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Abstract
Objective:The purpose of the paper was to explore the relationship between herpes zoster and pyogenic liver abscesses in Taiwan.Methods:This was a nationwide cohort study. Using the database of the Taiwan National Health Insurance Program, there were 33049 subjects aged 20-84 years who were newly diagnosed with herpes zoster from 1998 to 2010 that were selected for our study, and they were our herpes zoster group. 131707 randomly selected subjects without herpes zoster were our non-herpes zoster group. Both groups were matched by sex, age, other comorbidities, and the index year of their herpes zoster diagnosis. The incidence of pyogenic liver abscesses at the end of 2011 was then estimated. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratio and 95% confidence interval for pyogenic liver abscesses associated with herpes zoster and other comorbidities.Results:The overall incidence rate was 1.38-fold higher in the herpes zoster group than in the non-herpes zoster group (4.47 vs. 3.25 per 10000 person-years, 95% confidence interval 1.32, 1.44). After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscesses was 1.34 in the herpes zoster group (95% confidence interval 1.05, 1.72) when compared with the non-herpes zoster group. Sex (in this case male), age, presence of biliary stones, chronic kidney diseases, chronic liver diseases, cancers, and diabetes mellitus were also significantly associated with pyogenic liver abscesses.Conclusions:Patients with herpes zoster are associated with an increased hazard of developing pyogenic liver abscesses.
Highlights
The incidence of pyogenic liver abscesses was considered rare in the past, the condition, related to underlying hepatobiliary diseases and polymicrobial infection, often leads to severe illness and death.[1]
Sex, age, biliary stones, chronic kidney diseases, chronic liver diseases, cancers, and diabetes mellitus
According to the results of select studies, the annual incidence rate of pyogenic liver abscesses in Canada, United States and Denmark was only 2.3 × 10-6, 3.6 × 10-6 and 1.1 × 10-6 in 2003, 2005, and 2006 respectively, but in Taiwan it was 17.5 × 10-6 in 2004.[14,15,16] large-scale populationbased studies, which have been conducted to explore the relationship between herpes zoster and subsequent pyogenic liver abscesses, have far been few
Summary
The incidence of pyogenic liver abscesses was considered rare in the past, the condition, related to underlying hepatobiliary diseases and polymicrobial infection, often leads to severe illness and death.[1]. Biliary disease, renal diseases, and cancers have been found to be the high predisposing comorbidities for pyogenic liver abscess. Chronic kidney disease and diabetes are definitely known to result in a compromised immune system and are considered to be risk factors for some infectious diseases.[4, 5]. The cause of herpes zoster is known to be the reactivation of the varicella-zoster virus, which occurs in cases of declined cellmediated immunity. Less than 5% of the population will be attacked by a second episode of herpes zoster, and second episodes that do occur frequently do so more in immune-compromised populations, like the aged, those with chronic renal disease, diabetes, malignancies, organ transplantation, or HIV infection.[6, 7]
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