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.

Varicella in Pakistan

The Ministry of National Health Services, Regulations and Coordination. Of Pakistan recently reported a total of 76 suspected cases of Varicella [Chickenpox] including 15 deaths [CFR: 19.7%]. These cases were reported From 2 January to 15 April 2017. So far all varicella cases have been reported from Faisalabad city, a highly populous city in Punjab province in the eastern part of the country

Seroprevalence of varicella zoster virus infections in Colombo district, Sri Lanka.

BACKGROUND: Although Varicella Zoster virus (VZV) infections occur worldwide, the epidemiology is remarkably different in tropical and temperate climates. VZV infections result in significant morbidity and mortality among adults in Sri Lanka. AIMS: For future VZV vaccination strategies, we set to determine the age-specific seroprevalence rate of VZV infections in Colombo, Sri Lanka. MATERIALS AND METHODS: The study was carried out from 1999 to 2000. Multi-stage cluster sampling technique was used to collect 913 blood samples, which were tested for the presence of VZV-specific IgG antibodies. RESULTS: VZV seroprevalence rates were markedly lower in all age groups when compared to temperate climates. The seroprevalence rates increased with age in both the rural and urban populations. Of those aged 60 years, only 50% in the rural population and 78.9% in the urban population were immune to VZV. Seroprevalence rates of VZV infections were significantly different between the urban and rural populations (P< 0.001), with VZV-specific IgG antibodies detected in 47.5% in the urban population and 27.9% in the rural population. It was found that 56.2% (131) of females of childbearing age were nonimmune to VZV. CONCLUSIONS: These findings highlight the need for a VZV vaccination program, which is likely to have a huge impact on the incidence of chickenpox and its associated morbidity and mortality.

Seroprevalence of herpes simplex and Varicella zoster virus among diabetic and non-diabetic patients with acute peripheral facial palsy

The aim was to study the prevalence of herpes simplex virus [HSV] and varicella zoster virus [VZV] seropositive patients among diabetic patients with acute peripheral facial paralysis [APFP] as compared to non-diabetics with APFP and a healthy control group. Participants consisted of 40 diabetic patients and 40 non-diabetic patients with APFP from Hai Al-Jamea Hospital, Jeddah, Kingdom of Saudi Arabia studied over a period from July 2000 to December 2001. In addition, 20 age and sex matched healthy volunteers were included as a control group. Paired sera were obtained from all participants within the first 4 days of the illness [acute phase] and 2-3 weeks later [convalescent phase]. Paired sera were also obtained from the control group within an equivalent period. Detection of immunoglobulin [Ig] M and IgG class antibodies to HSV and VZV in these sera was carried out using enzyme-linked immunosorbent assays kits. The demonstration of IgM antibodies, 2-fold elevations of IgG antibodies or both was considered positive evidence for virus infection. The present study has shown that there was no statistically significant difference in the prevalence of HSV-seropositive patients in the diabetic and non-diabetic patients with Bell's palsy; however, it was significantly higher in both groups than in the healthy control group. There were no statistically significant differences in the prevalence of VZV-seropositive patients among the 3 groups. The significantly high prevalence of HSV-seropositive patients among the diabetic as well as the non-diabetic patients with Bell's palsy suggests an equally important role of HSV infection in the pathogenesis of Bell's palsy in the diabetic as in the non-diabetic patients

randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients

In this randomized, double-blind, multicenter, acyclovir-controlled study, the efficacy and safety of famciclovir were evaluated for the treatment of herpes zoster in patients who were immunocompromised following bone marrow or solid organ transplantation or oncology treatment. A total of 148 patients, 12 years or older with clinical evidence of localized herpes zoster, received either oral famciclovir, 500 mg three times daily, or acyclovir, 800 mg five times daily, for 10 days. Famciclovir was equivalent to acyclovir with respect to the numbers of patients reporting new lesion formation while on therapy [77 percents - 73 percent, respectively]. There were no significant differences between the group in the time to cessation of new lesion formation, full crusting, complete healing of lesions, or loss of acute phase pain. Treatment with famciclovir was well tolerated, with a safety profile comparable to that of acyclovir. Thus oral famciclovir is a convenient, effective, and well-tolerated regimen for immunocompromised patients with herpes zoster

Neumonía por varicela en adultos / Varicella pneumonia in adults

La neumonía por varicela es una rara complicación en el curso de una Varicela (10-20 por ciento) de ocurrencia preferentemente en adultos e inmunocomprometidos, potencialmente mortal, de curso variable y parcialmente prevenible. La neumonía por varicela se presenta en los primeros días del cuadro clínico, puede ser asintomática o generar falla respiratoria y requerir asistencia ventilatoria. Su diagnóstico es clínico y por imágenes; los estudios serológicos (medición de IgM) y de aislamiento viral son complementarios. Pese a la posibilidad de efectuar profilaxis en los huéspedes susceptibles con gamaglobulina o aciclovir, la medida más costoefectiva es la vacunación, disponible en Chile. Una vez desencadenado el cuadro, las medidas terapéuticas son restringidas, consistente en aciclovir o valaciclovir usados precozmente y medidas de soportes ventilatorio de ser necesario. Pese a la falta de evidencias sólidas respecto al uso de corticoides, su beneficio parece superar el riesgo involucrado en su uso

Necrose progressiva da retina externa (PORN) e neurite quiasmática por varicela-zoster em paciente com AIDS / Progressive outer retinal necrosis and necrotising chiasmatic neurites due to varicela-zoster in AIDS patient

Objetivo: Esclarecer a etiologia de neurite óptica quiasmática e de necrose progressiva da retina externa (PORN) em pacientes com AIDS. Local: Serviço de Uveites do Hospital Säo Geraldo (UFMG), departamento de Anatomia Patológica da Faculdade de Medicina da UFMG e Departamento de Neuropatologia e Neuroquímica da Universidade de Viena, Austria. Método: Cérebro, retinas e quiasma Wptico foram submetidos à avaliaçäo anatomo-patológica, ultra-estrutural, imunocitoquímica e hibridizaçäo in situ. Resultado: Cistos de Toxoplsma gondi foram encontrados no cérebro. A midroscopia eletrônica evidenciou particulas características do grupo herpes e a imunocitoquímica confirmou a presença do VZV como causa da retinite e leucoencefalopatia necrosante. Conclusäo: A neurite óptica pelo VZV pode ser a causa de comprometimento de acuidade e/ou campo visual em um paciente com AIDS, e sua presença alerta para o risco de retinite fulminante pelo mesmo agentes Seu diagnóstico indica o Tratamento imediato com drogas anti-zoster visando um prognóstico menos sombrio (au)

Herpes zoster varicela: prevalencia en el Centro Médico Nacional 20 de Noviembre / Varicella herpes zoster prevalence at Centro Médico Nacional 20 de Noviembre

Se presenta una revisión de la literatura sobre herpesvirus en relación con el herpes zoster varicela. Se estudió una serie de 2,799 pacientes que presentaron esta afección y fueron atendidos en la consulta externa y hospiralización del Centro Médico Nacional 20 de Noviembre, ISSSTE, en el periodo comprendido entre 1984 y 1997. Sesenta y siete pacientes se catalogaron como sanos por no presentar padecimiento subyacente de inmunocompromiso como neoplasias malignas, transplantes, SIDA diabetes mellitus, etc. La forma de presentación, evolución y/o complicaciones no varió significativamente en relación con otras fuentes consultadas, a excepción de la diabetes mellitus, que en nuestro país es una enfermedad con gran incidencia

SIDA y saliva. Aspectos actuales / AIDS and saliva. Current aspects

El sindrome de inmunodeficiencia adquirida (SIDA) se caracteriza por una marcada disminución inmunológica, teniendo como consecuencia una mayor susceptibilidad a enfermedades oportunistas, pasando por varios estadios hasta llegar invariablemente a la muerte. Dentro de las enfermedades oportunistas características del sindrome, existen varias trasmitidas por saliva: hepatitis B, tuberculosis, herpes zoster, herpes simple, citomegalovirus y mononucleosis. Por otra parte, aunque la evidencia ocupacional, familiar y prácticas sexuales establecen que el SIDA no se trasmite por vía oral (saliva), muchos individuos continúan expresando miedo acerca del contagio de VIH por esta vía. Para tratar de esclarecer y conocer los aspectos actuales acerca de este rubro, el principal objetivo de este trabajo es conocer y discutir la relación que guarda la saliva con el virus de inmunodeficiencia humana (VIH)

Varicela en el parto: estudio retrospectivo / Varicela in the partum: a retrospective trial

Se realizó un estudio retrospectivo, clínico y transversal, en el Hospital Central Militar de México, de septiembre de 1990 a mayo de 1994. Encaminado a recopilar los partos complicados con varicela, embarazos complicados con varicela, partos totales y encamados por varicela en este nosocomio. Se encontró que la incidencia de partos complicados con varicela es del 0.033 por ciento, con un promedio de edad de 18.7 años; el cuadro clínico de varicela fue típico y sin complicaciones, no provocó alteraciones durante el trabajo de parto, no requirieron tratamiento especial, excepto aislamiento; todos los productos fueron de término, el 25 por ciento de los productos padecieron varicela con un cuadro clínico común, aún con tratamiento profiláctico (aciclovir) por ser considerados potencialmente infectados. La distribución de la varicela durante el embarazo fue del 22 por ciento en el primer trimestre, del 40 por ciento en el segundo, del 16 por ciento en el tercero y del 22 por ciento durante el parto

Viremia VHC e infección por virus herpes zoster en un paciente en hemodiálisis tratada con eritropoietina / VHC viremia and herpes zoster infection in a patient in hemodialysis treated with erythropoietin

Hepatitis C virus infection in chronic hemodialysis patients is associated with several unresolved problems. We report a 85 years old female patient in chronic hemodialysis and treated with erythropoietin, that during the course of an Herpes zoster, presented severe malaise, weight loss and muscle weakness. Two weeks later, a slight rise in serum transaminases was detected. The patients had a negative antibodies for HIV and hepatitis C virus and negative hepatitis B surface antigen. A PCR test was positive for serum hepatitis C virus RNA. The patient's condition deteriorated and she died 7 days after admission. Erythropoietin administration, whose immunosupressive effect has been reported previously, could have influenced the dismal outcome of this patient