“Recurrent herpes zoster”: An unproved entity?

Heskel, Neil S.; Hanifin, Jon M.

doi:10.1016/s0190-9622(84)80099-7

Cited by 25 publications

(16 citation statements)

References 18 publications

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“…13 To reduce miscoding, we excluded recurrent HZ, which can be confused with herpes simplex. 8,9 The THIN database does not require GPs to specify location of the HZ, which may explain the 10-fold lower than expected percentage of HZO cases in this study compared with previous UK studies (table 1). 12 Low levels of HZO recording has also been observed for another UK general practice database, the GPRD.…”

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confidence: 62%

“…We excluded 6,696 cases (5.90%) of recurrent zoster because of the possibility that they represented misclassified cases of recurrent herpes simplex. 8,9 We further evaluated 106,601 HZ cases together with 213,202 controls, 2 for each case, matched for age, sex, and general practice (figure e-1 on the Neurology ® Web site at Neurology.org). The total person-years follow-up for cases of HZ was 781,740.…”

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confidence: 99%

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Herpes zoster as a risk factor for stroke and TIA

et al. 2014

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Objectives: Stroke and TIA are recognized complications of acute herpes zoster (HZ). Herein, we evaluate HZ as a risk factor for cerebrovascular disease (stroke and TIA) and myocardial infarction (MI) in a UK population cohort.Methods: A retrospective cohort of 106,601 HZ cases and 213,202 controls, matched for age, sex, and general practice, was identified from the THIN (The Health Improvement Network) general practice database. Cox proportional hazard models were used to examine the risks of stroke, TIA, and MI in cases and controls, adjusted for vascular risk factors, including body mass index .30 kg/m 2 , smoking, cholesterol .6.2 mmol/L, hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent arterial claudication, carotid stenosis, and valvular heart disease, over 24 (median 6.3) years after HZ infection. Conclusion: HZ is an independent risk factor for vascular disease in the UK population, particularly for stroke, TIA, and MI in subjects affected before the age of 40 years. In older subjects, better ascertainment of vascular risk factors and earlier intervention may explain the reduction in risk of stroke after HZ infection. Neurology ® 2014;83:e27-e33 GLOSSARY BMI 5 body mass index; GP 5 general practitioner; HZ 5 herpes zoster; HZO 5 herpes zoster ophthalmicus; ICD 5 International Classification of Diseases; MI 5 myocardial infarction; THIN 5 The Health Improvement Network; VZV 5 varicellazoster virus. ResultsHerpes zoster (HZ) is caused by varicella-zoster virus (VZV), a ubiquitous pathogen, which, after primary chickenpox in children, persists asymptomatically (latently) in the sensory ganglia, including the trigeminal ganglion. Reactivation of VZV from latency and translocation, via sensory nerve endings, to the skin where it replicates is associated with the characteristic HZ rash. 1 Both ischemic and hemorrhagic strokes have been described after HZ affecting the ophthalmic branch of the trigeminal nerve.2 In these patients, virus spreads transaxonally to cerebral arteries, via trigeminal and other ganglionic afferents.2 At autopsy, viral inclusions, DNA, and antigen present in cerebral arteries confirms that VZV vasculopathy in these patients is associated with stroke and TIA.2 Similar pathology has also been found in strokes and TIA, which follow HZ occurring at nonophthalmic sites and even in the absence of rash, raising the possibility that VZV is more widely implicated in the pathogenesis of cerebrovascular disease. 2,3 This possibility is supported by findings from a Taiwanese population study showing a 30% increase in the

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confidence: 99%

Herpes zoster as a risk factor for stroke and TIA

et al. 2014

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“…The plausibility, actual occurrence, and frequency of recurrent HZ have been debated. [1][2][3][4][5] Studies of HZ recurrence often focus on special populations with hematologic malignancies or exposure to chemotherapeutic or immunotoxic agents like arsenic, [6][7][8][9] or they are population studies with small numbers of cases or short follow-up periods. [10][11][12][13][14][15][16] This study assessed the rate of HZ recurrence with up to 12 years of follow-up in a population-based cohort of 1669 persons with a confirmed previous episode of HZ between January 1, 1996, and December 31, 2001.…”

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Herpes Zoster Recurrences More Frequent Than Previously Reported

Yawn

Wollan

Kurland

et al. 2011

Mayo Clinic Proceedings

201

138

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H erpes zoster (HZ), or shingles, is usually considered a once-in-a-lifetime experience, with HZ recurrences thought to be limited to immunocompromised individuals. The plausibility, actual occurrence, and frequency of recurrent HZ have been debated. [1][2][3][4][5] Studies of HZ recurrence often focus on special populations with hematologic malignancies or exposure to chemotherapeutic or immunotoxic agents like arsenic, [6][7][8][9] or they are population studies with small numbers of cases or short follow-up periods. [10][11][12][13][14][15][16] This study assessed the rate of HZ recurrence with up to 12 years of follow-up in a population-based cohort of 1669 persons with a confirmed previous episode of HZ between January 1, 1996, and December 31, 2001. Like the index episodes, HZ recurrences were required to meet predefined diagnostic criteria of dermatomal rash and pain. [17][18][19][20] These data should provide health care professionals, insurers, and policy makers a more robust basis for practice, insurance, and policy decisions regarding prevention and treatment of HZ recurrences. PATIENTS AND METHODSWe reviewed the medical records of a community population-based cohort of people with a confirmed episode of HZ followed up for recurrence for as long as 12 years after the index episode. Recurrence rates were expressed by time from the index episode to the first recurrence and stratified by sex, age, and immune status (immunocompromised or immunocompetent) as assessed at the time of the initial or index episode of HZ. Data from the Rochester Epidemiology Project 22,23 made it possible to identify all care provided to each of these individuals by any outpatient or inpatient health care facility within the county during the follow-up period.Identification and confirmation of the index episodes of HZ have been described previously.17 Briefly summarized, the original incidence study looked at the medical records of all residents of Olmsted County, Minnesota, aged 22 years or older who, according to administrative data, presented to any health care site with an acute HZ episode between January 1, 1996, and December 31, 2001. Using detailed medical record review, we confirmed the index HZ case and collected data on HZ complications, treatment, and immune status. Any person with an administrative HZ code before the period of interest (January 1, 1996, through December 31, 2001) was excluded from the cohort in an effort to assess rates of first HZ occurrence.For this recurrence study, the medical records of all individuals with a confirmed HZ episode in the initial incidence study were reviewed from the date of their index HZ episode through December 31, 2007 (ie, a 6-to 12-year follow-up) to identify HZ recurrences. All medical records of all Olmsted County, Minnesota, health care facilities were reviewed to identify any recurrences for each individual in

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“…6,7 In the otherwise normal population herpes zoster and varicella usually occur each as single episodes. In patients who are immunocompromised relapsing shingles, 8 other atypical VZV-related cutaneous infections, [9][10][11][12] and recurrent VZV retinitis 13 have been described. Recurrent varicella has also been reported in children infected with HIV and in children with cancer.…”

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confidence: 99%

Atypical recurrent varicella in 4 patients with hemopathies

Nikkels¹,

Simonart²,

Kentos³

et al. 2003

Journal of the American Academy of Dermatology

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Relapsing varicella may occur in children with HIV infection and more rarely in younger adults. Our aim was to report unusual clinical, histologic, and virologic aspects of 4 elderly patients with malignant hemopathies who had an unusual form of recurrent varicella develop. Conventional microscopy, immunohistochemistry, and in situ hybridization were applied to smears and skin biopsy specimens. The patients presented a few dozen, scattered, large, papulovesicular lesions with central crusting. No zoster-associated pain or dermatomal distribution of the lesions was noted. Conventional microscopy revealed vascular changes and epidermal alterations typical for ␣-herpes virus infection. The varicella zoster virus major viral envelope glycoproteins gE and gB, and the immediate-early varicella zoster virus IE63 protein and the corresponding genome sequence for gE were detected on Tzanck smears; they were localized in endothelial cells and keratinocytes on skin biopsy specimens. The varicella zoster virus infection in endothelial cells, the vascular involvement, and the widespread distribution of the lesions suggest that the reported eruptions are vascular rather than neural in origin. These findings invalidate the diagnosis of herpes zoster but strongly support the diagnosis of recurrent varicella in an indolent and yet unreported presentation. Furthermore, these eruptions differ from relapsing varicella in children and young adults by the age of the patients, the paucity of clinical lesions, the larger diameter of the lesions and their peculiar clinical aspect, the significantly longer time interval between primary varicella and the recurrence, the prolonged healing time of the lesions, their mild disease course, and the fact that all the lesions are in the same stage of development. (J Am Acad Dermatol 2003;48:442-7.)

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“Recurrent herpes zoster”: An unproved entity?

Cited by 25 publications

References 18 publications

Herpes zoster as a risk factor for stroke and TIA

Herpes zoster as a risk factor for stroke and TIA

Herpes Zoster Recurrences More Frequent Than Previously Reported

Atypical recurrent varicella in 4 patients with hemopathies

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