Herpes zoster and Post herpetic neuralgia in elderly adults in a community hospital in Buenos Aires. June 2013-May 2017

Abstract

Background: There are limited data on the characteristics of HZ in South America, especially in the elderly. Methods & Materials: We analyzed epidemiological and clinical characteristics of 1313 patients over 65 years assisted for HZ, between June 2013 and May 2017. Results: The average age was 76.7 years (65-100), 55.5% had thoracic location; 88% of the initial consultations were held at emergency rooms (ER); 66% had pain + vesicles as initial symptoms, and 28% only blisters. Diagnosis was made between 1-3 days from the beginning of the episode in 89.7% in the first year of follow up, 2013 and virtually in all patients in later years. 77% of patients asked for 1 to 5 appointments during the episode, 3% required hospitalization. Antiviral treatment was supplied to 92.9%. Treatment was adequate in dose and time in 56% during 2013, and 62% in 2016, showing a learning curve during those four years. This was probably related to a better outcome in terms of occurrence of post herpetic neuralgia (PHN). The incidence of PHN lowered from 23.57% (IC95% 18.72 – 28.99) in 2013, to 15.44% (IC95% 11.85 – 19.63) in 2016. Initial pain treatment was indicated in 2/3 of patients. Most frequently used drugs were non-steroidal painkillers (NSPK)(73%) at the beginning, and pregabalin (65%) in following consultations. Steroids were used much less in 2016 than in 2013 both for initial (15% vs 7%), and following treatment (11% vs 4%). 58% of patients had no comorbidities. The comorbidities which were found related to NPH were tabaquism/COPD; and transplant (p0.002, and 0.015 respectively). 57.6% of episodes lasted 2 to 3 weeks, 2% of the patients (25) were still in pain after more than one year. Conclusion: Increasing age was a risk factor to develop both HZ and PHN. Comparing 2013 and 2016, diagnoses were made earlier and treatments were most appropriate, showing a learning curve. NSPK were most used as initial treatment for pain, and pregabalin as following treatment. In the multivariate analysis, risk of developing PHN was higher in women, increasing age, thoracic localization and COPD or transplant patients.