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Marijam A, Vroom N, Bhavsar A, Posiuniene I, Lecrenier N, Vroling H. Systematic Literature Review on the Incidence of Herpes Zoster in Populations at Increased Risk of Disease in the EU/EEA, Switzerland, and the UK. Infect Dis Ther 2024; 13:1083-1104. [PMID: 38656653 PMCID: PMC11098998 DOI: 10.1007/s40121-024-00963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Older adults and patients with underlying conditions such as immunocompromised (IC) populations (e.g., due to medical conditions or immunosuppressive medication) are at increased risk for herpes zoster (HZ). The first HZ recombinant vaccine for IC patients was approved in 2020. Limited evidence exists to inform decision-makers on HZ incidence in high-risk patients in Europe. This systematic literature review (SLR) assessed HZ incidence across 14 high-risk populations in the European Union/European Economic Area, Switzerland, and the United Kingdom. METHODS An SLR (Embase, Medline, 2002-2022, observational studies) was performed to identify HZ incidence (i.e., primary outcomes: rate or cumulative; secondary: relative incidence) in type 1 and 2 diabetes mellitus (DM); chronic obstructive pulmonary disease and asthma; depression; rheumatic disorders (RD); multiple sclerosis (MS); inflammatory bowel diseases (IBD); psoriasis; lupus; human immunodeficiency virus (HIV); solid organ transplantation (SOT); solid organ malignancy (SOM); hematologic malignancy (HM); and stem cell transplantation (SCT). RESULTS Of 776 unique records screened, 59 studies were included (24 reported incidence rate per 1000 person-years; two, cumulative incidence per 1000 persons; and 33, relative incidence). The highest incidence rates were reported for SOT (12.1-78.8) and SCT (37.2-56.1); HM (2.9-32.0); RD (0.41-21.5); lupus (11.0-16.5); IC mixed population (11.3-15.5); HIV/AIDS (11.8-13.0); chronic respiratory diseases (4.7-11.4); SOM (8.8-11.0); IBD (7.0-10.8); DM (4.3-9.4); depression (7.2-7.6); MS (5.7-6.3); and psoriasis (5.3-6.1). In many high-risk populations, HZ incidence was higher for older age groups, women, and some treatments. CONCLUSIONS The HZ incidence rate in Europe increased with age and varied across high-risk populations, with high rates for solid organ and stem cell transplants, cancer, and rheumatoid arthritis. Most studies were retrospective with methodological differences affecting generalizability and comparability. Future studies should stratify data by IC population, age, sex, severity, medication, and study timeframe.
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Affiliation(s)
| | - Nikki Vroom
- Pallas Health Research & Consultancy, A P95 Company, Rotterdam, The Netherlands
| | | | | | | | - Hilde Vroling
- Pallas Health Research & Consultancy, A P95 Company, Rotterdam, The Netherlands
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Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: From disease, surgery, and radiation. Int J Dermatol 2020; 60:394-406. [PMID: 33226140 DOI: 10.1111/ijd.15303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Emily C Milam
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren K Rangel
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years. Vaccines (Basel) 2020; 8:vaccines8010020. [PMID: 31936724 PMCID: PMC7157675 DOI: 10.3390/vaccines8010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/27/2022] Open
Abstract
The effect of severe Herpes Zoster (HZ) on chronic diseases is a component of the real burden of this vaccine-preventable disease that is not commonly considered. A retrospective cohort study was conducted to assess the health burden of severe HZ in adults ≥50 years residing in Liguria Region from 2015 to 2017. Subjects hospitalized with and without HZ were matched (1:6 ratio). 437 subjects in the HZ cohort and 2622 subjects in the non-HZ cohort were enrolled. Previous immunodeficiency, autoimmune, and rare diseases are identified as main chronic conditions related to HZ hospitalization. Higher incidences of autoimmune (1.4% vs. 0.22%, p = 0.002) and gastrointestinal (7.04% vs. 3.62%, p = 0.015) diseases after hospitalization were observed in the HZ cohort compared to the non-HZ cohort. Significantly higher incidences were found after hospitalization versus the previous period for cardiovascular diseases (11.17% vs. 2.09%, p < 0.001), cerebral vasculopathy (6.13% vs. 0.60%, p < 0.001), non-arrhythmic myocardiopathy (4.31% vs. 0.59%, p = 0.002), and neuropathy (2.62% vs. 0.56%, p = 0.033). The HZ cohort showed a relative risk 10-fold higher for cerebral vasculopathy, 5-fold higher for cardiovascular diseases, and 7-fold higher for non-arrhythmic myocardiopathy. HZ causes a substantial impact on the chronic conditions. These data could suggest an implementation of HZ vaccination programs in the elderly and in high-risk groups.
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Lai YL, Su YC, Kao CH, Liang JA. Increased risk of varicella-zoster virus infection in patients with breast cancer after adjuvant radiotherapy: A population-based cohort study. PLoS One 2019; 14:e0209365. [PMID: 30625182 PMCID: PMC6326420 DOI: 10.1371/journal.pone.0209365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
Background/Purpose Limited evidence has been obtained on varicella-zoster virus (VZV) infection in patients with breast cancer as a complication related to adjuvant radiotherapy. We conducted a cohort study aimed to assess the risk of VZV infection in this patient setting. Materials and methods We used the National Health Insurance Research Database to identify 65,981 patients with breast cancer in Taiwan who underwent breast surgery between 2000 and 2011. After a 1:1 propensity score match was obtained between patients with and without radiotherapy, a competing risk regression model was constructed to estimate the hazard ratios and the incidence rate difference (IRD) of VZV infection in the patients with breast cancer receiving radiotherapy and those not receiving radiotherapy. Results After adjusting for covariates, the radiotherapy cohort showed a 1.51-fold higher risk (95% confidence interval = 1.06–5.16, p = 0.02, IRD = 4.98/10000 person-years) of subsequent VZV infection than the nonradiotherapy cohort. Furthermore, VZV infection risk was 3.85-fold higher among patients aged >65 years who received radiotherapy than among those of the same age who did not receive radiotherapy (95% confidence interval = 1.1–13.4, p < 0.05, IRD = 11.09/10000 person-years). The risk increased with adjusted hazard ratio of 6.6 (95% confidence interval I = 1.51–28.8, p < 0.05, IRD = 32.01/10,000 person-years) and 7.08 (95% confidence interval = 1.64–30.5, p < 0.01, IRD = 35.72/10,000 person-years) in follow-up period less than 3 months and 3–5 months respectively. Conclusion Radiotherapy was associated with an increased risk of VZV infection among patients with breast cancer. The risk was significantly higher in older patient (>65 years old) and/or those who received chemotherapy. Regular clinical follow-up and additional serological testing in the first 5 months after radiotherapy are recommended.
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Affiliation(s)
- Yo-Liang Lai
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
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Choi JY, Kim M, Keam B, Kim TM, Kim DW, Heo DS, Jo SJ. The Risk of Herpes Zoster in Patients with Non-small Cell Lung Cancer according to Chemotherapy Regimens: Tyrosine Kinase Inhibitors versus Cytotoxic Chemotherapy. Cancer Res Treat 2018; 51:169-177. [PMID: 29621875 PMCID: PMC6333989 DOI: 10.4143/crt.2017.491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 01/08/2023] Open
Abstract
Purpose Despite the successful use of tyrosine kinase inhibitors (TKIs) in cancer patients, their effect on herpes zoster development has not been studied. The aim of this study was to evaluate and compare the effects of epidermal growth factor receptor (EGFR) TKI and cytotoxic chemotherapy on the risk of herpes zoster development in non-small cell lung cancer (NSCLC) patients. Materials and Methods We conducted a medical review of all eligible NSCLC patients in Seoul National University hospital between 2002 and 2015. We classified patients based on whether they previously underwent EGFR TKI therapy into either the TKI group or the cytotoxic group. We compared the incidence rates of herpes zoster during TKI therapy and cytotoxic chemotherapy. Additionally, the longitudinal risk of herpes zoster from TKIs was analyzed using the incidence rate ratio (IRR) of the TKI group to the cytotoxic group and the log-rank test of the Kaplan-Meier method. Results Of the 2,981 NSCLC patients, 54 patients (1.54%) developed herpes zoster. In the TKI group (2,002 patients), the IRR of herpes zoster during TKI therapy compared to that during cytotoxic chemotherapy was 1.05 (95% confidence interval [CI], 0.53 to 2.09). The IRR of the TKI group compared to the cytotoxic group was 1.33 (95% CI, 0.64 to 2.76). The Kaplan-Meier cumulative risk of both groups was not significantly different. Conclusion Our results show that the incidence rate of herpes zoster in the TKI group was not statistically different from the incidence in the cytotoxic group during and after chemotherapy in NSCLC patients.
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Affiliation(s)
- Ji Young Choi
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University Hospital, Seoul, Korea.,Center for Skin Cancer and Adverse Skin Reaction to Chemotherapeutics, Seoul National University Cancer Hospital, Seoul, Korea
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Abstract
Herpes zoster is an infectious disease caused by varicella-zoster virus that may occur sporadically at any age. We report on two patients with herpes zoster who received chemotherapy for breast cancer. Both patients were immunocompromised and received filgrastim therapy for the management of neutropenia. Zoster occurred during filgrastim therapy but the symptoms were alleviated rapidly in the course of therapy. We conclude that granulocyte colony-stimulating factor therapy helped symptom alleviation and accelerated the recovery from herpes zoster in our chemotherapy-treated patients. Free full text available at www.tumorionline.it
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Affiliation(s)
- Meral Sayin
- Department of Radiation Oncology, Ankara Education and Investigation Hospital of Ministry of Health, Mamak, Ankara
| | - Bekir H Bakkal
- Department of Radiation Oncology, Zonguldak Karaelmas University Faculty of Medicine, Zonguldak, Turkey
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Mao J, McPheeters JT, Finelli L. Healthcare utilization and costs among patients with herpes zoster and solid tumor malignancy on chemotherapy: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e8746. [PMID: 29310348 PMCID: PMC5728749 DOI: 10.1097/md.0000000000008746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Immunosuppressed patients with solid tumor malignancies (STMs) are particularly vulnerable to herpes zoster (HZ). This study estimated the incidence of HZ and evaluated healthcare resource utilization and costs for persons with STM receiving chemotherapy with and without incident HZ.We conducted a retrospective claims study of adults with STM receiving chemotherapy between January 1, 2010 and June 30, 2014. Patients were followed from their first chemotherapy date through development of HZ, health plan disenrollment, the study end date, or 24 months. HZ incidence was calculated and stratified by patient characteristics. Adjusted HZ incidence was estimated using Poisson regression. Healthcare resource utilization and costs were compared between patients with HZ (cases) and propensity score-matched controls without HZ during a variable follow-up period. Adjusted healthcare costs were estimated using Lin regression to control for informative censoring.Of 155,480 patients with STM receiving chemotherapy, 3100 (2.0%) developed HZ, yielding an adjusted HZ incidence rate of 13.8/1000 person-years (PY). HZ cases (n = 3004) had significantly higher healthcare resource utilization than matched controls (n = 15,020). Adjusted annual costs were $48,077 for cases vs $41,645 for matched controls, corresponding to a differential cost of $6432 annually.After adjustment for potential confounders, patients with STM receiving chemotherapy had an HZ incidence of 13.8/1000 PY; those who developed HZ used more healthcare resources and incurred higher costs than those who did not. These findings suggest that HZ prevention by vaccination could improve outcomes and reduce costs in this population.
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Rodenburg EM, Vermeij FH, van den Bent MJ, Zuetenhorst JM. Varicella zoster virus encephalitis in a patient with a solid carcinoma: a case report. J Neurol 2017; 264:1281-1283. [PMID: 28364297 DOI: 10.1007/s00415-017-8466-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- E M Rodenburg
- Department of Internal Medicine, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - F H Vermeij
- Department of Neurology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - M J van den Bent
- Department of Neuro-oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J M Zuetenhorst
- Department of Internal Medicine, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
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Lymphocyte depletion and repopulation after chemotherapy for primary breast cancer. Breast Cancer Res 2016; 18:10. [PMID: 26810608 PMCID: PMC4727393 DOI: 10.1186/s13058-015-0669-x] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/22/2015] [Indexed: 01/10/2023] Open
Abstract
Background Approximately 30 % of breast cancer patients receive chemotherapy, yet little is known about influences of current regimens on circulating lymphocyte levels and phenotypes. Similarly, clinico-pathological factors that modify these influences, and implications for future immune health remain mainly unexplored. Methods We used flow-cytometry to assess circulating lymphocyte levels and phenotypes in 88 primary breast cancer patients before chemotherapy and at time-points from 2 weeks to 9 months after chemotherapy completion. We examined circulating titres of antibodies against pneumococcal and tetanus antigens using ELISAs. Results Levels of B, T and NK cells were significantly reduced 2 weeks after chemotherapy (p < 0.001). B cells demonstrated particularly dramatic depletion, falling to 5.4 % of pre-chemotherapy levels. Levels of all cells recovered to some extent, although B and CD4+ T cells remained significantly depleted even 9 months post-chemotherapy (p < 0.001). Phenotypes of repopulating B and CD4+ T cells were significantly different from, and showed no sign of returning to pre-chemotherapy profiles. Repopulating B cells were highly depleted in memory cells, with proportions of memory cells falling from 38 % to 10 % (p < 0.001). Conversely, repopulating CD4+ T cells were enriched in memory cells, which increased from 63 % to 75 % (p < 0.001). Differences in chemotherapy regimen and patient smoking were associated with significant differences in depletion extent or repopulation dynamics. Titres of anti-pneumococcal and anti-tetanus antibodies were both significantly reduced post-chemotherapy and did not recover during the study (p < 0.001). Conclusion Breast cancer chemotherapy is associated with long-term changes in immune parameters that should be considered during clinical management. Electronic supplementary material The online version of this article (doi:10.1186/s13058-015-0669-x) contains supplementary material, which is available to authorized users.
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Mullane KM, Winston DJ, Wertheim MS, Betts RF, Poretz DM, Camacho LH, Pergam SA, Mullane MR, Stek JE, Sterling TM, Zhao Y, Manoff SB, Annunziato PW. Safety and immunogenicity of heat-treated zoster vaccine (ZVHT) in immunocompromised adults. J Infect Dis 2013; 208:1375-85. [PMID: 23908479 DOI: 10.1093/infdis/jit344] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Safety and immunogenicity of heat-treated zoster vaccine (ZVHT) were assessed in immunocompromised adults. METHODS In a randomized, double-blind, placebo-controlled, multicenter study, 4 doses ZVHT or placebo were administered approximately 30 days apart to adults with either solid tumor malignancy (STM); hematologic malignancy (HM); human immunodeficiency virus (HIV) with CD4(+) ≤200; autologous hematopoietic stem-cell transplant (HCT) or allogeneic-HCT recipients. Varicella-zoster virus (VZV) T-cell responses by interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT) and VZV antibody concentrations by glycoprotein enzyme-linked immunosorbent assay (gpELISA) were measured at baseline and approximately 28 days after each dose. RESULTS No safety signals were found in any group. IFN-γ ELISPOT geometric mean fold rises (GMFR) after dose 4 in STM, HM, HIV, and autologous-HCT patients were 3.00 (P < .0001), 2.23 (P = .004), 1.76 (P = .026), and 9.01 (P = NA), respectively. Similarly, antibody GMFR were 2.35 (P < .0001), 1.28 (P = .003), 1.37 (P = .017), and 0.90 (P = NA), respectively. T-cell and antibody responses were poor after 4 doses of ZVHT in allogeneic-HCT patients. CONCLUSION ZVHT was generally safe and immunogenic through 28 days post-dose 4 in adults with STM, HM, and HIV. Autologous-HCT but not allogeneic-HCT patients had a rise in T-cell response; antibody responses were not increased in either HCT population. Study identification. V212-002 Clinical Trials Registration. NCT00535236.
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Habel LA, Ray GT, Silverberg MJ, Horberg MA, Yawn BP, Castillo AL, Quesenberry CP, Li Y, Sadier P, Tran TN. The epidemiology of herpes zoster in patients with newly diagnosed cancer. Cancer Epidemiol Biomarkers Prev 2012; 22:82-90. [PMID: 23118142 DOI: 10.1158/1055-9965.epi-12-0815] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the limited literature, we conducted a study to examine the epidemiology of herpes zoster (HZ) among newly diagnosed cancer patients. METHODS We identified adult health plan members of Kaiser Permanente Northern California diagnosed with invasive cancer from 2001 to 2005. Electronic health records with inpatient and outpatient diagnoses, laboratory tests, and antiviral medications were used to identify HZ diagnoses from 2001 to 2006. HZ diagnoses and associated complications were confirmed by medical chart review. Treatment with chemotherapy and corticosteroids was used to classify patients by immunosuppression level. RESULTS Among 14,670 cancer patients, 424 were diagnosed with HZ during follow-up (median 22 months). The incidence of HZ was 31/1,000 person-year (PY) in patients with hematologic malignancies and 12/1,000 PY in patients with solid tumors. The corresponding 2-year cumulative incidence of HZ was approximately 6% and 2%, respectively. Compared with incidence rates of HZ reported in a general US population, the age- and sex-standardized rates of HZ were 4.8 times higher [95% confidence interval (CI), 4.0-5.6] in patients with hematologic malignancies and 1.9 times higher (95% CI, 1.7-2.1) in those with solid tumors. HZ risk increased with increasing level of immunosuppression. Among HZ cases, 19% with hematologic malignancies and 14% with solid tumors had HZ-associated pain for at least 30 days. The corresponding numbers for nonpain-related complications were 30% and 18%, respectively. CONCLUSIONS Cancer patients are at substantially increased risk of HZ and among those with HZ, complications are relatively common. IMPACT Better HZ prevention and treatment options for cancer patients are needed.
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Affiliation(s)
- Laurel A Habel
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA, USA.
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Kuo CC, Lee CT, Lee IM, Ho SC, Yang CY. Risk of Herpes Zoster in Patients Treated With Long-term Hemodialysis: A Matched Cohort Study. Am J Kidney Dis 2012; 59:428-33. [DOI: 10.1053/j.ajkd.2011.10.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/19/2011] [Indexed: 11/11/2022]
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The Great Mimicker: Zona Zoster at the Mastectomy Site Causing Contralateral Intramammary Lymph Node Enlargement. Case Rep Oncol Med 2012; 2012:468576. [PMID: 22606455 PMCID: PMC3350229 DOI: 10.1155/2012/468576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/04/2012] [Indexed: 11/22/2022] Open
Abstract
Zona zoster is rarely observed in patients with malignancy; when present, it follows a dermatomal fashion. Involvement of widely separated regions is very rare. Hereby, zona zoster causing enlarged intramammary lymph nodes (IMLN) in the opposite breast is reported for the first time in literature. The masses were hypoechoic on US with no hilum and hypervascular on color Doppler US. MRI showed hypointense masses with type 3 time-intensity curve and adjacent vessel sign. The complete regression of the nodes after the antiviral therapy confirmed the diagnosis. In breast cancer patients, IMLN enlargements may mimic breast cancer metastasis, and zona zoster infection of the mastectomy site may present with contralateral IMLN enlargement due to altered lymphatic drainage. When breast US is not sufficient for the differential diagnosis, breast MRI may warrant proper diagnosis, and prevent unnecessary biopsies. Antiviral treatment with followup would be sufficient for management.
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Hata A, Kuniyoshi M, Ohkusa Y. Risk of Herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study. Infection 2011; 39:537-44. [PMID: 21800108 PMCID: PMC3218277 DOI: 10.1007/s15010-011-0162-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 07/04/2011] [Indexed: 11/26/2022]
Abstract
Purpose To determine the incidence of Herpes zoster in patients with one of 17 specific underlying diseases compared with that in patients with other underlying diseases. Methods We conducted a retrospective hospital-based cohort study using data from patients’ electronic medical records for the period 2001–2007 of the Kitano Hospital Research Database. These analyses included 55,492 patients with one of 17 underlying diseases, which were those reported as related to the contraction of Herpes zoster. Of these, 769 patients contracted Herpes zoster. The main outcome measure was the clinical diagnosis of Herpes zoster. Results The adjusted hazard ratios (95% confidence interval) for Herpes zoster in patients with the 17 diseases were compared with other patients, with the following results: brain tumor [3.84 (2.51–5.88)], lung cancer [2.28 (1.61–3.22)], breast cancer [2.41 (1.52–3.82)], esophageal cancer [4.19 (2.16–8.11)], gastric cancer [1.95 (1.39–2.72)], colorectal cancer [1.85 (1.33–2.56)], gynecologic cancer [3.45 (2.08–5.70)], malignant lymphoma [8.23 (6.53–10.38)], systemic lupus erythematosus [3.90 (2.66–5.70)], rheumatoid arthritis [2.00 (1.60–2.50)], diabetes mellitus [2.44 (2.10–2.85)], hypertension [2.04 (1.75–2.38)], renal failure [2.14 (1.65–2.79)], and disk hernia [2.18 (1.52–3.13)]. Conclusions Patients with diabetes mellitus, renal failure, and malignancies have a 1.8–8.4-fold higher risk of a Herpes zoster event than patients with other diseases. Future studies should investigate alteration of the immune system in the underlying diseases and approaches for Herpes zoster prevention.
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Affiliation(s)
- A Hata
- Department of Infectious Diseases, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20, Ohgimachi, Kita-ku, Osaka 530-8480, Japan.
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