Abstract:BackgroundHerpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5% ∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients.ObjectiveThe purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence.MethodsFrom January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in … Show more
“…The study was relatively large and long-term, surveying 14,343 inpatients and outpatients diagnosed with HZ between January 2005 and December 2015 at six hospitals in South Korea. The study reported that 169 patients experienced recurrence (a recurrence frequency of 1.2%); however, the number of recurrences per patient was not reported [ 15 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…These studies suggest that individuals may be exposed to a uniformly increasing cumulative risk of HZ recurrence after the first episode. More studies of this type are required to confirm this hypothesis, both in more varied populations and over longer time periods, given that, when reported, mean time between the first HZ episode and first recurrent HZ episode ranged between 2.0 and 13.7 years [ 11 , 15 , 16 , 20 ].…”
Introduction
Herpes zoster (HZ; shingles) is a painful, cutaneous disease caused by reactivation of the varicella zoster virus, which causes varicella (chickenpox) typically during childhood. The considerable healthcare burden of HZ is relatively well documented, with approximately one in three individuals experiencing at least one episode during their lifetime, debilitating symptoms including neuropathic pain, and complications such as post-herpetic neuralgia, vision loss, and rarely, stroke, and increased severity in immunocompromised individuals. However, we are not aware of a comprehensive review of literature specifically examining the burden of HZ recurrence.
Methods
We conducted a PubMed search (1 January 2003–2 February 2023) to assess available literature on the incidence, risk factors, and clinical features of HZ recurrence.
Results
The incidence of HZ recurrence reported by the studies identified was wide ranging. Studies in general populations of immunocompetent or immunocompetent/immunosuppressed (mixed) populations with an initial HZ episode estimate that approximately 1.2–9.6% of individuals may experience HZ recurrence, with an incidence rate of 1.7–16.6 cases per 1000 person-years. HZ recurrence was reported in 0.0–18.2% of immunocompromised individuals with HZ, with an incidence rate of 17.0–55 cases per 1000 person-years. Incidence rates varied according to study design, follow-up, and study populations. Recognized risk factors for HZ recurrence include immunocompromised status, female sex, family history, and comorbidities such as diabetes. Other factors that may predispose individuals to recurrence include long-lasting pain after the initial HZ episode and the presence of herpes zoster ophthalmicus.
Discussion
Our review underlines that following an initial HZ episode, individuals remain at risk of HZ recurrence, adding to the disease burden in a population. As HZ is preventable by vaccination, national HZ vaccination recommendations should include the need for and timing of vaccination in both immunocompetent and immunocompromised individuals who have a history of HZ.
“…The study was relatively large and long-term, surveying 14,343 inpatients and outpatients diagnosed with HZ between January 2005 and December 2015 at six hospitals in South Korea. The study reported that 169 patients experienced recurrence (a recurrence frequency of 1.2%); however, the number of recurrences per patient was not reported [ 15 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…These studies suggest that individuals may be exposed to a uniformly increasing cumulative risk of HZ recurrence after the first episode. More studies of this type are required to confirm this hypothesis, both in more varied populations and over longer time periods, given that, when reported, mean time between the first HZ episode and first recurrent HZ episode ranged between 2.0 and 13.7 years [ 11 , 15 , 16 , 20 ].…”
Introduction
Herpes zoster (HZ; shingles) is a painful, cutaneous disease caused by reactivation of the varicella zoster virus, which causes varicella (chickenpox) typically during childhood. The considerable healthcare burden of HZ is relatively well documented, with approximately one in three individuals experiencing at least one episode during their lifetime, debilitating symptoms including neuropathic pain, and complications such as post-herpetic neuralgia, vision loss, and rarely, stroke, and increased severity in immunocompromised individuals. However, we are not aware of a comprehensive review of literature specifically examining the burden of HZ recurrence.
Methods
We conducted a PubMed search (1 January 2003–2 February 2023) to assess available literature on the incidence, risk factors, and clinical features of HZ recurrence.
Results
The incidence of HZ recurrence reported by the studies identified was wide ranging. Studies in general populations of immunocompetent or immunocompetent/immunosuppressed (mixed) populations with an initial HZ episode estimate that approximately 1.2–9.6% of individuals may experience HZ recurrence, with an incidence rate of 1.7–16.6 cases per 1000 person-years. HZ recurrence was reported in 0.0–18.2% of immunocompromised individuals with HZ, with an incidence rate of 17.0–55 cases per 1000 person-years. Incidence rates varied according to study design, follow-up, and study populations. Recognized risk factors for HZ recurrence include immunocompromised status, female sex, family history, and comorbidities such as diabetes. Other factors that may predispose individuals to recurrence include long-lasting pain after the initial HZ episode and the presence of herpes zoster ophthalmicus.
Discussion
Our review underlines that following an initial HZ episode, individuals remain at risk of HZ recurrence, adding to the disease burden in a population. As HZ is preventable by vaccination, national HZ vaccination recommendations should include the need for and timing of vaccination in both immunocompetent and immunocompromised individuals who have a history of HZ.
“…However, some studies have found a lower rate of recurrence within 12 months of the first onset of HZ, and subsequently comparable to the incidence of the first HZ. 5,6 Recurrence of HZ may be associated with immunosenescence. 1 The level of herpes zoster specific cell-mediated immunity (CMI) gradually decreases with age.…”
A 64-year-old man presented with painful rash on the trunk and extremities for more than half a month. Nephrotic syndrome had been diagnosed 2 years ago and had been regularly treated with glucocorticoids and immunosuppressants. He developed herpes zoster 1 year ago. Laboratory investigation demonstrated varicella-zoster virus DNA (VZV-DNA), varicella-zoster virus IgM (VZV-IgM), and varicella-zoster virus antibody IgG (VZV-IgG) were all positive. After the clinical diagnosis of relapsed disseminated cutaneous herpes zoster had been confirmed, systemic therapy with brivudine 125 mg everyday was started.
“…Recurrent HZ is defined as the appearance of HZ in a patient with a previously infected person with a dermatomal rash and pain. 3 The diagnosis is made clinically in most cases however, the polymerase chain reaction can confirm atypical cases. 4 Treatment of HZ includes optimal and early use of antiviral therapy and analgesics.…”
Section: Discussionmentioning
confidence: 99%
“…2 Recurrent HZ is an uncommon event with a global recurrence rate found varying from as low as 1% to up to 6%. [2][3]6 Treatment for recurrent HZ is similar to that of first episode with antivirals and supportive medications including analgesics.…”
Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.
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