Complications of herpes zoster in children

Abstract

BackgroundHerpes zoster (HZ) may cause complications; however, information regarding complications of HZ in children is relatively sparse. We reviewed cases of HZ in children retrospectively and investigated the risk factors contributing to the development of complications.MethodsA retrospective observational study was conducted at a tertiary care children’s hospital in Japan. Children receiving a diagnosis of HZ between January 2010 and October 2016 were identified from electronic medical records. In this study, the following diseases were recognized as complications of HZ: bacterial skin infection, facial paralysis, meningitis, uveitis and keratitis, postherpetic neuralgia, acute retinal necrosis, pneumonia, and otitis interna. Details regarding clinical information of HZ patients with complications were described.ResultsWe found 138 cases with HZ. Among these, 58 (42%) occurred in immunocompetent children and 80 cases (58%) occurred in immunocompromised children. Complications were observed in 10 cases of immunocompromised children and in eight cases of immunocompetent children. Although secondary bacterial skin infection was the most common complication (n = 6, 33.3%), severe complications such as facial paralysis (n = 3, 16.7%), meningitis (n = 2, 11.1%), uveitis and keratitis (n= 2, 11.1%), acute retinal necrosis (n = 1, 5.6%), pneumonia (n = 1, 5.6%), and otitis interna (n = 1, 5.6%) were observed. Patients with complications tended to have a rash on the head or neck, compared with those without complications (n = 9, 50% vs n = 18, 15%; P = 0.001).ConclusionsSevere HZ complications may occur in immunocompetent children. Development of a rash on the head or neck might be a risk factor for complications.

Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study

“…Indeed, PRF at ICN can also relieve PHN. When the body’s immunity reduces, the latent virus always replicates along the sensory nerve reaching the corresponding skin area, which results in peripheral nerve necrosis, inflammation, and demyelination [ 27 ]. Peripheral nerve sensitization plays a particularly important role in neuropathic pain.…”

Clinical Manifestations of Herpes Zoster Associated with Complications in Children

“…PHN is regarded the most common complication in adults and an important complication of HZ due to its impact on quality of life. However, the incidence in children has been low, as in our study [25,26]. In this analysis, the involved nerve roots varied from cranial to lumbar, and PHN cases predominantly involved older aged patients.…”

“…Most patients did not have any underlying diseases. Previous studies on children have also demonstrated that complicated cases tend to develop in immunocompetent children [25,26], and German data showed that immunocompetent children accounted for most hospitalizations and complications (25). Therefore, awareness regarding HZ complications and preventive measures is not only important in older people but also in immunocompetent and younger populations.…”

Herpes zoster in an immunocompetent infant with a history of varicella in early infancy and after a minor injury - case report and literature review

“…Pediatric HZ has a good prognosis. The most common complication among immunocompetent children is a bacterial skin infection, while postherpetic neuralgia, the most common complication in adults, is less frequent in children [20].…”