Bye William A, Sparrow Miles P, Connor Susan J, Andrews Jane M, Ellard Katie, Ng Watson, Hume Georgia, Antoniades Sally, Walsh Alissa J
Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2017 Nov;47(11):1263-1269. doi: 10.1111/imj.13488.
Immunosuppressed inflammatory bowel disease (IBD) patients have an increased risk of herpes zoster virus (HZV) infection. The existing live-attenuated HZV vaccine is contraindicated in some of these patients and can only be used with caution in others.
To describe characteristics of IBD patients suffering HZV to enable implementation of risk mitigation strategies for those at highest risk.
Gastroenterologists completed a proforma for IBD patients who experienced HZV infection: IBD phenotype, details of HZV infection, immunosuppression and any change to treatment upon diagnosis of HZV.
A total of 30 cases was identified: Crohn disease (CD) (n = 25) and ulcerative colitis (n = 5). In total, 80% (20/25) of the CD patients had penetrating, stricturing or perianal disease. Time from commencement of immunosuppression to HZV infection was highly variable (range: 3 months to over 10 years). A total of 90% (27/30) of patients was on at least one immunosuppressive therapy; of those, one-third was on monotherapy (9/27) and two-thirds (18/27) on dual therapy. A total of 89% (24/27) of immunosupressed patients was on a thiopurine (monotherapy; 6/27) or in combination (18/27). Complications of HZV occurred in 27% (8/30) of patients.
Our series is consistent with existing epidemiological analysis that identified more severe IBD and the use of multiple immunosuppressive therapies as risk factors for HZV. If the promise of an investigational subunit HZV vaccine is realised in immunocompromised patients, better protection may be possible in the future. Thiopurine medications were the most commonly used immunosuppressant in this series. Age and duration of immunosuppressive therapy do not appear to predict HZV infection.
免疫抑制的炎症性肠病（IBD）患者感染带状疱疹病毒（HZV）的风险增加。现有的减毒活HZV疫苗在部分此类患者中为禁忌，在其他患者中也只能谨慎使用。
描述患HZV的IBD患者的特征，以便为高危患者实施风险缓解策略。
胃肠病学家为感染HZV的IBD患者填写一份表格：IBD表型、HZV感染细节、免疫抑制情况以及诊断HZV后治疗的任何变化。
共识别出30例病例：克罗恩病（CD）（n = 25）和溃疡性结肠炎（n = 5）。总体而言，80%（20/25）的CD患者患有穿透性、狭窄性或肛周疾病。从开始免疫抑制到HZV感染的时间差异很大（范围：3个月至10多年）。90%（27/30）的患者至少接受一种免疫抑制治疗；其中，三分之一接受单一疗法（9/27），三分之二（18/27）接受联合疗法。89%（24/27）的免疫抑制患者使用硫唑嘌呤（单一疗法；占6/27）或联合使用（占18/27）。27%（8/30）的患者发生了HZV并发症。
我们的系列研究结果与现有流行病学分析一致，后者确定更严重的IBD以及使用多种免疫抑制疗法是HZV的危险因素。如果研究性亚单位HZV疫苗在免疫受损患者中取得成功，未来可能会提供更好的保护。硫唑嘌呤药物是本系列中最常用的免疫抑制剂。免疫抑制治疗的年龄和持续时间似乎不能预测HZV感染。
