Higher risk of herpes zoster in stroke patients

Abstract

Background Stroke is a leading cause of death, morbidity and disability worldwide. Infection is a common complication in the acute phase after stroke. Herpes zoster is a common viral disease, in which the most debilitating complication is post-herpetic neuralgia, which can have a very large negative impact on quality of life. The aim of this study was to investigate whether stroke increases the risk of herpes zoster. Methods This cohort study compared patients who had herpes zoster with and without a first incident of stroke. The Taiwan National Health Insurance Research Database was utilized to identify 20,551 stroke patients and 20,551 controls matched for age, gender, age categories and Charlson Comorbidity Index (CCI) score categories at a one-to-one ratio. Cox proportionalhazards regression models were employed to estimate herpes zoster risk in the stroke group relative to general population. Results Compared to the control group, the stroke group had a greater risk for herpes zoster, especially within 1 year after stroke (adjust HR = 25.27). Both hemorrhagic stroke and ischemic stroke were significantly associated with herpes zoster (hemorrhagic type (IRR = 2.31, 95% CI, 1.67-3.20); ischemic type (IRR = 2.51, 95% CI 2.09-3.02)). However, the hemorrhagic stroke patients had a higher risk of herpes zoster ophthalmicus (IRR = 12.46, 95% CI 4.00-38.76) whereas the ischemic stroke patients had a higher risk of post-herpetic neuralgia (IRR = 2.24, 95% CI 1.56-3.20). Conclusion Physicians should know about that adults with stroke have a higher than normal risk of herpes zoster. Thus, physicians must be acquainted with proper antiviral therapy and pain

Causal association of chronic diseases with herpes zoster and postherpetic neuralgia: a two-sample Mendelian randomization study

“…The underlying mechanisms of the effect of ischemic stroke on the risk of herpes zoster are unclear. The possible explanation is that stroke leads to increased cell death and in ammatory response in the affected area, which in turn affects nervous system regulation and immune suppression, and immune system suppression increases the risk of infection with herpes zoster [14,34]. Furthermore, one possible biological explanation for the effects of herpes zoster on ischemic stroke is that herpes zoster infection involves viral invasion of the arterial wall, which causes granulomatous and necrotizing vasculitis [35].…”

Systematic review and meta-analysis: the effectiveness and safety of acupuncture in the treatment of herpes zoster

“…A large proportion of patients (18-41%) experience severe or very severe pain, which usually persists after the rash has healed (25)(26)(27). The acute and chronic pain of post-HZ neuralgia may seriously affect patients' quality of life, carry high medical costs, and interfere with patients' physical, emotional and social functions (28).…”

The global disease burden of varicella‐zoster virus infection from 1990 to 2019

“…The infection during pregnancy could be transmitted to the fetus easily and may result in congenital varicella syndrome or childhood herpes zoster 15 . VZVI can be affected by various patient‐related factors such as diabetes mellitus, stroke, and dementia, 26–28 which are common in aging people. Wollina and Machetanz 29 reported that older age was a risk factor for herpes zoster and postherpetic neuralgia requiring hospitalization.…”