Shingles Research Today is a free monthly online journal that collates and summarizes the latest research about Shingles, including details on symptoms, treatment, causes, virus.

Incidence, Risk Factors, and Outcome of Herpes Zoster in Systemic Lupus Erythematosus.

Borba EF, Ribeiro AC, Martin P, Costa LP, Guedes LK, Bonfá E

From the Rheumatology Division, São Paulo University, São Paulo, SP, Brazil.

BACKGROUND:: The incidence and outcome of Herpes zoster (HZ) in systemic lupus erythematosus (SLE) are not completely defined as well as the relevance to HZ of disease and therapy factors. OBJECTIVE:: To determine HZ features in SLE. PATIENTS AND METHODS:: SLE patients (1997 update of the American College of Rheumatology classification criteria) with definitive HZ infection were identified from our Lupus Clinic computerized database with 1145 patients. RESULTS:: HZ was diagnosed in 51 SLE patients (4.45%) with an annual incidence rate of 6.4 events/1000 patient-years. At HZ diagnosis, mean disease duration was 9.78 +/- 8.37 years, median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was 1, and only 17.6% had SLEDAI >/=8. Frequency of manifestations and immunosuppressor use were similar between patients with and without HZ. Forty-two patients (82.5%) with HZ were under prednisone with concomitant immunosuppressive therapy in 66.7%. Thirty-five patients (68.6%) were using immunosuppressors: azathioprine (39.2%), cyclophosphamide (9.8%), and mycophenolate mofetil (9.8%). The mean lymphocyte count was 1219 +/- 803/mm (43.1% <1000/mm and 17.6% <500/mm). Only patients using azathioprine and cyclophosphamide had lymphocyte counts <500/mm (15% and 40%).All patients received acyclovir, 19.6% had postherpetic neuralgia, and recurrence occurred in only 7.8%. Thoracic nerves were the most involved site (56.8%) followed by lumbar (23.5%). Bacterial suprainfection occurred in 11.7% but was not associated with therapy, lymphocyte count, or SLEDAI scores (P > 0.05). CONCLUSION:: This is the largest cohort to determine that HZ is a late SLE complication with some peculiar features, such as good prognosis and typical dermatomal distribution. In addition, we have identified that the major trigger factor for this viral infection in SLE is therapy, particularly the concomitant use of corticosteroid and immunosuppressors, and not active disease.

Published 10 March 2010 in J Clin Rheumatol.
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Articles on Shingles published 10 March 2010:

Varicella-zoster virus meningoencephalitis in an immunocompetent patient without a rash.   Scand J Infect Dis.

Abstract Varicella-zoster virus (VZV) is an unusual cause of meningoencephalitis in the immunocompetent patient. Most cases of VZV-associated aseptic meningitis or encephalitis are associated with the skin rash of primary varicella, localized herpes zoster, or disseminated zoster. We report a case of VZV meningoencephalitis without a rash occurring in a normal host. [Abstract] [Full-text]

Articles on Shingles published 9 March 2010:

Comparison of the Biological and Biochemical Activities of Several Members of the Alphaherpesvirus ICP0 Family of Proteins.   J Virol, 84(7): 3476-87.

Immediate-early protein ICP0 of herpes simplex virus type 1 (HSV-1) is an E3 ubiquitin ligase of the RING finger class that is required for efficient lytic infection and reactivation from latency. Other alphaherpesviruses also express ICP0-related RING finger proteins, but these have limited homology outside the core RING domain. Existing evidence indicates that ICP0 family members have similar properties, but there has been no systematic comparison of the biochemical activities and biological ... [Abstract] [Full-text]

Herpes zoster ophthalmicus and the risk of stroke: A population-based follow-up study.   Neurology, 74(10): 792-7.

OBJECTIVE: To investigate the risk of stroke development following a diagnosis of herpes zoster ophthalmicus (HZO). METHODS: Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of HZO (ICD-9-CM code 053.2) in 2003 and 2004 (n = 658). The comparison cohort was comprised of randomly selected patients (3 for every HZO patient, n = 1974) matched with the study group in terms of age and gender. ... [Abstract] [Full-text]

Articles on Shingles published 3 March 2010:

Risk factors of herpes zoster among children immunized with varicella vaccine: results from a nested case-control study.   Pediatr Infect Dis J, 29(3): 205-8.

BACKGROUND: Previous studies of varicella-zoster virus reactivation in children have provided little information on potential risk factors. The aim of this study was to investigate the effects of race, chronic medical conditions and treatments, and recent vaccination, on the risk of herpes zoster (HZ) in children vaccinated with one dose of varicella vaccine. METHODS: Case subjects were identified from a cohort of subjects who were members of the Southern California Kaiser Permanente Health ... [Abstract] [Full-text]

Tumor necrosis factor blockade and the risk of viral infection.   Nat Rev Rheumatol, 6(3): 165-74.

Tumor necrosis factor (TNF) blockers are widely used to treat rheumatoid arthritis and other chronic inflammatory diseases. Many studies have demonstrated an increased risk of opportunistic infections such as tuberculosis and fungal infection in patients treated with TNF blockers, which is thought to be related to the primary role of TNF both in host defense and in the immune response. Little is known, however, about the association between TNF blockade and the development of viral infection. ... [Abstract] [Full-text]

Articles on Shingles published 2 March 2010:

Wegener's granulomatosis: experience from a Brazilian tertiary center.   Clin Rheumatol.

Most epidemiological studies with Wegener's granulomatosis (WG) patients are based on populations from the Northern hemisphere, whereas very few studies have been conducted in Southern hemisphere populations, particularly from South America. The authors performed a large retrospective, demographic study including clinical and laboratory profiles of 134 consecutive WG patients seen at one Brazilian center from 1999 to 2009. Mean age at initial WG diagnosis was 43.4 +/- 15.5 years, and mean ... [Abstract] [Full-text]

Vaccine-associated Herpes Zoster Opthalmicus and Encephalitis in an Immunocompetent Child.   Pediatrics.

Varicella-zoster virus vaccine has diminished the consequences of chicken pox in terms of health and economical burden. The increasing number of doses administered worldwide has revealed rare but important adverse effects that had not occurred during clinical trials. We report here the case of an immunocompetent 3(1/2)-year-old girl who developed encephalitis and herpes zoster opthalmicus 20 months after her immunization with varicella-zoster virus vaccine. Molecular analysis confirmed the ... [Abstract] [Full-text]

Articles on Shingles published 1 March 2010:

Acute retinal necrosis: the effects of intravitreal foscarnet and virus type on outcome.   Ophthalmology, 117(3): 556-60.

PURPOSE: To study the effects of intravitreal foscarnet and the clinical differences between varicella zoster virus (VZV) and herpes simplex virus (HSV) induced acute retinal necrosis (ARN). DESIGN: Retrospective comparative case series. PARTICIPANTS: Eighty-one eyes of 74 patients. METHODS: A retrospective case note analysis was performed in 2 tertiary referral centers. MAIN OUTCOME MEASURES: Presenting and final visual acuity, and progression to retinal detachment. RESULTS: Thirty-three eyes ... [Abstract] [Full-text]

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