Vacunación contra el herpes zóster en Argentina / Vaccination against herpes zoster in Argentina

Durante los últimos meses, quienes trabajamos en Argentina en el ámbito de la atención primaria como médicos de cabecera hemos recibido muchas consultas de pacientes solicitando nuestra opinión sobre una vacuna que no está actualmente incluida en el Calendario Nacional de Vacunación y que además estaba fuera de nuestra agenda: la vacuna contra el herpes zóster. Este artículo editorial pretende ayudar a los equipos de salud a realizar con sus pacientes un proceso de toma de decisiones compartidas en las consultas acerca de esta nueva vacuna. (AU)

During the last few months, those of us who work in Argentina in the field of primary care as general practitioners have received many inquiries from patients requesting our opinion about a vaccine that is not currently included in the National Vaccination Schedule and that, in addition, was off our scope: the herpes zoster vaccine. This editorial article aims to help our health teams carry out a shared decision-making process with their patients regarding this new vaccine. (AU)

Clinical significance of methyl-CpG binding protein 2 in postherpetic neuralgia: an observational study / Importancia clínica de la proteína 2 de unión a metil-CpG (MECP2) en la neuralgia posherpética: un estudio observacional

Abstract The present study was aimed to investigate the clinical significance of methyl-CpG binding protein 2 (MECP2) in patients with postherpetic neuralgia (PHN). This prospective case control study enrolled 319 cases of PHN patients from April 2017~December 2019. The patients' sleep quality and quality of life were evaluated using the Pittsburgh sleep quality score and the SF- 36 scale, respectively. The serum levels of MECP2, CRP, IL -6 and TNF-α were tested using enzyme linked immunosorbent assay (ELISA). The pain condition of the patients was evaluated using the visual analogue scale (VAS). The levels of MECP2 were significantly increased in PHN patients compared with the patients without PHN. Serum MECP2 levels were the highest in patients with severe pain, and were the lowest in patients with mild pain. Similarly, the frequency of severe pain in patients with low expression of MECP2 was significantly lower than the patients with higher MECP2 expression. Besides, serum levels of inflammatory factors CRP, IL -6 and TNF-α were markedly increased in PHN patients, which were also increased with the increase of the severity of pain. CRP, IL -6 and TNF-α were positively correlated with serum levels of MECP2 in PHN patients. Before the study, patients with lower MECP2 levels showed a significantly higher SF-36 score and lower Pittsburgh and VAS scores than patients with higher levels of MECP2. However, after one month, no significant difference was found between the patients. ROC curve showed MECP2 had the potential as a diagnostic biomarker for PHN. In conclusion, higher serum MECP2 levels are associated with a more severe pain condition and increased release of inflammatory factors.

Resumen El objetivo de este estudio fue investigar la importancia clínica de la MECP2 en pacientes con neuralgia posherpética (NPH). Este estudio observacional prospectivo incluyó 319 pacientes con NPH entre abril de 2017 y diciembre de 2019. La calidad del sueño y la calidad de vida de los pacientes se evaluaron con la escala de calidad del sueño de Pittsburgh y la escala SF - 36, respectivamente. Los niveles séricos de MECP2, PCR, IL -6 y TNF-α fueron determinados por ELISA. Se utilizó la escala visual analógica (EVA) para evaluar la intensidad del dolor. Los niveles de MECP2 en pacientes con NPH aumentaron significativamente en comparación con los pacientes sin NPH. El nivel sérico de MECP2 fue más alto en pacientes con dolor grave y el más bajo en pacientes con dolor leve. Además, la incidencia de dolor grave en pacientes con baja expresión de MECP2 fue significativamente menor que en pacientes con alta expresión de MECP2. Además, los niveles séricos de PCR, IL -6 y TNF-α aumentaron significativamente en pacientes con NPH, y se incrementaron con el aumento del grado de dolor. Los niveles séricos de PCR, IL -6 y TNF-α en pacientes con NPH se correlacionaron positivamente con los niveles séricos de MECP2. Antes del estudio, los pacientes con niveles más bajos de MECP2 tenían puntuaciones significativamente más altas de SF - 36, y puntuaciones más bajas de Pittsburgh y EVA que los pacientes con niveles más altos de MECP2. Sin embargo, no se encontraron diferencias significativas entre los pacientes un mes después. Las curvas ROC mostraron que la MECP2 podría ser un biomarcador de diagnóstico para la NPH. En general, los niveles séricos más altos de la MECP2 se asociaron con condiciones de dolor más graves y un aumento de la liberación de factores inflamatorios.

Estudio observacional prospectivo que evalúa la carga de enfermedad del HZ en Colombia / Prospective observational study evaluating the disease burden of HZ in Colombia

Resumen Introducción: el herpes zóster (HZ) es una enfermedad debilitante que afecta negativamente la calidad de vida (CV). Este estudio buscó describir la carga de la enfermedad por el HZ en Colombia. Métodos: estudio prospectivo, observacional, de cohorte única realizado en 10 centros clínicos colombianos. Para ser elegibles, los pacientes tenían que ser inmunocompetentes, ≥50 años de edad, y tener un diagnóstico confirmado de HZ en fase aguda o dolor posherpético. Los resultados del estudio incluyeron el inventario breve del dolor por zóster (ZBPI), la CV evaluada con el cuestionario EQ-5D y la utilización de recursos de atención médica (URAM) debido a HZ. El seguimiento fue de 180 días. Resultados: se incluyeron 154 pacientes con una media (DE) de la edad de 64.6 (9.6) años. La media (DE) del peor dolor agudo fue 8.2 (2.1), mientras la neuralgia posherpética (dolor por HZ ≥3 que persistió ≥90 días) fue reportado por 36.5% de los pacientes. Los predictores significativos del aumento de la carga de dolor fueron la edad avanzada y puntuaciones de peor dolor más altas desde el inicio de la erupción. El aumento en el dolor asociado a HZ estuvo acompañado con reducción significativa en CV, la cual duró aproximadamente 60 días. En términos de la URAM, medicamentos para el HZ y que fueron recetados a 98.7% de los pacientes, incluyendo aciclovir en 85.1% de los pacientes, 79.2% tuvieron un seguimiento por un médico general, 38.2% visitó una sala de emergencia y 29.2% visitó un especialista Conclusión: HZ está asociado a carga de enfermedad significativa en Colombia, incluyendo dolor, impacto en la CV y URAM. A medida que la población colombiana envejece, se deben implementar estrategias para manejar y/o prevenir de manera más efectiva la carga asociada al HZ. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).

Abstract Introduction: herpes zoster (HZ) is a debilitating disease with a negative effect on quality of life (QL). This study sought to describe the burden of disease of HZ in Colombia. Methods: this was a prospective, observational single-cohort study in 10 Colombian clinical centers. To be eligible, patients had to be immunocompetent, ≥50 years old, and have a confirmed diagnosis of acute phase HZ or postherpetic pain. The study outcomes included the Zoster Brief Pain Inventory (ZBPI), QL assessed through the EQ-5D questionnaire, and healthcare resource utilization (HCRU) due to HZ. Patients were followed for 180 days. Results: 154 patients were included with a mean (SD) age of 64.6 (9.6) years. The mean (SD) worst acute pain was 8.2 (2.1), while postherpetic neuralgia (HZ pain ≥3 which lasted for ≥90 days) was reported by 36.5% of the patients. The significant predictors of increased pain burden were advanced age and higher worst pain score from the onset of the rash. Increased HZ-related pain was associated with a significant reduction in QL, which lasted approximately 60 days. In terms of HCRU, HZ medications were prescribed for 98.7% of the patients, including acyclovir in 85.1%; 79.2% were followed by a general practitioner; 38.2% were seen in the emergency room and 29.2% consulted a specialist. Conclusion: HZ is associated with a significant burden of disease in Colombia, including pain and an impact on QL and HCRU. As the Colombian population ages, strategies should be implemented to more effectively manage and/or prevent the HZ-related burden. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).

Burden of herpes zoster among Brazilian adults: a hospital-based study / Carga da herpes zoster em adultos brasileiros: um estudo de base hospitalar

OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18­96), and the majority were women (63.05%) and aged ≥ 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.

OBJETIVO: Descrever as características clínicas do herpes zoster em pacientes adultos atendidos em um grande hospital terciário no Brasil por um período de cinco anos. METODOLOGIA: Os casos suspeitos de herpes zoster (com base nos códigos da CID-10) foram identificados para revisão completa dos prontuários. Foi realizada uma amostragem por conveniência para selecionar os prontuários de interesse em um hospital terciário em São Paulo. Foram coletadas informações de prontuários médicos sobre condições coexistentes, características clínicas e uso de medicamentos relacionados ao herpes zoster (como primeiro episódio ou episódio de herpes zoster recorrente) e uso de recursos de saúde. RESULTADOS: Entre 2010 e 2014, 249 indivíduos com um primeiro episódio de herpes zoster foram incluídos, com uma idade média de 55 anos (variando de 18 a 96 anos). A maioria era do sexo feminino (63,05%) e com idade ≥ 50 anos (63,86%). Comorbidades médicas foram relatadas em 92,77% dos pacientes, incluindo diabetes (19,68%) e infecção por HIV (7,63%); o uso atual / recente de agentes imunossupressores foi relatado em 31,73%. Hospitalização foi relatada em 65,86% dos casos; 102 pacientes (40,96%) foram admitidos para o tratamento do episódio de herpes zoster e 62 pacientes (24,90%) já estavam recebendo atendimento hospitalar. O tempo médio de permanência no hospital foi de 16,60 dias. Um terço (34,14%) de todos os casos foi tratado ambulatorialmente. A neuralgia pós-herpética foi relatada como complicação em 18,07% dos casos. CONCLUSÕES: Os resultados do presente estudo descritivo retrospectivo demonstram alta frequência de episódios de herpes zoster em idosos com comorbidades, buscando atendimento médico em um hospital terciário. Esses resultados também ressaltam a importância de entender a epidemiologia dessa doença e considerar as estratégias de controle nas populações de risco no Brasil.

Herpes zoster en adultos mayores en un hospital privado de la ciudad de Buenos Aires, junio 2013 - mayo 2014 / Herpes zoster in elderly adults in a community hospital in Buenos Aires. June 2013-May 2014

El herpes zoster (HZ) se produce por reactivación del virus varicela zoster. Sus principales factores de riesgo son edad avanzada y presencia de comorbilidades (diabetes, inmunodepresión). Existen escasos datos de HZ en Sudamérica, y especialmente en adultos mayores. Analizamos retrospectivamente las características epidemiológicas y clínicas de 340 pacientes mayores de 60 años atendidos por HZ, entre junio 2013 y mayo 2014. La edad promedio de consulta fue de 74 años (60-100), localización torácica 210 (62%); el 75% (255) de las consultas iniciales se realizaron en guardias. El 68%, 143, presentaron dolor y vesículas, y 4% (14) solo dolor al inicio; el dolor persistió luego de finalizar el episodio en el 41% (139) de los pacientes. El diagnóstico se realizó entre 1 y 3 días de iniciado el cuadro en el 53% (180). El promedio de consultas por episodio fue de 3.6 (1-24). Tratamiento antiviral se indicó en 91% (309) de los pacientes [en 49% (167) fue inadecuado en tiempo o dosis], y tratamiento para el dolor en el 66% (224) de los casos: drogas más usadas (solas o en combinación) AINES (43%, 146), pregabalina (30%, 102), opiáceos (24%, 82), y corticoides (12%, 41). Solo el 9% (31) presentó comorbilidades y el 27% (126) dolor post episodio (duración promedio: 138.7 días). El diagnóstico fue tardío, dificultando el uso correcto de antivirales. El dolor post episodio fue más frecuente que en la literatura consultada; sin embargo, son pocos los datos en este grupo etario.

Herpes zoster (HZ) is caused by reactivation of the varicella zoster virus. Its main risk factor is increasing age and comorbidities. There are limited data on the characteristics of HZ in South America, especially in the elderly. We analyzed epidemiological and clinical characteristics of 340 patients over 60 years assisted for HZ, between June 2013 and May 2014. The average age was 74 years (60-100), 62% (210) had thoracic location; 75% (255) of the initial consultations were held in guards; 68% (143) had pain and vesicles, and 4% (14) only pain at baseline. Pain persisted after finishing the episode in 41% (139). The diagnosis was made between 1 and 3 days from the beginning of the episode in 53% (180 patients). Average number of visits per episode was 3.6 (1-24). Antiviral treatment was supplied to 91% (309); however it was inadequate in dose or time in 49.1% (167 cases). Pain treatment was indicated in 66% (224). Most frequently used drugs (alone or in combination) were non-steroidal painkillers (43%, 146), pregabalin (30%, 102), opiates (24%, 82), and steroids (12%, 41); 9% (31) presented comorbidities; 27% (126) experienced pain after the ending of the episode, with an average duration of 138.7 days. In general, diagnosis was done late, making it difficult to use antivirals correctly. The presence of pain was more frequent than reported in other publications, however there are few data in this age group.

Actualización en Herpes Zóster / Update in Shingles

El Herpes Zóster es un rash vesiculoso producido por la reactivación del virus Varicela-Zóster. Es más frecuente en adultosmayores y se manifiesta con dolor intenso. El diagnóstico clínicogeneralmente es sencillo, y el tratamiento se orienta hacia elmanejo del dolor y la prevención de la Neuralgia Posherpética. Encasos graves, dentro de las 72 horas de producido el rash, sepueden indicar antivirales por vía oral o endovenosa, según losrequerimientos del paciente.

Shingles is a vesicular rash caused by reactivation of theVaricella-Zoster virus. It is more common in older adults andpresents with severe pain. The clinical diagnosis is usually simple,and treatment is aimed at pain management and prevention ofPostherpetic Neuralgia. In severe cases, within 72 hours of therash, oral or intravenous antivirals may be prescribed,depending on the patients' requirements.

Herpes-zóster e neuralgia pós-herpética / Herpes-zoster and post-herpetic neuralgia

BACKGROUND AND OBJECTIVES: Herpes-zoster (HZ) is a vesicular painful skin rash resulting from the reactivation of vari¬cella-zoster virus (VZV) in dorsal root ganglia or cranial nerves, which occurs decades after the primary varicella infection. However, even after skin healing, pain may persist for months or even years. This is a complication known as post-herpetic neuralgia (PHN). This review aimed at giving an overview of herpes-zoster and PHN clinical history, focusing on pain control. CONTENTS: PHN is characterized by chronic neuropathic pain. Its incidence is higher among the elderly and immunocompromised individuals. There are several treatment options, which may be pharmacological or interventionist, both with variable efficacy. CONCLUSION: Pain affects quality of life of patients, interfering with their daily activities. In spite of advances already obtained in the analgesic therapy for HZ and PHN, there are still difficulties in its approach. So, it is very important to prevent, diagnose and early treat HZ and its complications.

JUSTIFICATIVA E OBJETIVOS: O herpes-zóster (HZ) é uma erupção cutânea vesicular dolorosa resultante da reativação do vírus varicela-zóster (VVZ) nos gânglios da raiz dorsal ou nos nervos cranianos, que ocorre décadas após a infecção primária de varicela. Entretanto, mesmo após a cicatrização cutânea, a dor pode persistir por meses e até anos. Esta é uma das complicações conhecida como neuralgia pós-herpética (NPH). O objetivo desta revisão é fornecer uma visão geral da história clínica do herpes-zóster e da NPH, focando a abordagem do controle da dor.CONTEÚDO: A NPH caracteriza-se por dor neuropática crônica. Há incidência aumentada em idosos e indivíduos imunocomprometidos. Muitas opções de tratamento estão disponíveis, podendo ser farmacológico e intervencionista, ambos apresentam eficácia variável.CONCLUSÃO: A dor afeta a qualidade de vida dos pacientes, interfererindo nas suas atividades diárias. Apesar dos avanços já obtidos na terapia analgésica do HZ e da NPH, ainda existem inúmeras dificuldades na sua abordagem. Portanto, é muito importante prevenir, diagnosticar e tratar precocemente o HZ e suas complicações.

Neuralgia pós-herpética em área anatômica pouco usual: relato de caso / Post-herpetic neuralgia in unusual anatomic area: case report

JUSTIFICATIVA E OBJETIVOS: O herpes zoster (HZ) é uma doença causada pela reativação do vírus varicela-zoster nos nervos cranianos e nos gânglios das raízes espinhais dorsais, geralmente deflagradas décadas depois da infecção primária de varicela. Sua complicação mais comum é a neuralgia pós-herpética (NPH), que é caracterizada por dor neuropática crônica e que se inicia entre um e seis meses após a cura das erupções cutâneas do HZ. O objetivo deste estudo foi relatar um caso de quadro de neuralgia pós-herpética em área anatômica pouco comum. RELATO DO CASO: Paciente do sexo feminino, 55 anos, com diagnóstico de HZ, que evoluiu para neuralgia pós-herpética. A paciente queixa-se de dor intensa e persistente em queimação localizada inicialmente em toda a extensão do membro inferior esquerdo (MIE). Ao exame físico apresentava alodínia e hiperalgesia no MIE até a raiz da coxa. CONCLUSÃO: O HZ apresenta-se mais frequentemente envolvendo os dermátomos facial e torácico. No entanto, deve-se sempre lembrar as áreas anatômicas pouco frequentes, para que seja realizado precocemente o diagnóstico e o tratamento, evitando assim as complicações.

BACKGROUND AND OBJECTIVES: Herpes zoster (HZ) is caused by the reactivation of the varicella-zoster virus in cranial nerves and spinal root ganglia, in general triggered decades after the primary varicella infection. Its most common complication is post-herpetic neuralgia (PHN), characterized by chronic neuropathic pain and starting one to six months after the healing of HZ skin rashes. This study aimed at reporting a case of post-herpetic neuralgia in unusual anatomic area. CASE REPORT: Female patient, 55 years old, with diagnosis of HZ evolving to post-herpetic neuralgia. Patient complains of severe and persistent burning pain initially located throughout her left lower limb (LLL). At physical evaluation she presented LLL allodynia and hyperalgesia up to the root of the thigh. CONCLUSION: HZ usually involves face and chest dermatomes. However, one has to consider unusual anatomic areas to provide early diagnosis and treatment, thus preventing complications.

Effects of dorsal root ganglion destruction by adriamycin in patients with postherpetic neuralgia / Efeitos da destruição da raiz dorsal ganglionar pela adriamicina em pacientes com neuralgia pós-herpética

PURPOSE: To investigate the effects of dorsal root ganglion destruction in patients with postherpetic neuralgia (PHN). METHODS: Seventy-two patients with PHN selected were randomly divided into two groups (n=36). Group A was the control group (treated by injection) and group B was the group of dorsal root ganglion destruction by adriamycin. Visual analog scale scores (VAS), SAS, SF-MPQ scores. Clinical effects and therapy safety were evaluated before therapy, one week, three and six months after therapy. Forty-four patients were available for intention-to-treat analysis. RESULTS: The average pain scores on the Likert scale were significantly reduced at each point in group B. Patients in group B reported clinical effectiveness at six months as excellent response, good response, improved but unsatisfactory or unchanged 16, 12 and 8.VAS scores at each time point after the operation were lower than that before operation and in group A, there was significant difference. Patients showed significant improvement in sleep scores in group B. There was significant difference at T2 in group A than T1. There was no significant difference in group A at T3, T4 after the operation than that before operation. Between group comparison: there was significant difference between group A and group B at each time point after the operation. CONCLUSIONS: Dorsal root ganglion destruction by adriamycin under guidance of C-arm perspective, the puncture operation was accurate without any adverse reaction or serious complications, which could effectively relieve pain of patients with postherpetic neuralgia, but the long-term effects needed further study.

OBJETIVO: Investigar os efeitos da destruição da raiz dorsal ganglionar em pacientes com neuralgia pós-herpética. MÉTODOS: Setenta e dois pacientes selecionados com neuralgia pós-herpética foram randomicamente distribuídos em dois grupos (n=36). Grupo A foi o grupo controle (tratado por injeção) e o grupo B foi o grupo com destruição da raiz dorsal do gânglio pela adriamicina. Os escores da Escala Analógica Visual (VAS), SAS, SF-MPQ escores, efeitos clínicos e segurança terapêutica foram avaliados as antes da terapia, uma semana, três e seis meses após a terapia. Quarenta e quatro pacientes foram avaliados pela análise de intenção-em-tratar. RESULTADOS: A média dos escores de dor na escala de Likert foi significativamente reduzida em cada ponto no grupo B. Pacientes no grupo B relataram efetividade clínica aos seis meses com excelente resposta (16), boa resposta (12), melhora mais insatisfatória ou sem modificações (8). Escores VAS a cada tempo após o procedimento foram melhores em comparação ao pré-operatório. No grupo A não foi observada diferença significativa. Pacientes mostraram melhora nos escores de dormir no grupo B. Houve diferença significante no T2 no grupo A que T1. Não houve diferença significante no grupo A nos tempos T3 e T4 após a cirurgia em relação a antes. Comparação entre os grupos: houve diferença significante entre os grupos A e B a cada tempo após a cirurgia. CONCLUSÕES: A destruição da raiz dorsal ganglionar pela adriamicina sob perspectiva guiada pelo C-arm, a cirurgia pontual foi acurada sem qualquer reação adversa ou complicação séria, que pode efetivamente aliviar a dor em pacientes com neuralgia pós-herpética, mas os efeitos de longo prazo necessitam mais estudos.

Herpes zoster: Epidemiología y clínica / Clinical and epidemiological aspects of Herpes zoster

El herpes zoster (HZ) constituye una enfermedad de distribución mundial; sin embargo, existen es casos datos comunicados sobre la misma en países de Latinoamérica. Con el objetivo de evaluar aspectos clínicos y epidemiológicos de esta enfermedad en nuestra población, realizamos un análisis retrospectivo de historias clínicas de un centro privado de referencia en enfermedades infecciosas en Buenos Aires, Argentina (período: 2000-2005). Se realizó un análisis estadístico univariado para evaluar los factores asociados a neuralgia posherpética en este grupo de pacientes. Sobre un total de 302 casos evaluables, el 62% correspondieron a mujeres. La mediana de edad fue de 57 años. El 16.1% de los pacientes presentó condiciones predisponentes al desarrollo de zoster. Las localizaciones más frecuentes fueron la torácica, oftálmica y lumbosacra. El 7.75% presentó compromiso de más de dos metámeras. El 94% de los pacientes recibió medicación antiviral, siendo el aciclovir la droga más utilizada. El 94% recibió alguna medicación coadyuvante (antiinflamatorios no esteroideos, antineuríticos, corticoides). La complicación más frecuente fue la neuralgia posherpética (12%) y se encontró estadísticamente asociada a edad mayor de 50 años.

Herpes zoster (HZ) is a public health problem worldwide. Although, there is paucity of data of this disease from South American countries. The objective of this study was to evaluate clinical and epidemiological aspects of HZ in a population of patients from South America. We underwent a retrospective analysis of clinical charts of an infectious diseases reference center (period: 2000-2005). Univariate analysis was performed to assess variables related to post herpetic neuralgia (PHN). From a total of 302 cases, 62% were in women. The median age was 57 years; 16.1% of the patients had a predisposing condition for the development of HZ. Most frequent dermatomes involved were: thoracic, ophthalmic and lumbar; 93.5% of the patients received antiviral drugs and 94% complementary medications. The most frequent complication was PHN and was related with age over 50 years. Clinical and epidemiological aspects of HZ and the frequency of complications in our population were similar to data from developed countries.

Varicella Zoster: aspectos clínicos e abordagem terapêutica da neuralgia pós-herpética / Varicella Zoster: clinical features and therapeutical approach of the post herpetic neuralgia

O presente artigo busca informar o médico generalista sobre os aspectos clínicos da infecção causada pelo vírus varicela zoster. O autor cita o comportamento viral de inatividade nos gânglios das raízes dorsais e as causas prováveis para sua reativação, tais como idade avançada, ou extremamente precoce, doenças do sistema imunológico e determinados tumores entre outras circunstâncias, que são capazes de propiciar condições para a reinfecção conhecida como herpes zoster, cujas características clínicas são também apresentadas, bem como seu diagnóstico e tratamento. As complicações neurológicas relacionadas à infecção pelo vírus varicela zoster são estudadas no artigo. É feita, ainda, a conceituação da neuralgia pós-herpética, e a atualização da abordagem terapêutica deste tipo de dor neuropática. São estudados os vários fatores fisiopatológicos responsáveis por sua gênese, cujo conhecimento fundamenta o tratamento medicamentoso eficiente.

The aim of the present article is to inform the internist on the clinical aspects of the varicella zoster virus infection. The author refers the viral inactivity behavior, harbored in the dorsal root ganglia. The probable causes to its reactivation are mentioned, such as advanced or very precocious age, immunocompromised states and some tumors among other circunstances. These conditions are capable to create the right enviromnent to the reinfection, called herpes zoster, whose clinical aspects, diagnosis and treatment are presented. The neurological complications related to the Varicella Zoster Virus infection are studied in the article. The post herpetic neuralgia is defined as a specific type of naturopathic pain. The author brings up to date the therapeutical approach of the painful condition caused by herpes zoster and emphasizes the significance of understanding the post herpetic neuralgia pathophysiologic mechanisms to its effective treatment.

A lesão do trato de Lissauer e do corno posterior da medula espinal e a estimulação do sistema nervoso central para o tratamento da neuralgia pós-herpética / DREZ lesions and electrical stimulation of the central nervous system fortreatment of post-herpetic pain

Dor é uma complicação freqüente em doentes que apresentam erupção pelo vírus do herpes zóster. Os autores descrevem os resultados do tratamento operatório de 22 doentes com neuralgia pós-herpética. Sete doentes foram tratados pela técnica de lesão do trato de Lissauer(TL) e do corno posterior da medula espinal (CPME), sete pela técnica de estimulação elétrica da medula espinal, dois doentes por ambos os procedimentos e seis pela técnica de nucleotratotomia trigeminal estereotáxica. Foi observada significativa melhora imediata em 66,7%dos doentes com a técnica de estimulação medular, sendo mantida em 44,4% dos doentes a longo prazo. Ocorreu significativa melhora imediata em 50% dos doentes tratados pela nucleotratotomia trigeminal. A longo prazo, 33,3% dos doentes foram beneficiados. Foi observada melhora significativa imediata em 88,9% dos doentes tratados pela técnica da lesão do TL e do CPME. A longo prazo, a melhora foi observada em 66,6% dos casos. Síndrome cordonal posterior temporária ocorreu em dois doentes tratados pela nucleotratotomia trigeminal. Ela foi permanente em dois doentes tratados por essa técnica e em quatro pela lesão do TL e do CPME. Dos doentes tratados pela lesão do TL e do CPME ocorreu discreta hemiparesia permanente em quatro e um faleceu de embolia pulmonar durante o oitavo dia de pós-operatório. Concluiu-se que a lesão do trato de TL e do CPME e a estimulação elétrica da medula espinal proporcionaramresultados similares a longo prazo (p > 0,05). A técnica de estimulação, entretanto, é mais segura.

Post-herpetic pain is a very common and incapacitating disease. The authors analyse the effectiveness of the technique of dorsal root entry zone (DREZ) lesions, stereotaxic trigeminal nucleotractotomy (TNT) and dorsal column stimulation (DCS) for treatment of post-herpetic neuralgia. Twenty two patients were treated. Seven underwent DREZ; 7, DCS; 2 underwent both DREZ and DCS and 6, TNT. Immediate improvement (for 3 to 60 months ? median 12 months) of the symptoms occurred in 88.9% of the patients treated by DREZ. After a long term follow up period satisfactory results were observed in 66.7% of these patients. TNT resulted in significant immediate improvent of 50.0% of the patients and a long term (3 to 120 months ? median 8.5 (months) improvement of 33.3% of the cases. The DCS resulted in immediate improvement of pain in 66.4% of the patients. During a long term follow up period (6 to 18 months ? median 12 (months), 44.4% of the patients were better.The complication rate was higher among DREZ and TNT patients. It was concluded that the results of DREZ, TNT and DCS are similar (p > 0.05). However, DCS is safer, specially in cases of post-herpetic neuralgia affecting intercostal roots.