Evaluation of clinical characteristics, risk factors and prognosis of herpes zoster (shingles) infection in Türkiye: VARICOMP-adult-2 study.

Bilateral thalamic encephalitis due to Epstein-Barr virus (EBV) is a rare and severe manifestation of EBV infection, often leading to rapid neurological deterioration and poor outcomes. We report the case of an 82-year-old man with a history of arterial hypertension and a previous herpes zoster infection who presented to the emergency department with high fever and acute neurological impairment evolving into coma (Glasgow Coma Scale, GCS 3). Cerebrospinal fluid (CSF) analysis revealed mild lymphocytic pleocytosis, elevated protein and normal glucose. EBV-DNA was detected by polymerase chain reaction (PCR) and serology confirmed positive anti-EBV IgM antibodies. Autoimmune and paraneoplastic panels, including anti-NMDA receptor, anti-GQ1b, anti-MOG, anti-AQP4 and anti-LGI1 antibodies, were negative. Magnetic resonance imaging (MRI) demonstrated bilateral thalamic hyperintensities on T2-weighted and FLAIR sequences, with restricted diffusion on DWI and corresponding hypointensity on ADC maps, without contrast enhancement. Angiography showed normal patency of the main intracranial vessels. Differential diagnoses such as autoimmune encephalitis, acute disseminated encephalomyelitis, Bickerstaff's brainstem encephalitis, vascular, metabolic and other viral causes were excluded. Despite prompt antiviral and corticosteroid therapy and intensive supportive management, the clinical outcome was poor. A comprehensive literature review was performed, highlighting key clinical and radiological findings from previously published cases of EBV-related bilateral thalamic encephalitis, to improve recognition and understanding of this rare and devastating condition.

Upadacitinib (UPA)-an oral, reversible selective Janus kinase inhibitor-has a favorable benefit-risk profile for patients with Crohn's disease (CD) and ulcerative colitis (UC). We evaluated the benefit-risk of UPA in select subgroups with CD or UC. Patients were randomized to UPA 45 mg (UPA45) once daily (QD) or placebo (PBO) induction for 12 (CD: U-EXCEED, U-EXCEL) or 8 weeks (UC: U-ACHIEVE, U-ACCOMPLISH). Clinical responders were re-randomized to QD UPA 15 mg (UPA15), UPA 30 mg (UPA30), or PBO for 52-week maintenance (CD: U-ENDURE; UC: U-ACHIEVE). This exploratory post-hoc analysis assessed efficacy and safety outcomes (adverse events of special interest [AESIs]: serious infections, major adverse cardiovascular [CV] events, malignancies, and venous thromboembolic events) by CV risk, prior treatment failure, and age. This analysis included 1021 patients with CD and 1097 with UC during induction, and 673 with CD and 746 with UC during maintenance. Improved efficacy outcomes comparable to the overall study populations were observed with UPA versus PBO across subgroups. Patients receiving UPA30 generally showed numerically higher rates of improvements versus UPA15. AESI rates were generally comparable between UPA and PBO across subgroups except for numerically higher rates of herpes zoster and serious infections in CD with UPA. UPA resulted in consistent benefit versus placebo across CV risk, prior treatment failure, and age subgroups. No treatment differences were seen in AESIs across subgroups except herpes zoster and serious infections, reinforcing the favorable benefit-risk profile for UPA in CD and UC seen in the overall study populations. NCT02819635, NCT03653026, NCT03345836, NCT03345849, NCT03345823.

In real-world clinical practice, 3 Janus kinase (JAK) inhibitors-tofacitinib, filgotinib, and upadacitinib-are now available for the treatment of ulcerative colitis. Emerging real-world evidence highlights distinct efficacy and safety profiles among these agents, largely attributed to differences in JAK selectivity and dosing strategies. Notably, data are accumulating on differential efficacy, predictors of therapeutic response, and outcomes in patients who switch between JAK inhibitors, contributing to a clearer understanding of the optimal positioning of each agent. Regarding safety, particular attention has been given to risks such as herpes zoster infection and drug-induced acne, underscoring the importance of appropriate patient education and individualized risk assessment. This review summarizes clinical trials and current real-world data on tofacitinib, filgotinib, and upadacitinib in ulcerative colitis, and discusses strategies for optimizing their clinical application.

ObjectivesSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with highly heterogenous clinical manifestations and severity. Herpes zoster (HZ) is a viral disease caused by reactivation of varicella-zoster virus which remains dormant in the dorsal root sensory ganglia after a previous varicella infection. There is limited information on the association between HZ and childhood-onset SLE (cSLE). This study aimed to determine the risk factors for HZ in patients diagnosed with cSLE.Patients and methodsSingle-center retrospective cohort study which included all patients less than 19 years old with SLE at a tertiary hospital in the Philippines.ResultsA total of 388 patients were included in the study. The prevalence of HZ was 15.72%, with an incidence rate of 38.40 per 100 person-years. The most common location of the HZ was the upper extremities (18.03%). The median SLEDAI at HZ diagnosis was 4, 16.39% had recurrent HZ, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with HZ (54.10% vs. 40.37%). Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid doses of ≥ 5 mg increased the risk for the development of HZ by 1.61 (p = 0.048), 2.07 (p = 0.009), and 10.20 (p = 0.001) times, respectively.ConclusionThe prevalence and incidence of HZ in cSLE patients are 15.72% and 38.40 per 100 person-years, respectively. The risk factors identified for HZ among cSLE patients were lymphopenia, lupus nephritis, and immunosuppressive agents. Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ.

Post-herpetic neuralgia (PHN) is the most common complication of Herpes zoster infection. Although numerous targeted therapeutic drugs have been developed, it is difficult to achieve a complete cure. Abnormalities in neural circuits, ion channels, inflammatory factors, and gene regulation are crucial factors contributing to the development of PNH; however, the underlying mechanism remains unclear. Therefore, a comprehensive understanding of the underlying mechanisms of PNH is critical for advancing research and developing novel therapeutic strategies. Based on the latest findings, we systematically reviewed the current understanding of PHN mechanisms and corresponding treatment options and provided a comprehensive reference for future studies.

Data on disseminated herpes zoster (HZ) infections in solid organ transplant (SOT) recipients are limited. We aimed to investigate the clinical characteristics and outcomes of HZ infection in SOT patients presenting with microbiologically confirmed disease. All SOT recipients who tested positive for varicella-zoster virus (VZV) from any sample type between January 2013 and December 2022 were included. Disseminated HZ was defined as skin lesions involving > 2 contiguous dermatomes or evidence of end organ disease. An analysis of risk factors associated with disseminated infection was performed. A total of 146 adult SOT patients with confirmed VZV infections were included in the study. Of these, 4 were primary varicella and 142 were HZ. Median time to HZ presentation was 1.8 years (range 0.02-27). Disseminated HZ was diagnosed in 55/142(38.7%). Post-herpetic neuralgia (PHN) occurred in 33(22.6%) patients and vaccine breakthrough in 5(3.5%). Hospitalization was in 101(71.6%) patients, and 5(3.5%) died within 30 days, none attributable to HZ. VZV DNAemia was detected in 12/13 (92.3%) patients with disseminated disease versus 11/29 (37.9%) with localized disease (p=0.002). Recurrent HZ rate was 10/142 (7.0%) over a median follow-up of 4.1 years with 90% of recurrences occurring in thoracic transplant. On multivariable logistic regression, no clinical factors were associated with disseminated disease. In a large cohort of SOT patients with VZV, disseminated disease and PHN were frequent. VZV DNAemia was noted in both disseminated and localized infections suggesting that subclinical detection of virus in blood is frequent. The implications of this require further study.

Abstract Purpose of review New advances in the treatments of autoimmune rheumatic diseases have altered the landscape of opportunistic infection risk, including infections such as herpes zoster, tuberculosis and pneumocystis jirovecii pneumonia. Recommendations for preventative strategies, including vaccination and prophylaxis, have also evolved in response to availability of new vaccines and decreased reliance on glucocorticoid therapy. Recent findings The newest treatment options, including Janus Kinase (JAK) inhibitors and the type 1 interferon receptor inhibitor, anifrolumab, have been associated with an increased risk of herpes zoster compared to other existing immunosuppressive agents in rheumatology, beyond the already high baseline risk. The adjuvanted zoster virus has allowed safe immunization of rheumatology patients in attempt to reduce the incidence of herpes zoster albeit with recent population based studies demonstrating less effectiveness than in immunocompetent patients. Summary Infection risk assessment requires stratification of host, disease and treatment factors. Despite advances in immunosuppressive therapy, glucocorticoid use is still substantial and contributes to risk of opportunistic infections. Introduction of Shingrix, a non-live vaccine has made immunization for HZ more straight forward for immunocompromised patients. It is important to assess risk for other opportunistic infections, like pneumocystis jirovecii and tuberculosis, and prescribe prophylaxis.

Diagnosis and Management of Phrenic Paralysis Associated Hypoxemia.

Herpes zoster infection and myocardial infarction risk: Evaluating the impact of antiviral therapy in a nationwide self-controlled case series study.

ABSTRACT Background Baricitinib is a selective Janus kinase (JAK)1/JAK2 inhibitor approved in more than 70 countries for the treatment of moderate‐to‐severe atopic dermatitis (AD) in adults, and in over 30 countries for adolescents and children from age 2 years with moderate‐to‐severe AD, who are candidates for systemic therapy. Objectives We report the final integrated safety profile of the AD clinical programme in adult patients up to 4.6 years of treatment. Methods The analysis includes three data sets from the integrated AD baricitinib clinical trial programme, described previously. All‐bari AD included patients that received at least one dose of baricitinib (1‐, 2‐, or 4‐mg). We report the proportion of patients with events and incidence rates (IRs)/100 patient‐years (PY) at risk. Results In total, 2637 patients received baricitinib for 5216.2 PY, with a median exposure duration of 594 days (1.6 years) and a maximum exposure of 1688 days (4.6 years). In All‐bari AD, the rate of discontinuation due to adverse events (AEs) was low (IR = 3.3). The IR for serious adverse events (SAEs) in All‐bari AD was 5.0. The most frequently reported SAEs were in the infections System Organ Class (IR = 1.7), and the IR for any infection was 64.0, whereas IRs for herpes simplex, herpes zoster and opportunistic infection were 6.2, 2.7 and 0.3, respectively. AEs of special interest in All‐bari AD included 10 positively adjudicated major adverse cardiovascular events (MACEs) (IR = 0.19), 3 of which were categorised as myocardial infarctions (IR = 0.06) and 6 stroke (IR = 0.11); 4 pulmonary embolisms (PEs; 1 patient experienced both a deep vein thrombosis [DVT] and PE) (IR = 0.07); 21 malignancies excluding nonmelanoma skin cancer (IR = 0.39), and 6 deaths (IR = 0.1). Conclusions In this final analysis, baricitinib continues to demonstrate a consistent and well‐established safety profile, with no new safety signals. Rates of serious infections, DVT/PE, MACE and malignancies were within ranges of background rates in patients with AD. Trial Registration NCT02576938 (JAHG), NCT03334396 (JAHL; BREEZE‐AD1), NCT03334422 (JAHM; BREEZE‐AD2), NCT03334435 (JAHN; BREEZE‐AD3), NCT03428100 (JAIN; BREEZE‐AD4), NCT03435081 (JAIW; BREEZE‐AD5), NCT03559270 (JAIX; BREEZE‐AD6) and NCT03733301 (JAIY; BREEZE‐AD7).

Herpes zoster (HZ) is a reactivation of the varicella-zoster virus. It is a common infection, especially among patients with diabetes mellitus (DM). This study aimed to assess the awareness and uptake of the HZ vaccine, as well as their determinants, among patients with diabetes DM in the Aseer Region, Saudi Arabia. An anonymous cross-sectional study was conducted using a self-administered questionnaire between July 1, 2024 and October 31, 2024. We randomly included participants aged 18 years or older with DM. The questionnaire addressed socio-demographic characteristics, medical history regarding HZ, diabetes control, awareness, perception, and uptake practices regarding the HZ vaccine. A total of 200 participants were included: 34.5% were aged over 50 years, 51.0% were males, 90.5% were Saudi, 68.0% were married, 40.5% held a university degree, 67.0% were nonsmokers, and 57.0% had chronic diseases other than DM. Of the studied participants, 18.5% reported a previous HZ infection. Older age, smoking, and comorbid chronic illnesses were significantly associated with HZ infection. A majority expressed positive perception toward the vaccine's effectiveness (77.0%), safety (82.5%), and side effects (80.0%). However, only 21.5% had actually received the vaccine. Predictors of awareness were being aged over 50 years (adjusted odds ratio [aOR] = 4.44, 95% confidence interval [CI]: 1.36-14.54, P = .014), divorced individuals [aOR = 12.70, 95% CI: 1.52-106.43, P = .019), and being nonsmokers (aOR = 0.36, 95% CI: 0.16-0.81, P = .014). The perceived side effects of the vaccine emerged as a significant predictor of vaccine uptake. Specifically, participants who believed the vaccine causes no side effects (aOR = 22.37, 95% CI: 2.31-216.32, P = .007). This study reveals a concerningly low vaccine uptake despite high levels of awareness and positive perception toward its effectiveness and safety. Efforts to maintain the high awareness and promote vaccination are needed.

Unveiling the uncommon – A case of genital Herpes Zoster infection

IntroductionPostherpetic Neuralgia (PHN) constitutes a severe sequelae following herpes zoster (HZ) Infection, and one of the most problematic issues is the treatment of cephalo-facial PHN in patients over 50 years of age, which severely affects the patient’s work mood, sleep and activities of daily living. The efficacy of conventional treatments for PHN remains unsatisfactory. Therefore, there is an urgent need for alternative approaches to explore simpler, more convenient, effective, and inexpensive treatment options in the clinical treatment of PHN. This trial aims to thoroughly evaluate the effectiveness and safety of EA as a therapeutic modality for individuals suffering from cephalo-facial PHN.Methods and analysisThe protocol outlines a double-center, randomized, and controlled trial design where both patients and assessors are blinded to the intervention being administered. The duration of the trial’s therapeutic intervention will span 4 weeks, followed by a 2-month observation period for monitoring any subsequent effects or outcomes. The 124 qualified individuals will be randomly allocated in a balanced 1:1 ratio to either the EA group or the drug group. All variables will undergo evaluation at the start of the study (week 0, baseline), during the treatment period at weeks 2 and 4, and during the follow-up period at weeks 8 and 12. The primary outcome is the Visual Analog Scale (VAS). Secondary outcomes include the Brief pain inventory-Facial scale (BPI-Facial), Pittsburgh Sleep Quality Index Scale (PSQI), Self-rating depression scale (SDS), Hamilton depression scale (HAMD), and Quality of Life Rating Scale (SF-36). The occurrence of any adverse reactions will be monitored and assessed throughout the duration of the trial.ConclusionThis study will preliminarily evaluate the efficacy and safety of electroacupuncture (EA) in the treatment of patients with postherpetic neuralgia (PHN).Ethics and disseminationEthical approval for this trial has been obtained from the Institutional Ethics Review Board of the Third Affiliated Hospital of Zhejiang Chinese Medical University (No. ZSLL-KY-2023-029-01) and Zhejiang Hospital (No. 2024-030-K). Before enrollment, participants will be required to sign a form of informed consent.Clinical trial registrationIdentifier NCT06420778, https://clinicaltrials.gov/study/NCT06420778.

ABSTRACTReports on surgical treatment for postherpetic trigeminal neuralgia after COVID vaccination have not been found in the literature. Here, we described a case of postherpetic trigeminal neuralgia after COVID vaccination that was treated with percutaneous retrogasserian glycerol rhizotomy (PRGR) resulting in complete pain relief. We reported a case involving a 70‐year‐old female who had herpes zoster infection in the ophthalmic branch (V1) dermatome following COVID vaccination and presented with paroxysmal electric shock‐like sensation without a trigger. Her pain was refractory to medical management. Her Barrow Neurological Institute pain intensity score was IV. Magnetic resonance imaging of the brain was normal. PRGR was performed. The patient's pain decreased over the next 2 h, and she was pain‐free from post‐procedure Day 2 while taking carbamazepine 400 mg/day, which was tapered over 2 weeks. At her 3‐month follow‐up, the patient was reviewed and remained pain‐free. Percutaneous treatment of postherpetic trigeminal neuralgia may be considered the treatment of choice in vaccination‐induced postherpetic trigeminal neuralgia.

Background:Herpes zoster (HZ) is a secondary viral infection that results from the reactivation of latent varicella zoster virus, characterized by dermatological manifestations and neurological sequelae. The incidence of HZ increases with age and is higher among immunocompromised individuals. While the global literature extensively documents HZ disease and its impact, there is a paucity of data in regional studies. Despite the availability of vaccines, HZ poses a public health challenge, especially in regions with limited healthcare access, underscoring the need for better surveillance and management strategies globally, regionally, and nationally.The study aims to estimate the incidence of HZ among attendees of primary healthcare facilities in the Kingdom of Bahrain, analyze the demographic distribution of patients based on age, sex, and risk factors, and gain insights into the clinical presentation and the most common complications within the local society.Methods:This study used a retrospective cross-sectional design, targeting all patients who visited governmental healthcare facilities and were reported to have been diagnosed with HZ in 2021, according to electronic medical records. Patients were contacted via phone to collect specific information related to the episodes they experienced, while additional information was retrieved from electronic health records (EHR). Informed consent was obtained from all participants. During the calls, five patients declined to provide details about the episodes; their decision was respected, and only the information available in their EHR was used. All collected data were systematically recorded in an Excel spreadsheet for analysis.Results:The total incidence of HZ was 59.09 per 100,000 population. The median age was 42.8 ±19 years, with a higher prevalence observed in males (53.4%). Of the study participants 79.1% were Bahrainis, 22.3% had diabetes, and 3% had other comorbidities. The most frequently reported clinical manifestations were rash (79.9%) and pain (15.8%). The trunk (30.5%), back (19.5%), and abdomen (13.9%) were the most commonly reported locations affected by HZ. Antiviral treatment was administered to 65.2% of the patients. The most commonly reported complications included post-herpetic neuralgia (6.7%) and cellulitis (4.4%).Conclusion:Individuals in older age groups exhibit a significantly higher likelihood of developing HZ infection along with the associated post-infection complications. This finding aligns with those from other studies. It is recommended to implement interventions aimed at reducing both the incidence and morbidity of HZ, particularly targeting those at higher risk.

Isolated Glossopharyngeal Nerve Herpes Zoster Infection Following Varicella Vaccination in an Emergency Physician: A Case Report.

Case Report of Secondary Trigeminal Neuralgia Following Nerve Block-Induced Herpes Zoster Infection.

The causes of most esophageal motility disorders (EMDs) remain unknown. Recent reports have suggested a potential association between the EMD achalasia and varicella zoster virus (VZV) reactivation. This study aimed to investigate the relationship between various EMDs and VZV infection. This was cross-sectional study. The participants in this study underwent high-resolution manometry (HRM) at Chiba University Hospital between 2022 and 2024. Saliva and blood samples were collected from all patients. The presence of VZV DNA in the saliva was determined using nested polymerase chain reaction (PCR) and electrophoresis. VZV-immunoglobulin M and immunoglobulin G antibody titers were measured in the blood samples. Based on the HRM results, the patients were divided into an EMD group and a normal group. The results were compared between these groups. A total of 72 patients were included. Of these, 32 (44.4%) were in the normal group and 40 (55.6%) were in the EMD group, including 22 with esophagogastric junction (EGJ) outflow disorders (achalasia and EGJ outflow obstruction) and 18 with peristalsis disorders (absent contractility, distal esophageal spasm, hypercontractile esophagus, and ineffective esophageal motility). One patient with absent contractility had a concurrent herpes zoster infection, and VZV DNA was detected in this patient's saliva. However, all other patients tested negative for VZV DNA. No significant difference in VZV antibody titers was observed between the two groups. VZV DNA in the saliva and VZV antibody titers do not appear to be associated with EMDs.

Awareness and acceptability of herpes zoster vaccination in people living with HIV.