A Clinico-Epidemiological Study of Cases of Herpes Zoster in a Tertiary Care Hospital

Abstract

Background: Herpes zoster (HZ) is a viral disease caused by the reactivation of the varicella-zoster virus characterized by distinctive prodromal pain followed by herpetiform vesicular eruptions. The immunocompromised states, such as old age, diabetes, human immunodeficiency virus (HIV) infection, and immunosuppressive drugs, are known predisposing factors in this regard. Objectives: The study aimed to investigate the clinic-epidemiological profile of HZ cases attending a tertiary care center. Methods: All consecutive cases of HZ reported to the dermatology outpatient department (OPD) at a tertiary care dermatological center in North India within January - June in 2019 were enrolled after obtaining informed consent and ethical clearance. The clinical profile of patients was noted on predesigned proforma. Laboratory investigations, including complete blood count, routine urine examination, renal function test, and blood sugar, were performed. The HIV antibody was tested by enzyme-linked immunosorbent assay in all cases. The data were analyzed by tabulation, mean, standard deviation on Microsoft Excel for Windows 10 operating system. Results: A total of 190 HZ cases were enrolled, that constituted 0.84% of total dermatology OPD cases of the above-mentioned duration. There were 126 male and 64 female subjects with a gender ratio of 2: 1. Out of the total number of cases, 53% were below 50 years of age, and 59% had a definite history of chickenpox. Moreover, 66 (34%) cases had comorbidities, which included 43 (22% of total cases) cases with some form of immune suppression. In addition, 11 cases were HIV positive, out of whom 2 subjects were diagnosed with HIV infection while evaluating HZ. More than 90% of cases had prodrome before eruptions. Thoracic dermatome was most commonly involved, followed by the trigeminal nerve. Corneal involvement was observed in 4 out of 11 cases of HZ ophthalmicus. The resolution period was within the range of 8 - 15 days. Moreover, 51 (27%) cases developed some complications. Postherpetic neuralgia (PHN) was present in 41 (21.5%) cases. Conclusions: The HZ constituted 0.84% of total dermatology OPD in 6 months and reflected a sizable burden in a tertiary care centre. The presence of this disease in a relatively young population or in the male gender might be due to the demographic characteristics of the dependent clientele. There was a higher incidence of PHN (21.5%) in prolonged follow-up. The involvement of thoracic dermatome as the most common segment in HZ and PHN and association with diabetes mellitus is consistent with the results of other studies.