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Park SY, Kim JY, Kim JA, Kwon JS, Kim SM, Jeon NY, Kim MC, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Diagnostic Usefulness of Varicella-Zoster Virus Real-Time Polymerase Chain Reaction Analysis of DNA in Saliva and Plasma Specimens From Patients With Herpes Zoster. J Infect Dis 2019; 217:51-57. [PMID: 29029120 DOI: 10.1093/infdis/jix508] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/19/2017] [Indexed: 12/29/2022] Open
Abstract
Background We evaluated the diagnostic usefulness of polymerase chain reaction (PCR) analysis for detecting varicella-zoster virus (VZV) infection and reactivation of VZV, using DNA extracted from saliva and plasma specimens obtained from subjects with suspected herpes zoster and from healthy volunteers during stressful and nonstressful conditions. Methods There were 52 patients with a diagnosis of herpes zoster (group 1), 30 with a diagnosis of zoster-mimicking disease (group 2), and 27 healthy volunteers (group 3). Saliva and plasma samples were evaluated for VZV DNA by real-time PCR analysis. Results Among patients with suspected herpes zoster (ie, patients in groups 1 and 2), the sensitivity of PCR analysis of salivary DNA for detecting VZV (88%; 95% confidence interval [CI], 74%-95%) was significantly higher than that of PCR analysis of plasma DNA (28%; 95% CI, 16%-44%; P < .001), whereas the specificity of PCR analysis of salivary DNA (100%; 95% CI, 88%-100%) was similar to that of PCR analysis of plasma DNA (100%; 95% CI, 78%-100%; P > .99). VZV DNA was not detected in saliva and plasma samples from group 3 (0%; 95% CI, 0%-14%). Conclusions Real-time PCR analysis of salivary DNA is more sensitive than that of plasma DNA for detecting VZV among patients with suspected herpes zoster. We found no subclinical reactivation of VZV in group 3 following exposure to common stressful conditions.
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Affiliation(s)
- Seong Yeon Park
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang
| | - Ji Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Ae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kwon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun-Mi Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Na Young Jeon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Chul Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
Background Herpesviruses notably establish lifelong infections, with latency and reactivation. Many of the known human herpesviruses infect large proportions of the population worldwide. Treatment or prevention of herpes infections and recurrent disease still pose a challenge in the 21st century. Sources of data Original papers and review articles, meeting abstracts, a book (Clinical Virology; DD Richman, RJ Whitley & FG Hayden eds) and company web sites. Areas of agreement For herpes simplex types 1 and 2 and for varicella zoster, acyclovir (ACV; now increasingly replaced by its prodrug valacyclovir, VACV) and famciclovir (FCV) have greatly reduced the burden of disease and have established a remarkable safety record. Drug-resistance, in the otherwise healthy population, has remained below 0.5% after more that 20 years of antiviral use. In immunocompromised patients, drug resistance is more common and alternative drugs with good safety profiles are desirable. For human cytomegalovirus disease, which occurs in immunocompromised patients, ganciclovir and increasingly its prodrug valganciclovir are the drugs of choice. However, alternative drugs, with better safety, are much needed. Areas of controversy Various questions are highlighted. Should the new 1-day therapies for recurrent herpes labialis and genital herpes replace the current standard multi-day therapies? The marked differences between VACV and FCV (e.g. triphosphate stability, effect on latency) may not yet be fully exploited? Do current antivirals reduce post-herpetic neuralgia (PHN)? For immunocompromised patients with varicella zoster virus (VZV) disease, should the first-line treatment be FCV, not ACV or VACV? Should there be more support to explore new avenues for current antivirals, for example in possibly reducing herpes latency or Alzheimer's disease (AD)? Should primary Epstein-Barr virus (EBV) disease in adolescents be treated with antivirals? How can new compounds be progressed when the perceived market need is small but the medical need is great. FCV was reclassified from prescription-only to pharmacist-controlled for herpes labialis in New Zealand in 2010; should this be repeated more widely? This article reviews new drugs in clinical trials and highlights some of the problems hindering their progress.
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Benbernou A, Drolet M, Levin MJ, Schmader KE, Oxman MN, Johnson R, Patrick D, Camden S, Mansi JA, Brisson M. Association between prodromal pain and the severity of acute herpes zoster and utilization of health care resources. Eur J Pain 2012; 15:1100-6. [DOI: 10.1016/j.ejpain.2011.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/03/2011] [Accepted: 04/21/2011] [Indexed: 11/28/2022]
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McKendrick MW, Ogan P, Care CC. A 9 year follow up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster. J Infect 2009; 59:416-20. [PMID: 19766139 DOI: 10.1016/j.jinf.2009.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 08/04/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED To characterise predisposition to post herpetic neuralgia following herpes zoster. DESIGN Late follow up of patients originally admitted with acute zoster to a double blind randomised placebo controlled study of oral acyclovir over 60 years of age. SETTING Two UK cities of 1.5 million population. RESULTS 158 of the 298 patients from the original study were available for evaluation at a mean follow up of 9 years. Thirty four (21%) described experiencing pain from the zoster within the previous 12 months. Pain at follow up was associated with characteristics at the time of acute zoster of: moderate or severe acute pain (p = 0.006), prodromal pain >72 h before rash (p = 0.006), severity of rash (p = 0.033) and female gender (p = 0.046). There was no association between pain at 9 year follow up and use of placebo or aciclovir nor with the presence or absence of pain at the point of discharge from the original study. Further analysis of 17 of the 34 patients with long term pain who have full data available, the median pain score was 4 out of 10 and more than 50% described persistent pain and interference with sleep. CONCLUSION Long term pain in the elderly following zoster is associated with identifiable characteristics during the acute illness.
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Affiliation(s)
- Mike W McKendrick
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Partridge DG, McKendrick MW. The treatment of varicella-zoster virus infection and its complications. Expert Opin Pharmacother 2009; 10:797-812. [DOI: 10.1517/14656560902808502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Volpi A, Gatti A, Pica F, Bellino S, Marsella L, Sabato A. Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol 2008; 80:1646-52. [DOI: 10.1002/jmv.21254] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Schmader KE, Dworkin RH. Natural history and treatment of herpes zoster. THE JOURNAL OF PAIN 2008; 9:S3-9. [PMID: 18166460 DOI: 10.1016/j.jpain.2007.10.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The objective of this article is to provide an overview of the natural history and treatment of herpes zoster, with a focus on pain management. Herpes zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of herpes zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes zoster begins with reactivation of varicella zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for herpes zoster acute pain reduction. If moderate to severe herpes zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered. PERSPECTIVE This article presents information on the clinical features and treatment of herpes zoster. This information will help clinicians diagnose and manage herpes zoster pain.
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Affiliation(s)
- Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University Medical Center and Geriatric Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC 27705, USA.
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Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJM, Wallace MS, Wassilew SW, Whitley RJ. Recommendations for the management of herpes zoster. Clin Infect Dis 2007; 44 Suppl 1:S1-26. [PMID: 17143845 DOI: 10.1086/510206] [Citation(s) in RCA: 434] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.
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Affiliation(s)
- Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA.
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Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, Jackson K, Parmelee PA, Rudy TE, Lynn Beattie B, Chibnall JT, Craig KD, Ferrell B, Ferrell B, Fillingim RB, Gagliese L, Gallagher R, Gibson SJ, Harrison EL, Katz B, Keefe FJ, Lieber SJ, Lussier D, Schmader KE, Tait RC, Weiner DK, Williams J. An Interdisciplinary Expert Consensus Statement on Assessment of Pain in Older Persons. Clin J Pain 2007; 23:S1-43. [PMID: 17179836 DOI: 10.1097/ajp.0b013e31802be869] [Citation(s) in RCA: 357] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
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Haanpää M. Chapter 43 Acute herpes zoster pain. HANDBOOK OF CLINICAL NEUROLOGY 2006; 81:653-659. [PMID: 18808865 DOI: 10.1016/s0072-9752(06)80047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med 2005; 20:748-53. [PMID: 16050886 PMCID: PMC1490195 DOI: 10.1111/j.1525-1497.2005.0150.x] [Citation(s) in RCA: 340] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Few recent studies have reported data on the incidence of herpes zoster (HZ) in U.S. general clinical practice. OBJECTIVE To estimate the age- and sex-specific incidence of HZ among U.S. health plan enrollees. DESIGN Data for the years 2000 to 2001 were obtained from the Medstat MarketScan database, containing health insurance enrollment and claims data from over 4 million U.S. individuals. Incident HZ cases were identified through HZ diagnosis codes on health care claims. The burden of HZ among high-risk individuals with recent care for cancer, HIV, or transplantation was examined in sub-analyses. Overall incidence rates were age- and sex-adjusted to the 2000 U.S. population. PARTICIPANTS MarketScan U.S. health plan enrollees of all ages. MEASUREMENTS AND MAIN RESULTS We identified 9,152 incident cases of HZ (3.2 per 1,000 person-years) (95% confidence interval [CI], 3.1 to 3.2 per 1,000). Annual HZ rates per 1,000 person-years were higher among females (3.8) than males (2.6) (P<.0001). HZ rates rose sharply with age, and were highest among individuals over age 80 (10.9 per 1,000 person-years) (95% CI, 10.2 to 11.6). The incidence of HZ per 1,000 person-years among patients with evidence of recent care for transplantation, HIV infection, or cancer (10.3) was greater than for individuals without recent care for these conditions (3.0) (P<.0001). CONCLUSIONS The overall incidence of HZ reported in the present study was found to be similar to rates observed in U.S. analyses conducted 10 to 20 years earlier, after age- and sex-standardizing estimates from all studies to the 2000 U.S. population. The higher rate of HZ in females compared with males contrasts with prior U.S. studies.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, Blue Bell, PA, USA.
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Abstract
Varicella zoster virus (VZV) causes varicella (chickenpox), becomes latent in cranial nerve, dorsal root, and autonomic ganglia; and reactivates decades later to produce zoster (shingles). The main complication of zoster is postherpetic neuralgia (PHN), pain that persists for months and often years after zoster. VZV also causes chronic radicular pain without rash (zoster sine herpete). Viremia is associated with each stage of VZV infection. Viral DNA has been found in peripheral blood mononuclear cells (MNCs) of patients with varicella, zoster, PHN, and zoster sine herpete. In varicella, viremia contributes to the widespread distribution of skin lesions and infection of multiple organs. Although the role of viremia in other VZV-associated diseases is not as clear, the detection of VZV DNA (and sometimes VZV RNA and proteins) helps diagnose neurological diseases produced by VZV, has indicated that PHN may reflect a chronic VZV ganglionitis, and has established that VZV reactivates subclinically, especially in immunocompromised humans. In vitro studies have established that VZV can productively infect MNCs for a short time and have identified the subpopulations of MNCs that are infected. Finally, simian varicella virus (SVV) infection of nonhuman primates shares clinical, pathological, and virologic features with VZV in humans. Like VZV, SV viremia in nonhuman primates during acute infection plays an important role in the pathogenesis of SVV. Infectious virus can be isolated from MNCs, and SVV DNA can be detected in MNCs during varicella. Further, SVV DNA can be detected for months in MNCs of monkeys after experimental infection with SVV. Herein, we review the current literature related to VZV infection of MNCs during naturally occurring varicella, PHN, and zoster sine herpete in humans, including studies of experimental infection of human MNCs with VZV. We also review SVV MNC interaction during naturally occurring simian varicella and after experimental infection of primates with SVV.
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Affiliation(s)
- Tiffany M White
- Departments of Neurology and Microbiology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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Fristad I, Bårdsen A, Knudsen GC, Molven O. Prodromal herpes zoster--a diagnostic challenge in endodontics. Int Endod J 2002; 35:1012-6. [PMID: 12653320 DOI: 10.1046/j.1365-2591.2002.00605.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case report highlights the diagnostic challenge that herpes zoster represents if pain develops in the prodromal stage. A 58-year-old male presented with pain in the left maxilla. The symptoms had lasted for 7 months. The first premolar had been extracted soon after the onset, and the second premolar root filled shortly thereafter. Symptoms were experienced as sudden pain attacks lasting for several hours and analgesics gave some pain relief. Clinical examination showed that the second premolar was tender to percussion. No sinus tract or swelling were present. Radiographic examination showed previously root-filled second premolar and first molar teeth, and no evidence of apical pathosis. Due to the uncertainty about the quality of the root filling in the second premolar and incomplete root filling in the first molar, retreatment was started prior to prosthetic treatment in the region. The pain continued and became more intense during the treatment. A diagnosis of herpes zoster was determined, when an acute attack with oedema and vesicles occurred, 2 months after retreatment was started. In the present case, therefore, the primary attack presented itself after months and the herpes zoster diagnosis could not be made until then. points. Key learning points. * A long lasting prodromal stage is an unusual event. * Symptoms combined with inadequate technical standard of root fillings may confuse the diagnostics. * No available data support or suggest the use of antiviral treatment as a diagnostic tool.
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Affiliation(s)
- I Fristad
- Department of Odontology - Endodontics, School of Dentistry, University of Bergen, Bergen, Norway.
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