Risk of Herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study

Abstract

PurposeTo determine the incidence of Herpes zoster in patients with one of 17 specific underlying diseases compared with that in patients with other underlying diseases.MethodsWe conducted a retrospective hospital-based cohort study using data from patients’ electronic medical records for the period 2001–2007 of the Kitano Hospital Research Database. These analyses included 55,492 patients with one of 17 underlying diseases, which were those reported as related to the contraction of Herpes zoster. Of these, 769 patients contracted Herpes zoster. The main outcome measure was the clinical diagnosis of Herpes zoster.ResultsThe adjusted hazard ratios (95% confidence interval) for Herpes zoster in patients with the 17 diseases were compared with other patients, with the following results: brain tumor [3.84 (2.51–5.88)], lung cancer [2.28 (1.61–3.22)], breast cancer [2.41 (1.52–3.82)], esophageal cancer [4.19 (2.16–8.11)], gastric cancer [1.95 (1.39–2.72)], colorectal cancer [1.85 (1.33–2.56)], gynecologic cancer [3.45 (2.08–5.70)], malignant lymphoma [8.23 (6.53–10.38)], systemic lupus erythematosus [3.90 (2.66–5.70)], rheumatoid arthritis [2.00 (1.60–2.50)], diabetes mellitus [2.44 (2.10–2.85)], hypertension [2.04 (1.75–2.38)], renal failure [2.14 (1.65–2.79)], and disk hernia [2.18 (1.52–3.13)].ConclusionsPatients with diabetes mellitus, renal failure, and malignancies have a 1.8–8.4-fold higher risk of a Herpes zoster event than patients with other diseases. Future studies should investigate alteration of the immune system in the underlying diseases and approaches for Herpes zoster prevention.

Kanserli hastalarda radyoterapi sonrası herpes zoster

“…Malignite varlığı, AİDS, otoimmün hastalık, SLE, romatoid artrit, psikolojik bozukluklar, majör depresyon, DM, hipertansiyon, konjestif kalp yetmezliği, operasyon, radyoterapi, kemoterapi, travma gibi bağışıklık sistemini baskılayan hastalıklar ve/ veya tedaviler HZ gelişimini kolaylaştırmakta ve görülme sıklığı %30-50'ye kadar çıkmaktadır [10][11][12] . İmmün sistemi güçlü olan hastalarda dermatom tutulumuna bağlı oluşan ağrı, postherpatik nevralji, bakteriyel süperinfeksiyon gibi semptomlar immün sistemi zayıflamış hastalarda daha şiddetli seyretmektedir [4][5][6]11,12 .…”

“…Yaşlılık, travma, stres ve immün süpresyonu virüsü aktifleştiren önemli faktörler arasında yer almaktadır. Yapılan çalışmalarla HZ'nin yaşla görülme sıklığının arttığı ve yaşlı erkeklerde kümelenmenin olduğu bilinmektedir 3,6,10,11,18,19 . Donahou ve ark.…”

“…Ragozzino ve Wurzel'in yaptıkları çalışmada böyle bir ilişkinin olmadığı rapor edilmiştir 11,21 . HZ'in özellikle lenfoproliferatif kanserlerde görülme sıklığının daha fazla olduğu bildirilmiştir 12 Hata ve ark 10 . 55,492 HZ'li hasta üzerinde yaptıkları çalışmada HZ görülme sıklığının binde 2,2 oranında olduğunu; SLE, RA, hipertansiyon, böbrek yetmezliği, disk hernisi, DM, böbrek yetmezliği ve kanseri olan hastalarda gelişme riskinin 1,8-8,4 kat fazla olabileceğini rapor etmişlerdir.…”

Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

“…An increased risk of HZ, which in any case is age-related, is also associated to some underlying medical conditions as diabetes, Chronic Obstructive Pulmonary Disease (COPD), in addition to stressful events/traumatic events, immunosuppression and immunosuppressive treatments. 1,30,31 Some chronic diseases are possibly associated with an altered functionality of the cell-mediated immune response (CMI) which can lead to an increase of HZ cases. 32 Some researches suggest that patients with HZ are more likely to have a history of myocardial infarction, hypertension, heart failure, diabetes mellitus, asthma, and COPD.…”

“…33 A retrospective cohort study found that patients with diabetes mellitus, kidney failure, cancer and other conditions have a risk of developing shingles 1.8-8.4 times higher than patients with other diseases. 31 A case-control study conducted in the US population found that the risk of developing HZ was significantly greater in patients who had risk factors (diabetes, cardiovascular disease, COPD). The same study found that 7.6% of the considered population was suffering from immunosuppression.…”