Herpes zoster in HIV infection with osteonecrosis of the jaw and tooth exfoliation

BackgroundHerpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.MethodsWe searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.ResultsFrom 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.ConclusionsSeveral countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

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“…Cases have been reported in both immunocompetent and immunocompromised Asians; the mechanism remains unknown [602–610]. …”

Section: Complicating Presentations and Disease Associationsmentioning

confidence: 99%

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

et al. 2017

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“…Other published reports document oral osteonecrosis in HIV-positive patients without ART but with oral herpes zoster infections (23)(24)(25). In these cases, herpes zoster infections are a possible comorbid factor because herpes zoster has been related to alveolar osteonecrosis in non-HIV-infected patients (26 -28).…”

Section: Possible Effects Of Hiv and Artmentioning

confidence: 98%

Osteonecrosis Related to Intraosseous Anesthesia: Report of a Case

Woodmansey¹,

White²,

He³

2009

Journal of Endodontics

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“…Un mois après l'apparition des premiers signes de nécrose, la patiente a perdu ses quatre incisives maxillaires spontanément du fait de la nécrose de l'os alvéolaire et du desmodonte. Des cas d'exfoliation dentaires spontanées similaires ont déjà été décrites après un zona chez des patients immunodéprimés [32] ou non [33]. Des pertes dentaires spontanées liés à une nécrose muqueuse ont également été observées chez un patient atteint d'une leucémie aiguë [10].…”

Section: After 19 Months Mandibular and Maxilla Mucosa Has Healed unclassified

Un cas de stomatite nécrosante : noma des pays riches ?

Catros

Prudence²,

Lerici³

et al. 2014

Med Buccale Chir Buccale

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Introduction : Il existe très peu de cas publiés de stomatites nécrosantes massives chez des patients immunodéprimés et aucun dans le cadre d'un traitement par méthotrexate (MTX). Le cas rapporté décrit une stomatite nécrosante sévère avec exfoliations dentaires spontanées chez une patiente immunodéprimée. Observation : Une femme de 45 ans, traitée par MTX et infliximab, a développé des ulcérations buccales, suggérant une toxicité du MTX. Malgré l'arrêt du MTX, les ulcérations se sont étendues, entrainant une nécrose osseuse avec exfoliation spontanée de plusieurs dents maxillaires. Une antibiothérapie probabiliste et une nutrition parentérale ont été instaurées, ce qui a permis une amélioration rapide de l'état général. Un mois plus tard, l'exposition osseuse concernait le tiers antérieur du palais et une partie de la mandibule. Les séquestres osseux ont été progressivement réséqués pour obtenir une fermeture muqueuse complète après 19 mois. Les prélèvements bactériens ont montré la présence de Pseudomonas aeruginosa et l'examen histopathologique des séquestres osseux a confirmé le processus de nécrose. Discussion : Le contexte de dénutrition et l'évolution favorable après mise en place de la nutrition parentérale et de l'antibiothérapie évoquent une forme de noma où il n'y aurait pas eu d'évolution vers les tissus mous musculo-cutanés du voisinage. Abstract -A case of necrotizing stomatitis: noma of the rich countries? Introduction:There are few cases of massive necrotizing stomatitis in immuno-compromised patients described in the literature and methotrexate has not been observed to induce such clinical manifestations. We report the case of a severe necrotizing stomatitis, including spontaneous dental exfoliations in an immuno-compromised patient. Case report: A 45-year-old female patient, treated by methotrexate (MTX) and infliximab, has developed oral mucosa ulcerations, suggesting a toxicity of MTX. Even if MTX was stopped, ulcerations have increased, leading to underlying bone necrosis along with spontaneous exfoliation of several maxillary teeth. Broad-spectrum antibiotherapy and parenteral nutrition have been established, which lead to a quick amelioration of general condition. One month later, bone exposure concerned the anterior part of palate and mandible. Bone sequestrums have been progressively removed and a complete mucosal closure was observed after 19 months. Bacterial swabs have revealed the presence of Pseudomonas aeruginosa and histopathological examination showed evidence of bone necrosis. Discussion: The medical history of denutrition and the clinical aspect of the lesions are close to the classical description of noma even if no extent towards soft tissues was observed.

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Herpes zoster in HIV infection with osteonecrosis of the jaw and tooth exfoliation

Abstract: Complications affecting the alveolar bone and teeth seem to be rare in HIV-infected patients.

Cited by 35 publications

References 26 publications

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Osteonecrosis Related to Intraosseous Anesthesia: Report of a Case

Un cas de stomatite nécrosante : noma des pays riches ?

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