Complication Of Herpes Zoster Research Articles

Pharmacological management of postherpetic neuralgia.

Postherpetic neuralgia, which occurs most typically in older persons, is one of the most common and serious complications of herpes zoster (or shingles). It is a chronic neuropathic pain syndrome and remains one of the most difficult pain disorders to treat. Known beneficial agents include antidepressants, antiepileptic drugs, opioid analgesics, local anaesthetics, capsaicin and other, less applied, modalities. Although monotherapy is commonly applied, no single best treatment for postherpetic neuralgia has been identified; nevertheless, gabapentin (antiepileptic) and transdermal lidocaine (anaesthetic) are often used as the first-choice treatments. Recent research has shed light on possible pain mechanisms as well as new avenues of treatment, which are discussed in the article. For patients with pain that is not adequately controlled, individualised treatment plans must be pursued. It is critical to recognise that postherpetic neuralgia, while difficult to manage, can be a treatable neuropathic pain syndrome.

Prophylaxis of herpesvirus infections in immunocompetent and immunocompromised older patients.

In older patients, prophylaxis of herpesvirus infections mainly involves preventing the recurrence of herpes simplex virus (HSV) and complications of herpes zoster in immunocompetent patients, while in immunocompromised patients it is more concerned with the prevention of opportunistic virus reactivation. HSV ocular infection is the most frequent cause of corneal blindness in the US. The effectiveness of aciclovir 400mg twice daily in preventing the recurrence of HSV eye disease in immunocompetent patients has been well demonstrated. The issue of treatment duration for patients with highly recurrent ocular herpes remains unresolved. Post-herpetic neuralgia (PHN) is one of the most common neuralgic illnesses worldwide. Some progress in prevention of PHN has been made with a combination of antiviral therapy (famciclovir or valaciclovir), started within 72 hours of onset of the rash, and analgesic treatment. However, the best prevention of PHN is the prevention of herpes zoster disease, and the varicella vaccine is an option which over the next few years will be tested in clinical trials. For immunocompromised patients of any age, restoring immunity prevents herpesvirus disease, as demonstrated for cytomegalovirus (CMV) in AIDS patients receiving highly active antiretroviral therapy. Specific antiviral therapy during the initial period after transplantation could prevent reactivation of HSV or CMV in seropositive recipients. Whether pre-emptive therapy or prophylaxis with ganciclovir is the optimal approach against CMV remains controversial, and the relative merits and limitations of each approach may guide the choice. In stem cell transplantation, pre-emptive therapy with foscarnet avoids the neutropenia and related complications associated with ganciclovir. In renal transplant recipients, universal prophylaxis of CMV infection with valaciclovir has the same efficacy as ganciclovir. Although it is relatively toxic, cidofovir should be further evaluated because of its in vitro activity against most DNA viruses.

Demonstration of varicella-zoster virus infection in the muscularis propria and myenteric plexi of the colon in an hiv-positive patient with herpes zoster and small bowel pseudo-obstruction (ogilvie’s syndrome)

Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie’s syndrome). The patient was a 34-yr-old HIV+ man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. Immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with Herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction.

Colonic pseudo-obstruction: a complication of herpes zoster

Herpes zoster has been associated rarely with somatic and visceral motor complications, including segmental motor paralysis, neurogenic bladder dysfunction and, unusually, colonic pseudo-obstruction. We report a patient who developed acute pseudo-obstruction of the colon which followed the appearance of dermatomal herpes zoster.

Colonic pseudo-obstruction: a complication of herpes zoster

Colonic pseudo-obstruction: a complication of herpes zoster

Clinical spectrum of herpes zoster in adults infected with human immunodeficiency virus.

To determine the incidence and clinical manifestations of herpes zoster in a hospital-based clinic for adults infected with human immunodeficiency virus (HIV), we reviewed the records of all patients for whom zoster was diagnosed at or after their first clinic visit. Fifty-two episodes of zoster occurred in 45 patients during 1,614 person-years of follow-up (incidence, 3.2 episodes per 100 person-years). The following major complications of zoster occurred in 12 patients (27%): ocular complications (5), neurological complications (4), and chronic atypical skin lesions (5). Six patients each had postherpetic neuralgia and bacterial superinfection, which were the common minor complications of zoster. Multivariate analysis revealed that only a low CD4 cell count (< or = 200/mm3) was predictive of a major complication of zoster (OR, 13.2; 95% CI, 1.52-114; P = .019). Thus, complications of herpes zoster are common in patients with HIV infection, especially those with advanced immunosuppression.

Transient Intrathecal IgG Synthesis in Herpes zoster Myelitis: 2 Case Reports

Alterations in cerebrospinal fluid in 2 cases of viral myelopathy associated with herpes zoster infection are reported. Viral myelopathy is a rare complication of herpes zoster. Quantitatively there was a slight increase in IgG production and oligoclonal IgG bands were detected by isoelectric focusing. These parameters returned to normal after 1 year suggesting a transient involvement of the central nervous system.

Early Vidarabine Therapy to Control the Complications of Herpes Zoster in Immunosuppressed Patients.

We conducted a double-blind, placebo-controlled trial to assess the value of vidarabine therapy for the prevention of complications from herpes zoster in immunocompromised patients. Of 121 patients with localized herpes zoster of 72 hours duration or less, 63 received vidarabine and 58 received the placebo. Populations were matched for pertinent characteristics. Therapy accelerated cutaneous healing and decreased the rates of cutaneous dissemination (from 24 per cent [14 patients] to 8 per cent [5 patients]) (P = 0.014); and of zoster-related visceral complications (from 19 per cent [11 patients] to 5 per cent [3 patients]) (P = 0.015). therapy also decreased the total duration of post-herpetic neuralgia (P = 0.047). Patients with lymphoproliferative cancers and those 38 years of age or older were at greatest risk for complications and benefited most from therapy. There was no serious drug toxicity. We conclude that vidarabine therapy, when started within the first three days, is valuable for the reduction of complications related to herpes zoster.

Unusual manifestations of herpes zoster: A clinical and electrophysiological study

The literature on complicated herpes zoster is summarized in this paper. The case histories of 18 patients with herpes zoster are presented. Two patients had encephalitis, 2 had myelitis and the other 14 patients had various types of lower motor neurone disturbance. Both patients with encephalitis — one of whom developed choreo-athetosis during the illness — recovered fully. Only 1 of the 2 patients with myelitis recovered fully; the other remains severely paraparetic and the reason for her incomplete recovery may be related to the presence of generalized arteriolar disease associated with seronegative rheumatoid disease. One patient developed a Guillain-Barré syndrome 3 weeks after the onset of herpes zoster. Recovery in the 15 patients with lower motor neurone involvement has been slow but complete — or almost complete — in all but 1, a patient with persistent facial weakness as part of the Ramsay Hunt syndrome and who also had weakness of one upper limb. Seven other patients had lower limb weakness. In 2 patients the weakness was confined to abdominal myotomes and 2 other patients had urinary retention. Electromyographic abnormalities were found in the muscles which were weak and frequently also in muscles which appeared strong. It is emphasized that neurological disturbances other than sensory abnormalities may be found in patients with herpes zoster. Motor complications of various types are not uncommon.

Herpes zoster (zona) encephalitis. Case report with electroencephalographic and cerebrospinal fluid studies.

Case Reports1 May 1962Herpes Zoster (Zona) EncephalitisCase Report with Electroencephalographic and Cerebrospinal Fluid StudiesMARTIN D. LIDSKY, M.D., DONALD W. KLASS, M.D., BERNARD F. MCKENZIE, M.S., NORMAN P. GOLDSTEIN, M.D.MARTIN D. LIDSKY, M.D.Search for more papers by this author, DONALD W. KLASS, M.D.Search for more papers by this author, BERNARD F. MCKENZIE, M.S.Search for more papers by this author, NORMAN P. GOLDSTEIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-56-5-779 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe purpose of this paper is to record our observation, extending over eight months, of a patient with herpes zoster encephalitis. The clinical appearance of an encephalopathy complicating herpes zoster may not be widely appreciated, particularly in view of the rare occurrence of such a complication. On the other hand, pediatricians are fully cognizant of the clinical picture of varicella encephalitis which is a rare complication of chickenpox. This situation is significant in view of the well-known epidemiologic relationship between herpes zoster and varicella (1, 2) and recent tissue culture studies indicating the striking similarity, if not identical character, of...

Herpes Zoster and Varicella in Identical Twins

The viruses of herpes zoster and varicella were established as identical in 1948 by Rake and Blank, by means of the electron microscope. It is not unusual to find a varicelliform eruption complicating herpes zoster, but we were unable to find a report of simultaneously infected identical twins, one of whom exhibited varicella, the other, herpes zoster. Report of Cases Two Negro, identical female twins, aged 7 years, were brought to the University Hospital Dermatology Clinic on Aug. 6, 1959. Patient 1 complained of pain in her right arm on Aug. 3, 1959. Later the same day, blisters were seen on the right side of her chest and back. Examination revealed groups of tense vesicles on erythematous bases on the right anterior chest wall, right axillary line, and right side of the back, distributed along the course of the seventh thoracic nerve. Scattered discrete vesicles were noted on the abdomen

Acute demyelinating disease complicating herpes zoster.

Acute demyelinating disease complicating herpes zoster.

NEUROLOGIC COMPLICATIONS OF HERPES ZOSTER

Three cases of neurologic complications of herpes zoster are reported. The relation of herpes zoster to varicella is discussed.

SOME UNUSUAL COMPLICATIONS OF HERPES ZOSTER

SOME UNUSUAL COMPLICATIONS OF HERPES ZOSTER

PATHOGENESIS OF CRANIAL NERVE LESIONS, NOTABLY OPHTHALMOPLEGIAS, COMPLICATING HERPES ZOSTER OPHTHALMICUS1

Acta Psychiatrica ScandinavicaVolume 23, Issue 1-2 p. 69-77 PATHOGENESIS OF CRANIAL NERVE LESIONS, NOTABLY OPHTHALMOPLEGIAS, COMPLICATING HERPES ZOSTER OPHTHALMICUS1 ERIK GODTFREDSEN M.D., ERIK GODTFREDSEN M.D. COPENHAGENSearch for more papers by this author ERIK GODTFREDSEN M.D., ERIK GODTFREDSEN M.D. COPENHAGENSearch for more papers by this author First published: June 1948 https://doi.org/10.1111/j.1600-0447.1948.tb09356.xCitations: 10 1 Read before the Oto-Neuro-Ophthalmological Society on May 7, 1947. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume23, Issue1-2June 1948Pages 69-77 RelatedInformation

ENCEPHALITIS ASSOCIATED WITH HERPES ZOSTER

This case is reported because the literature contains few records of cases of encephalitis complicating herpes zoster in which the brain was examined histologically after death. REPORT OF CASE History. —Mrs. L. V., a housewife aged 58, white, was seen by one of us (S. K.) in consultation on April 6, 1942, because she had become restless, noisy and irrational. She had been in relatively good health except for occasional headaches and backache, for which she was taking acetylsalicylic acid. On March 7 neuralgic pain developed in the left side of the face and neck. Two days later examination by the family physician revealed a herpetic rash over the lower part of the face, the neck and the upper part of the shoulder and chest on the left side. The patient had a slight fever (temperature 99.5 to 100.0 F.) for several days. The vesicles disappeared in about fourteen days,

Complicated Herpes Zoster

Complicated Herpes Zoster