Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection du...Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection during childhood[1].HZ tends to occur more frequently in older adults,in whom cellmediated immunity often declines.The incidence of HZ among immunocompetent unvaccinated individuals aged>50y is 9.92/1000 person-years[2].HZ ophthalmicus(HZO)occurs when HZ involves the first division of the trigeminal nerve,i.e.,the ophthalmic nerve[3].展开更多
[Objectives]To observe the clinical efficacy of external application of Scorzonera Herpes Ointment combined with Methylprednisolone Sodium Succinate for Injection in the treatment of herpes zoster oticus(HZO).[Methods...[Objectives]To observe the clinical efficacy of external application of Scorzonera Herpes Ointment combined with Methylprednisolone Sodium Succinate for Injection in the treatment of herpes zoster oticus(HZO).[Methods]A total of 100 HZO patients admitted to the 988 th Hospital of the Joint Logistics Support Force and Henan Provincial People's Hospital from June 2021 to June 2023 were selected.They were divided into a treatment group and a control group using a random number table method,with 50 cases in each group.Both groups received Methylprednisolone Sodium Succinate for Injection.Additionally,the treatment group was treated with external application of Scorzonera Herpes Ointment,while the control group received acyclovir ointment.Both groups were treated for 10 d.The comparisons included clinical efficacy,total symptom and sign scores,pain level[Visual Analogue Scale(VAS)],time for erythema reduction,cessation of blister formation,scab formation,and scab shedding,incidence of post-herpetic neuralgia(PHN),air conduction hearing threshold,and air-bone gap.[Results]After 10 d of treatment,the total effective rate was 98.00%(49/50)in the treatment group and 84.00%(42/50)in the control group,with a statistically significant difference between the two groups(P<0.05).After 10 d of treatment,the total symptom and sign scores and VAS scores of both groups decreased compared to those before treatment.The treatment group had significantly lower scores than the control group(P<0.05).The treatment group showed significantly shorter time for erythema reduction,cessation of blister formation,scab formation,and scab shedding compared to the control group(P<0.05).During the 1-month follow-up after treatment,no PHN cases occurred in the treatment group,while the incidence of PHN in the control group was 24.00%(12/50),showing a statistically significant difference(P<0.05).After 10 d of treatment,both groups showed reduced air conduction hearing thresholds,and the treatment group exhibited significantly lower air conduction thresholds and air-bone gaps compared to the control group(P<0.05).No statistically significant difference was observed in the air-bone gap before and after treatment in the control group(P>0.05).[Conclusions]The combination of external application of Scorzonera Herpes Ointment and Methylprednisolone Sodium Succinate for Injection can alleviate pain and other discomforts,reduce PHN incidence,shorten disease duration,and improve hearing in HZO patients.展开更多
Dear Editor,I am Dr.Asako Kodama,affiliated with the Department of Ophthalmology at Eiju General Hospital in Tokyo,Japan.Varicella-zoster virus(VZV)induces two distinct states:the primary infection(varicella)and secon...Dear Editor,I am Dr.Asako Kodama,affiliated with the Department of Ophthalmology at Eiju General Hospital in Tokyo,Japan.Varicella-zoster virus(VZV)induces two distinct states:the primary infection(varicella)and secondary endogenous reactivation of latent VZV in herpes zoster form.While herpes zoster lesions typically manifest on the trunk and abdomen,the most frequently involved cranial nerve is the trigeminal nerve.展开更多
Herpes zoster(HZ)is an acute infectious disease caused by varicella-zoster virus.The neurological sequelae of HZ include postherpetic neuralgia(PHN)and postherpetic itch(PHI).Severe pain and recurrent itching seriousl...Herpes zoster(HZ)is an acute infectious disease caused by varicella-zoster virus.The neurological sequelae of HZ include postherpetic neuralgia(PHN)and postherpetic itch(PHI).Severe pain and recurrent itching seriously affect the quality of life of patients.The pathogenesis of PHN is related to the mediation of immune-inflammatory response,activation of neuroglial cells,structural and functional alterations of the brain,aberrant expression of ion channels,and gene mediation.Overall,the immune-inflammatory response is a key factor mediating the pathogenesis of PHN.By reviewing the literature,the authors found that there are few studies on PHN both at home and abroad,so its pathogenesis is still unclear.No new progress has been made in recent years either,resulting in the understanding of PHI remaining in a state of confusion.The pathogenesis of PHI may be related to the loss of epidermal nerves,excitation of itch-specific neurons,absence of itch-inhibitory neurons,the action of itch-causing factors,and the vicious circle of itch and mood disorders.In general,most of them are conjectures,not supported by relevant experimental data.The treatments for PHN are varied and effective,while the pathogenesis of PHI is still unclear,so the treatment is often passive.This paper reviews the pathogenesis of PHN and PHI,expecting to provide new ideas for clinical treatment.展开更多
Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a...Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).展开更多
BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic...BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic and treatment process,clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.CASE SUMMARY Herein,we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery.Combining the patient's clinical manifestations and relevant laboratory tests,it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery,causing herpes zoster.Subsequently,the herpes virus invaded the visceral nerve fibers,causing gastrointestinal dysfunction and loss of intestinal peristalsis,which eventually led to intestinal obstruction.The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.CONCLUSION Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes.In cases of inexplicable intestinal obstructions,considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses。展开更多
Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herp...Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herpes zoster is a reactivation of the virus. It often occurs in immunocompromised situations such as AIDS. Several localizations can be observed in herpes zoster. Disseminated lesions are rarely described. Authors report a case of ophthalmic and generalized (or disseminated) herpes zoster in an immunocompetent child. No history of previous varicella and no particular medical background or family tare was found. However, maternal varicella when pregnant of our patient was reported. The patient had good nutritional status and no cause of immunosuppression. Immediate evolution was favorable for our patient, but the possibility of long-term complications of herpes zoster ophthalmicus should make consider the advisability of vaccination against varicella-zoster virus in children.展开更多
Objective To observe the analgesic effect on herpes zoster treated by the comprehensive therapy of blocking, surrounding needling, pricking and cupping combined with bloodletting at Longyan （龙眼, Extra） acupoint. M...Objective To observe the analgesic effect on herpes zoster treated by the comprehensive therapy of blocking, surrounding needling, pricking and cupping combined with bloodletting at Longyan （龙眼, Extra） acupoint. Methods According to the random mumber table, 104 cases of herpes zoster were randomized into an observation group and a control group, 52 cases in each one. In the observation group, the blocking method was used at the starting site and the ending site of herpetic zone, the surrounding needling method was applied toward the center of the painful zone, with horizontal needling technique; and the local pricking and cupping methods as well as the bloodletting at Longyan （Extra） acupoint were adopted. In the control group, Jiáj （夹脊 EX-B 2） at the corresponding affected nerve segments and the local Ashi points were selected and stimulated with electroacupuncture. The visual analogue scale （VAS） was adopted to determine the analgesic effect 20 min, 1, 6, 12, 24 and 48 h after treatment separately in each group. Results The onset time of analgesic effect in the observation group was shorter than that in the control group and the efficacy time of duration was longer than that in the control group （all P0.05）. The analgesic effect and the result of comprehensive efficacy assessment were superior to those of the control group （both P0.05）. Conclusion The comprehensive therapy of blocking, surrounding needling, pricking and cupping method combined with bloodletting at Longyan （Extra） achieves the significant analgesic effect on herpes zoster.展开更多
Varicella-zoster virus(VZV)is a type of herpes virus known to cause varicella,mainly in young children,and herpes zoster in adults.Although generally non-lethal,VZV infection can be associated with serious complicatio...Varicella-zoster virus(VZV)is a type of herpes virus known to cause varicella,mainly in young children,and herpes zoster in adults.Although generally non-lethal,VZV infection can be associated with serious complications,particularly in adults.Acute pancreatitis caused by VZV infection is a rare event,with reports primarily concerning immunocompromised individuals.Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection.The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side.A diagnosis of acute pancreatitis was confirmed based on abdominal pain,elevated levels of urine and serum amylase,and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography.This case highlights that,though rare,acute pancreatitis should be considered in VZV patients who complain of abdominal pain,especially in the epigastric area.Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality.展开更多
Objective To evaluate the clinical effect of acupuncture combined with direct moxibustion with fine-strip moxa for herpes zoster. Methods Sixty-two patients with herpes zoster were randomly divided into two groups acc...Objective To evaluate the clinical effect of acupuncture combined with direct moxibustion with fine-strip moxa for herpes zoster. Methods Sixty-two patients with herpes zoster were randomly divided into two groups according to attendance number, 32 in acupuncture group and 30 in western medicine group. The patients in the acupuncture group were treated by acupuncture at the nidus-related nerve segments Jiaji （夹脊 EX-B2） in combination with direct moxibustion with fine-strip moxa, while the patients in the western medicine group were treated by oral valaciclovir hydrochloride, vitamin B1, vitamin B12. The times of response, incrustation and decrustation were observed respectively, and pain relief degree of the two groups were compared. Results The response time, incrustation time and decrustation time of the acupuncture group were all less than those of the western medicine group [（1.74±0.43） days vs （3.86±0.58） days, （2.03±0.52） days vs （5.46±0.65） days, （5.14±0.33） days vs （8.34±0.59） days, all P〈O.05]. The pain relief degree （VAS score）, and pain duration in the acupuncture group were all higher obviously than those of the western medicine group [（10.41±12.1） vs （15.63±11.39）, （4.78±0.45） days vs （8.12±0.63） days, all P〈O.05]. The total effective rate of the acupuncture group was 96.9% （31/32）and that of the western medicine group was 90% （27/30）, thus the therapeutic effect of acupuncture group was better than that of western medicine group （P〈0.05）. Conclusion The therapeutic effect of acupuncture combined with direct moxibustion with fine-strip moxa is remarkable. It can effectively control the development of herpes zoster, alleviate pain and shorten therapy periods. It is worthy to be promoted and applied.展开更多
BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness...BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.展开更多
Objective To compare the difference of clinical efficacy of thin cotton moxibustion combined with plum-blossom needle and western medication in treatment of herpes zoster.Method Eighty patients with herpes zoster were...Objective To compare the difference of clinical efficacy of thin cotton moxibustion combined with plum-blossom needle and western medication in treatment of herpes zoster.Method Eighty patients with herpes zoster were divided into thin cotton moxibustion group（group A,n=40） and western medication group（group B,n=40） according to the sequence of admission.Patients in group A received thin cotton moxibustion that the colton was used as thin as a cicada＇s wings,combined with plum-blossom needle,and patients in group B received intravenous infusion with 0.25 g of acyclovir once a day,and acyclovir ointment application on affected part for 3-5 times per day.Five days were considered as a course of treatment.Analgesic effect and the incidence of postherpetic neuralgia were observed after two consecutive courses.Result The total effective rate was 97.5%（39/40） in group A,and80.0%（32/40） in group B（P〈0.05）;it was shown from the comparison of course between two groups that the cure rate after one in group A was markedly higher than that in group B（P〈0.01,P〈0.05）;the differences in effectual time and analgesic time between group A and group B were statistically significant（P〈0.05）;after treatment,the incidence of postherpetic neuralgia in group A was markedly lower than that in group B（P〈0.05）.Conclusion Thin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster can obviously shorten the time of therapy,effectively control pain,and reduce the incidence of postherpetic neuralgia.展开更多
BACKGROUND Tofacitinib is an oral Janus kinase(JAK)inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis(RA).Varicella zoster virus reactivati...BACKGROUND Tofacitinib is an oral Janus kinase(JAK)inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis(RA).Varicella zoster virus reactivation leading to herpes zoster(HZ)is an adverse effect of this drug;however,recurrent HZ at the same site is a rare clinical condition.CASE SUMMARY A 70-year-old female RA patient had undergone 1-year of tofacitinib treatment(10 mg daily).About 1 mo after initiation of oral tofacitinib,she developed blisters on the left flank and abdomen and was diagnosed with HZ;antiviral therapy with acyclovir was resolutory.However,5 d prior to presentation at our hospital,erythema and blisters with severe pain recurred at the same site.Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum,with a pain score of 8(visual analogue scale).Antiviral,nutritional supplement,analgesic and other treatments led to healing but over an atypically long period(approximately 26 d,vs approximately 1 wk).HZ is a common and serious adverse reaction of JAK inhibitors,but it rarely recurs.Our patient’s experience of HZ recurrence at the same site,with a wider affected area,more severe pain and longer healing period,is inconsistent with previous reports.CONCLUSION Same-anatomical site HZ recurrence may occur during oral tofacitinib treatment,with more severe clinical manifestations than in the initial occurrence.展开更多
BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV c...BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.展开更多
Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was fou...Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was found in all the blister lesions and in two of six biopsies from the skin lesions healed within two months by PCR. No VZV DNA was found in the skin lesions more than two months after healing in 10 cases of herpes zoster. VZV DNA may be detected at the sites of resolved herpes zoster lesions within short duration.展开更多
Varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cel...Varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine(v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia(PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms.展开更多
Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both pr...Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.展开更多
Postherpetic neuralgia(PHN) is a severe sequela of herpes zoster(HZ).Until now,only age and pain severity were considered predisposing factors for the development of PHN.We evaluated 49 patients with acute phase HZ,10...Postherpetic neuralgia(PHN) is a severe sequela of herpes zoster(HZ).Until now,only age and pain severity were considered predisposing factors for the development of PHN.We evaluated 49 patients with acute phase HZ,10 of whom developed PHN(Group A) and 39 of whom did not develop PHN(Group B).Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls(Group C).Numbers of serum CD3+(pan-T lymphocytes),CD4+(helper/inducer),and CD8+(suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group,but there were no statistical differences between Groups A and B.Interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,IL-8,and IL-10 were significantly elevated in Groups A and B relative to Group C.IL-6 was significantly higher in Group A than in Group B,and was significantly positively correlated with pain severity scored on a visual analog scale.Therefore,we suggest that the inflammatory response,especially that of IL-6,in the acute phase of HZ may be associated with hyperalgesia and the development of PHN.展开更多
Varicella-zoster virus(VZV)belongs to a neurotropic Alphaherpesvirinae and is the causative pathogen of both the varicella and herpes zoster.Currently,there are three different vaccines for the prevention,low does liv...Varicella-zoster virus(VZV)belongs to a neurotropic Alphaherpesvirinae and is the causative pathogen of both the varicella and herpes zoster.Currently,there are three different vaccines for the prevention,low does live-attenuated Oka(v Oka)against varicella,high does v Oka and glycoprotein E with the AS01B adjuvant system against zoster.Varicella vaccine containing v Oka effectively prevents varicella,but latency of v Oka can be detected in the inoculated population and its reactivation causes zoster.展开更多
Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral ...Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be consideredwhen dealing with non-obstructive(adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.展开更多
文摘Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection during childhood[1].HZ tends to occur more frequently in older adults,in whom cellmediated immunity often declines.The incidence of HZ among immunocompetent unvaccinated individuals aged>50y is 9.92/1000 person-years[2].HZ ophthalmicus(HZO)occurs when HZ involves the first division of the trigeminal nerve,i.e.,the ophthalmic nerve[3].
基金Supported by the Joint Construction Project of Medical Science and Technology Research Plan in Henan Province(LHGJ20190879).
文摘[Objectives]To observe the clinical efficacy of external application of Scorzonera Herpes Ointment combined with Methylprednisolone Sodium Succinate for Injection in the treatment of herpes zoster oticus(HZO).[Methods]A total of 100 HZO patients admitted to the 988 th Hospital of the Joint Logistics Support Force and Henan Provincial People's Hospital from June 2021 to June 2023 were selected.They were divided into a treatment group and a control group using a random number table method,with 50 cases in each group.Both groups received Methylprednisolone Sodium Succinate for Injection.Additionally,the treatment group was treated with external application of Scorzonera Herpes Ointment,while the control group received acyclovir ointment.Both groups were treated for 10 d.The comparisons included clinical efficacy,total symptom and sign scores,pain level[Visual Analogue Scale(VAS)],time for erythema reduction,cessation of blister formation,scab formation,and scab shedding,incidence of post-herpetic neuralgia(PHN),air conduction hearing threshold,and air-bone gap.[Results]After 10 d of treatment,the total effective rate was 98.00%(49/50)in the treatment group and 84.00%(42/50)in the control group,with a statistically significant difference between the two groups(P<0.05).After 10 d of treatment,the total symptom and sign scores and VAS scores of both groups decreased compared to those before treatment.The treatment group had significantly lower scores than the control group(P<0.05).The treatment group showed significantly shorter time for erythema reduction,cessation of blister formation,scab formation,and scab shedding compared to the control group(P<0.05).During the 1-month follow-up after treatment,no PHN cases occurred in the treatment group,while the incidence of PHN in the control group was 24.00%(12/50),showing a statistically significant difference(P<0.05).After 10 d of treatment,both groups showed reduced air conduction hearing thresholds,and the treatment group exhibited significantly lower air conduction thresholds and air-bone gaps compared to the control group(P<0.05).No statistically significant difference was observed in the air-bone gap before and after treatment in the control group(P>0.05).[Conclusions]The combination of external application of Scorzonera Herpes Ointment and Methylprednisolone Sodium Succinate for Injection can alleviate pain and other discomforts,reduce PHN incidence,shorten disease duration,and improve hearing in HZO patients.
文摘Dear Editor,I am Dr.Asako Kodama,affiliated with the Department of Ophthalmology at Eiju General Hospital in Tokyo,Japan.Varicella-zoster virus(VZV)induces two distinct states:the primary infection(varicella)and secondary endogenous reactivation of latent VZV in herpes zoster form.While herpes zoster lesions typically manifest on the trunk and abdomen,the most frequently involved cranial nerve is the trigeminal nerve.
文摘Herpes zoster(HZ)is an acute infectious disease caused by varicella-zoster virus.The neurological sequelae of HZ include postherpetic neuralgia(PHN)and postherpetic itch(PHI).Severe pain and recurrent itching seriously affect the quality of life of patients.The pathogenesis of PHN is related to the mediation of immune-inflammatory response,activation of neuroglial cells,structural and functional alterations of the brain,aberrant expression of ion channels,and gene mediation.Overall,the immune-inflammatory response is a key factor mediating the pathogenesis of PHN.By reviewing the literature,the authors found that there are few studies on PHN both at home and abroad,so its pathogenesis is still unclear.No new progress has been made in recent years either,resulting in the understanding of PHI remaining in a state of confusion.The pathogenesis of PHI may be related to the loss of epidermal nerves,excitation of itch-specific neurons,absence of itch-inhibitory neurons,the action of itch-causing factors,and the vicious circle of itch and mood disorders.In general,most of them are conjectures,not supported by relevant experimental data.The treatments for PHN are varied and effective,while the pathogenesis of PHI is still unclear,so the treatment is often passive.This paper reviews the pathogenesis of PHN and PHI,expecting to provide new ideas for clinical treatment.
基金supported by the Operation of Public Health Emergency Response Mechanism of the Chinese Center for Disease Control and Prevention(10239322002001,0000017)Research on Vaccine Evaluation Strategy and capacity Building Project(09207).
文摘Herpes zoster(HZ)is a painful condition resulting from reactivation of dormant varicella-zoster virus(VZV)in a previously VZV-infected person[1].Typical clinical manifestation of HZ are unilateral radicular pain and a vesicular rash limited to one side of the body in the distribution of a nerve[2].The most common complication of HZ postherpetic neuralgia(PHN).
文摘BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic and treatment process,clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.CASE SUMMARY Herein,we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery.Combining the patient's clinical manifestations and relevant laboratory tests,it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery,causing herpes zoster.Subsequently,the herpes virus invaded the visceral nerve fibers,causing gastrointestinal dysfunction and loss of intestinal peristalsis,which eventually led to intestinal obstruction.The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.CONCLUSION Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes.In cases of inexplicable intestinal obstructions,considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses。
文摘Herpes zoster and varicella are the two main clinical presentations of the varicella zoster virus infection. Varicella is the manifestation of primary infection. It is a systemic infection, frequent in childhood. Herpes zoster is a reactivation of the virus. It often occurs in immunocompromised situations such as AIDS. Several localizations can be observed in herpes zoster. Disseminated lesions are rarely described. Authors report a case of ophthalmic and generalized (or disseminated) herpes zoster in an immunocompetent child. No history of previous varicella and no particular medical background or family tare was found. However, maternal varicella when pregnant of our patient was reported. The patient had good nutritional status and no cause of immunosuppression. Immediate evolution was favorable for our patient, but the possibility of long-term complications of herpes zoster ophthalmicus should make consider the advisability of vaccination against varicella-zoster virus in children.
文摘Objective To observe the analgesic effect on herpes zoster treated by the comprehensive therapy of blocking, surrounding needling, pricking and cupping combined with bloodletting at Longyan （龙眼, Extra） acupoint. Methods According to the random mumber table, 104 cases of herpes zoster were randomized into an observation group and a control group, 52 cases in each one. In the observation group, the blocking method was used at the starting site and the ending site of herpetic zone, the surrounding needling method was applied toward the center of the painful zone, with horizontal needling technique; and the local pricking and cupping methods as well as the bloodletting at Longyan （Extra） acupoint were adopted. In the control group, Jiáj （夹脊 EX-B 2） at the corresponding affected nerve segments and the local Ashi points were selected and stimulated with electroacupuncture. The visual analogue scale （VAS） was adopted to determine the analgesic effect 20 min, 1, 6, 12, 24 and 48 h after treatment separately in each group. Results The onset time of analgesic effect in the observation group was shorter than that in the control group and the efficacy time of duration was longer than that in the control group （all P0.05）. The analgesic effect and the result of comprehensive efficacy assessment were superior to those of the control group （both P0.05）. Conclusion The comprehensive therapy of blocking, surrounding needling, pricking and cupping method combined with bloodletting at Longyan （Extra） achieves the significant analgesic effect on herpes zoster.
基金Supported by Zhejiang Provincial Natural Science Foundation of China No.LY14H160027,No.LQ12H16009the Science and Technology Bureau of Zhejiang Province,No.2013C33137,No.2013KKYA093
文摘Varicella-zoster virus(VZV)is a type of herpes virus known to cause varicella,mainly in young children,and herpes zoster in adults.Although generally non-lethal,VZV infection can be associated with serious complications,particularly in adults.Acute pancreatitis caused by VZV infection is a rare event,with reports primarily concerning immunocompromised individuals.Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection.The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side.A diagnosis of acute pancreatitis was confirmed based on abdominal pain,elevated levels of urine and serum amylase,and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography.This case highlights that,though rare,acute pancreatitis should be considered in VZV patients who complain of abdominal pain,especially in the epigastric area.Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality.
文摘Objective To evaluate the clinical effect of acupuncture combined with direct moxibustion with fine-strip moxa for herpes zoster. Methods Sixty-two patients with herpes zoster were randomly divided into two groups according to attendance number, 32 in acupuncture group and 30 in western medicine group. The patients in the acupuncture group were treated by acupuncture at the nidus-related nerve segments Jiaji （夹脊 EX-B2） in combination with direct moxibustion with fine-strip moxa, while the patients in the western medicine group were treated by oral valaciclovir hydrochloride, vitamin B1, vitamin B12. The times of response, incrustation and decrustation were observed respectively, and pain relief degree of the two groups were compared. Results The response time, incrustation time and decrustation time of the acupuncture group were all less than those of the western medicine group [（1.74±0.43） days vs （3.86±0.58） days, （2.03±0.52） days vs （5.46±0.65） days, （5.14±0.33） days vs （8.34±0.59） days, all P〈O.05]. The pain relief degree （VAS score）, and pain duration in the acupuncture group were all higher obviously than those of the western medicine group [（10.41±12.1） vs （15.63±11.39）, （4.78±0.45） days vs （8.12±0.63） days, all P〈O.05]. The total effective rate of the acupuncture group was 96.9% （31/32）and that of the western medicine group was 90% （27/30）, thus the therapeutic effect of acupuncture group was better than that of western medicine group （P〈0.05）. Conclusion The therapeutic effect of acupuncture combined with direct moxibustion with fine-strip moxa is remarkable. It can effectively control the development of herpes zoster, alleviate pain and shorten therapy periods. It is worthy to be promoted and applied.
文摘BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.
文摘Objective To compare the difference of clinical efficacy of thin cotton moxibustion combined with plum-blossom needle and western medication in treatment of herpes zoster.Method Eighty patients with herpes zoster were divided into thin cotton moxibustion group（group A,n=40） and western medication group（group B,n=40） according to the sequence of admission.Patients in group A received thin cotton moxibustion that the colton was used as thin as a cicada＇s wings,combined with plum-blossom needle,and patients in group B received intravenous infusion with 0.25 g of acyclovir once a day,and acyclovir ointment application on affected part for 3-5 times per day.Five days were considered as a course of treatment.Analgesic effect and the incidence of postherpetic neuralgia were observed after two consecutive courses.Result The total effective rate was 97.5%（39/40） in group A,and80.0%（32/40） in group B（P〈0.05）;it was shown from the comparison of course between two groups that the cure rate after one in group A was markedly higher than that in group B（P〈0.01,P〈0.05）;the differences in effectual time and analgesic time between group A and group B were statistically significant（P〈0.05）;after treatment,the incidence of postherpetic neuralgia in group A was markedly lower than that in group B（P〈0.05）.Conclusion Thin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster can obviously shorten the time of therapy,effectively control pain,and reduce the incidence of postherpetic neuralgia.
基金Supported by the Doctoral Startup Fund of Affiliated Hospital of Weifang Medical University,No.2021BKQ01.
文摘BACKGROUND Tofacitinib is an oral Janus kinase(JAK)inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis(RA).Varicella zoster virus reactivation leading to herpes zoster(HZ)is an adverse effect of this drug;however,recurrent HZ at the same site is a rare clinical condition.CASE SUMMARY A 70-year-old female RA patient had undergone 1-year of tofacitinib treatment(10 mg daily).About 1 mo after initiation of oral tofacitinib,she developed blisters on the left flank and abdomen and was diagnosed with HZ;antiviral therapy with acyclovir was resolutory.However,5 d prior to presentation at our hospital,erythema and blisters with severe pain recurred at the same site.Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum,with a pain score of 8(visual analogue scale).Antiviral,nutritional supplement,analgesic and other treatments led to healing but over an atypically long period(approximately 26 d,vs approximately 1 wk).HZ is a common and serious adverse reaction of JAK inhibitors,but it rarely recurs.Our patient’s experience of HZ recurrence at the same site,with a wider affected area,more severe pain and longer healing period,is inconsistent with previous reports.CONCLUSION Same-anatomical site HZ recurrence may occur during oral tofacitinib treatment,with more severe clinical manifestations than in the initial occurrence.
文摘BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.
文摘Varicella zoster virus(VZV) DNA in blister lesions and skin biopsies obtained from healed skin lesions in 16 patients with herpes zoster was detected using polymerase chain reaction. A 385 bp VZV DNA fragment was found in all the blister lesions and in two of six biopsies from the skin lesions healed within two months by PCR. No VZV DNA was found in the skin lesions more than two months after healing in 10 cases of herpes zoster. VZV DNA may be detected at the sites of resolved herpes zoster lesions within short duration.
文摘Varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine(v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia(PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms.
文摘Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.
基金Project (No.2008ZYC07) supported by the Zhejiang Medical Bureau of China
文摘Postherpetic neuralgia(PHN) is a severe sequela of herpes zoster(HZ).Until now,only age and pain severity were considered predisposing factors for the development of PHN.We evaluated 49 patients with acute phase HZ,10 of whom developed PHN(Group A) and 39 of whom did not develop PHN(Group B).Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls(Group C).Numbers of serum CD3+(pan-T lymphocytes),CD4+(helper/inducer),and CD8+(suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group,but there were no statistical differences between Groups A and B.Interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,IL-8,and IL-10 were significantly elevated in Groups A and B relative to Group C.IL-6 was significantly higher in Group A than in Group B,and was significantly positively correlated with pain severity scored on a visual analog scale.Therefore,we suggest that the inflammatory response,especially that of IL-6,in the acute phase of HZ may be associated with hyperalgesia and the development of PHN.
文摘Varicella-zoster virus(VZV)belongs to a neurotropic Alphaherpesvirinae and is the causative pathogen of both the varicella and herpes zoster.Currently,there are three different vaccines for the prevention,low does live-attenuated Oka(v Oka)against varicella,high does v Oka and glycoprotein E with the AS01B adjuvant system against zoster.Varicella vaccine containing v Oka effectively prevents varicella,but latency of v Oka can be detected in the inoculated population and its reactivation causes zoster.
文摘Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be consideredwhen dealing with non-obstructive(adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.
