A retrospective observational study on disseminated herpes zoster in immunocompetent patients.

IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Journal of Infection and Chemotherapy Pub Date : 2024-07-11 DOI:10.1016/j.jiac.2024.07.009
Hideya Itagaki, Jun Suzuki, Haruka Imai, Tomoyuki Endo, Shiro Endo, Mitsuo Kaku
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Abstract

Introduction: Disseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies.

Methods: We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients.

Results: Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower.

Conclusions: This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.

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关于免疫功能正常患者播散性带状疱疹的回顾性观察研究。
导言:播散性带状疱疹(DHZ)是一种严重感染,在免疫力低下的患者中发病率和死亡率都很高。虽然有研究表明免疫功能正常的患者也会患上这种疾病,但这种疾病的流行病学、临床表现和治疗效果仍不为人所知。因此,本研究旨在探讨免疫功能正常患者中 DHZ 的临床表现、治疗、并发症和治疗效果,并将这些结果与之前的研究进行比较:方法:我们纳入了本院 20 例免疫功能正常的 DHZ 患者,并回顾了之前发表的 42 例病例。然后,我们调查了所有病例的临床特征、致病因素、实验室检查结果、治疗和预后,包括院内死亡率、出院时的神经功能障碍和带状疱疹后遗神经痛。我们将免疫功能正常的DHZ患者与免疫功能低下的DHZ患者进行了比较:患者的中位年龄为 71.5 岁,以男性为主。三叉神经区域是最常见的初始皮疹部位,平均扩散时间为 6.5 天。疼痛是最常见的症状,其次是发热(约占 40%);阿昔洛韦是最常用的治疗方法。此外,院内死亡率为0%,约10%的患者出院时出现神经病变,约40%的患者出现带状疱疹后遗神经痛。在免疫力低下的病例中,死亡率为 12%,高于我们的病例;但神经病变和带状疱疹后遗神经痛的发生率较低:本研究为免疫功能正常患者 DHZ 病例的临床表现、治疗和预后提供了新的视角,强调了尽管 DHZ 病死率较低,但仍有残留神经损伤的倾向。
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来源期刊
Journal of Infection and Chemotherapy
Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
4.10
自引率
4.50%
发文量
303
审稿时长
47 days
期刊介绍: The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.
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