Öz
Aim: Herpes zoster is a dermatomal vesicular eruption caused by the reactivation of varicella-zoster virus (VZV) that remains latent in the dorsal root ganglia. Due to the impairment of cellular immune capacity with aging, it is commonly seen in advanced age. Approximately 3-10% of the cases need to be hospitalized. We aimed to determine the frequency of dissemination and the demographic and clinical characteristics in hospitalized herpes zoster patients in a dermatology clinic of a tertiary hospital.
Materials and Methods: The records of 19 herpes zoster patients hospitalized in our clinic between June 2019 and November 2020 were retrospectively reviewed. Patients' age, gender, dermatome involved, presence of dissemination, concomitant diseases, and development of post-herpetic neuralgia were noted.
Results: Disseminated herpes zoster was seen in 36.8% (no:7) of the patients. Of patients 63.2% (no:12) had ophthalmic herpes zoster. The relationship between dissemination and age, gender, presence of immunosuppression and development of post-herpetic neuralgia was not statistically significant. While no death was observed in the non-disseminated group, one patient died in the disseminated herpes zoster group.
Conclusion: In this study, the mean age of the patients, the accompanying immunosuppressive state, and the rate of post-herpetic neuralgia were found to be higher in the disseminated herpes zoster group than the non-disseminated group. But it was not significant. Studies on disseminated herpes zoster which have a higher mortality are limited due to the low frequency of the disease. Studies involving larger numbers of patients are needed in order to report the clinical features and mortality rates more clearly in these patients.
Anahtar Kelimeler
Kaynakça
- Kennedy PGE, Gershon AA. Clinical Features of Varicella-Zoster Virus Infection. Viruses. 2018; 10 (11): 609.
- Johnson RW, Levin MJ. Herpes Zoster and Its Prevention by Vaccination. Interdiscip Top Gerontol Geriatr. 2020; 43: 131-45.
- Bollea-Garlatti ML, Bollea-Garlatti LA, Vacas AS et al. Clinical Characteristics and Outcomes in a Population with Disseminated Herpes Zoster: A Retrospective Cohort Study. Actas Dermosifiliogr. 2017; 108 (2): 145-52.
- Gross GE, Eisert L, Doerr HW et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020; 18 (1): 55-78.
- Dworkin RH, Johnson RW, Breuer J et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007; 44 Suppl 1:S1-26.
- Vukelić D, Oroši Končić D, Prepolec J et al. Clinical characteristics of hospitalized adults and adolescents with herpes zoster in Croatia: more than 20 years of a single-center experience. Croat Med J. 2020; 61 (5): 401-9.
- Yin D, Van Oorschot D, Jiang N et al. A systematic literature review to assess the burden of herpes zoster disease in China. Expert Rev Anti Infect Ther. 2020:1-15.
- Nair PA, Patel BC. Herpes Zoster. 2021 Nov 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
- Pitton Rissardo J, Fornari Caprara AL. Herpes Zoster Oticus, Ophthalmicus, and Cutaneous Disseminated: Case Report and Literature Review. Neuroophthalmology. 2018; 43 (6):407-10.
- Chen LK, Arai H, Chen LY et al. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infect Dis. 2017; 17(1): 213.
- Sayeeda A, Al Arfaj H, Khalil N, Al Arfaj AS. Herpes Zoster Infections in SLE in a University Hospital in Saudi Arabia: Risk Factors and Outcomes. Autoimmune Dis. 2010; 2011: 174891.
- Ahronowitz I, Fox LP. Herpes zoster in hospitalized adults: Practice gaps, new evidence, and remaining questions. J Am Acad Dermatol. 2018; 78 (1): 223-30.e3.
- Bader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med. 2013; 125 (5): 78-91.
- Le P, Rothberg M. Herpes zoster infection. BMJ. 2019; 364: k5095.
- Esteban-Vasallo MD, Domínguez-Berjón MF, Gil-Prieto R, Astray-Mochales J, Gil de Miguel A. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain). Hum Vaccin Immunother. 2014; 10 (6): 1650-60.
- Özkol HU, Bilgili SG, Karadag AS, Altun F, Calka O. The Evaluation Clinical and Demographic Characteristics of 115 Patients Diagnosed with Herpes Zoster in Eeastern Turkey. Turk J Dermatol 2013; 7: 201-5.
- Köse Ş, Atalay S, Gül S, Sönmez U, Ödemiş İ. Tepecik Eğit Hast Derg 2013; 23 (2): 89-92.
- Buchan SA, Daneman N, Wang J et al. Incidence of Hospitalizations and Emergency Department Visits for Herpes Zoster in Immunocompromised and Immunocompetent Adults in Ontario, Canada, 2002-2016. Clin Infect Dis. 2020; 71 (1): 22-9.
Öz
Amaç: Herpes zoster dorsal kök gangliyonlarında latent kalan varisella zoster virüsün reaktive olmasıyla gelişen dermatomal veziküler erüpsiyondur. Yaş alma ile birlikte görülen hücresel bağışıklık kapasitesindeki azalma nedeniyle çoğunlukla ileri yaşta görülmektedir. Olgularının yaklaşık %3-10’unun hastaneye yatarak tedavi alması gerekir. Bu çalışmada kliniğimizde yatırılarak izlenen herpes zoster olgularının retrospektif olarak değerlendirilerek disseminasyon sıklığının ve bu hastalardaki demografik ve klinik özelliklerin saptanması amaçlanmıştır.
Gereç ve Yöntem: Haziran 2019 ile Kasım 2020 tarihleri arasında kliniğimizde yatarak izlenen 19 herpes zoster olgusunun dosyası retrospektif olarak gözden geçirildi. Hasta dosyalarından hastaların yaşı, cinsiyeti, tutulan dermatom, disseminasyon varlığı, eşlik eden hastalıklar, postherpetik nevralji gelişimi olup olmadığı not edildi.
Bulgular: Dissemine herpes zoster %36,8 (no:7) oranında görüldü. Hastaların %63,2’sinde (no:12) oftalmik herpes zoster mevcuttu. Disseminasyon ile yaş, cinsiyet, immunsupresyon varlığı ve PNH gelişimi arasındaki ilişki istatiksel olarak anlamlı değildi (p:0,051, p:0,216, p: 0,865, p:0,419). Dissemine olmayan hasta grubunda ölüm gözlenmezken dissemine herpes zoster grubunda bir hasta hayatını kaybetti.
Sonuç: Bu çalışmada dissemine herpes zoster olan grupta hastaların yaş ortalaması, eşlik eden immunsupresif durum, post herpetik nevralji gelişim oranı dissemine olmayan gruba göre daha yüksek saptanmıştır fakat bu yükseklik anlamlı bulunmamıştır. Mortalitesi klasik zonaya göre daha yüksek olan dissemine zona ile ilgili çalışmalar hastalığın sık görülmemesi nedeniyle kısıtlıdır. Bu hastalardaki klinik özellikleri ve mortalite oranlarını daha net bildirebilmek için daha fazla sayıda hasta içeren çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- Kennedy PGE, Gershon AA. Clinical Features of Varicella-Zoster Virus Infection. Viruses. 2018; 10 (11): 609.
- Johnson RW, Levin MJ. Herpes Zoster and Its Prevention by Vaccination. Interdiscip Top Gerontol Geriatr. 2020; 43: 131-45.
- Bollea-Garlatti ML, Bollea-Garlatti LA, Vacas AS et al. Clinical Characteristics and Outcomes in a Population with Disseminated Herpes Zoster: A Retrospective Cohort Study. Actas Dermosifiliogr. 2017; 108 (2): 145-52.
- Gross GE, Eisert L, Doerr HW et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020; 18 (1): 55-78.
- Dworkin RH, Johnson RW, Breuer J et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007; 44 Suppl 1:S1-26.
- Vukelić D, Oroši Končić D, Prepolec J et al. Clinical characteristics of hospitalized adults and adolescents with herpes zoster in Croatia: more than 20 years of a single-center experience. Croat Med J. 2020; 61 (5): 401-9.
- Yin D, Van Oorschot D, Jiang N et al. A systematic literature review to assess the burden of herpes zoster disease in China. Expert Rev Anti Infect Ther. 2020:1-15.
- Nair PA, Patel BC. Herpes Zoster. 2021 Nov 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
- Pitton Rissardo J, Fornari Caprara AL. Herpes Zoster Oticus, Ophthalmicus, and Cutaneous Disseminated: Case Report and Literature Review. Neuroophthalmology. 2018; 43 (6):407-10.
- Chen LK, Arai H, Chen LY et al. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infect Dis. 2017; 17(1): 213.
- Sayeeda A, Al Arfaj H, Khalil N, Al Arfaj AS. Herpes Zoster Infections in SLE in a University Hospital in Saudi Arabia: Risk Factors and Outcomes. Autoimmune Dis. 2010; 2011: 174891.
- Ahronowitz I, Fox LP. Herpes zoster in hospitalized adults: Practice gaps, new evidence, and remaining questions. J Am Acad Dermatol. 2018; 78 (1): 223-30.e3.
- Bader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med. 2013; 125 (5): 78-91.
- Le P, Rothberg M. Herpes zoster infection. BMJ. 2019; 364: k5095.
- Esteban-Vasallo MD, Domínguez-Berjón MF, Gil-Prieto R, Astray-Mochales J, Gil de Miguel A. Sociodemographic characteristics and chronic medical conditions as risk factors for herpes zoster: a population-based study from primary care in Madrid (Spain). Hum Vaccin Immunother. 2014; 10 (6): 1650-60.
- Özkol HU, Bilgili SG, Karadag AS, Altun F, Calka O. The Evaluation Clinical and Demographic Characteristics of 115 Patients Diagnosed with Herpes Zoster in Eeastern Turkey. Turk J Dermatol 2013; 7: 201-5.
- Köse Ş, Atalay S, Gül S, Sönmez U, Ödemiş İ. Tepecik Eğit Hast Derg 2013; 23 (2): 89-92.
- Buchan SA, Daneman N, Wang J et al. Incidence of Hospitalizations and Emergency Department Visits for Herpes Zoster in Immunocompromised and Immunocompetent Adults in Ontario, Canada, 2002-2016. Clin Infect Dis. 2020; 71 (1): 22-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Gönderilme Tarihi | 6 Ağustos 2021 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 1 |
Cited By
