Advanced age, male sex and a history of chronic disease were associated with COVID-19 critical illness and death. Identifying these risk factors could help in the clinical monitoring of susceptible populations.

scholarly journals Incidence and risk factors for herpes zoster in patients with rheumatoid arthritis receiving upadacitinib: a pooled analysis of six phase III clinical trials

2021 ◽  
Vol 81 (2) ◽  
pp. 206-213
Author(s):  
Kevin L Winthrop ◽  
Peter Nash ◽  
Kunihiro Yamaoka ◽  
Eduardo Mysler ◽  
Nasser Khan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Herpes Zoster ◽  
Cox Regression ◽  
Janus Kinase ◽  
Phase Iii ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
History Of ◽  
Event Rates

BackgroundUpadacitinib (UPA) is an oral Janus kinase (JAK) inhibitor approved for the treatment of rheumatoid arthritis (RA). JAK inhibitors have been associated with an increased risk of herpes zoster (HZ) in patients with RA.ObjectivesTo evaluate the incidence and risk factors for HZ in UPA-treated patients with RA from the UPA phase III clinical trial programme.MethodsExposure-adjusted incidence/event rates for HZ were determined in patients receiving UPA (monotherapy or combination therapy) in six randomised phase III trials (data cut-off on 30 June 2020). HZ incidence and event rates were also determined in patients receiving methotrexate (MTX) monotherapy or adalimumab (ADA) + MTX. Multivariable Cox regression analysis was used to identify HZ risk factors in UPA-treated patients.ResultsA total of 5306 patients were included in this analysis. The incidence rate of HZ/100 patient-years (95% CI) was 0.8 (0.3 to 1.9), 1.1 (0.5 to 1.9), 3.0 (2.6 to 3.5) and 5.3 (4.5 to 6.2), in the MTX monotherapy, ADA + MTX, UPA 15 mg and UPA 30 mg groups, respectively. The majority of HZ cases with UPA (71%) involved a single dermatome. Prior history of HZ and Asian region were HZ risk factors in UPA-treated patients.ConclusionIn the UPA phase III RA clinical programme, HZ incidence and event rates were higher with UPA versus ADA + MTX or MTX monotherapy, and higher with the 30 mg versus 15 mg dose. Patients from Asia and those with a history of HZ may be at increased risk of HZ while receiving UPA.

scholarly journals Herpes zoster in SLE: prevalence, incidence and risk factors

2022 ◽  
Vol 9 (1) ◽  
pp. e000574
Author(s):  
Andrew Kwan ◽  
Hanan Al Rayes ◽  
Tijana Lazova ◽  
Nicole Anderson ◽  
Dennisse Bonilla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Herpes Zoster ◽  
Associated Factors ◽  
Cox Regression ◽  
Time Dependent ◽  
Survival Analyses ◽  
Factors Associated ◽  
Patient Reported ◽  
Patients At Risk ◽  
Laboratory Measures

ObjectivesThis study aimed to evaluate the prevalence and incidence of herpes zoster (HZ) events and describe its associated factors in a study of patients with SLE.Methods491 consecutive SLE participants were screened for HZ events using a patient-reported questionnaire to capture outcomes on pain and other characteristics associated with HZ events. Sociodemographic, clinical and laboratory measures were also analysed, and time-dependent Cox regression survival analyses were performed to investigate factors associated with HZ events.ResultsPrevalence of HZ was 30.5%, incidence was 14.3 cases per 1000 person-years. Lymphopenia and glucocorticoid dosing were significantly associated with HZ events.ConclusionsHZ is highly prevalent in SLE, which may be linked to disease-related and treatment-related effects on cellular immunity. Our results suggest that the presence of certain risk factors may be useful to allow identification of patients at risk of HZ and improve its management in patients with SLE.

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