Itagaki Hideya, Suzuki Jun, Imai Haruka, Endo Tomoyuki, Endo Shiro, Kaku Mitsuo
Division of Infectious Diseases and Infection Control, Department of Social and Community Medicine, Graduate School of Medicine, Tohoku Medical and Pharmaceutical University, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan; Division of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan.
Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan.
J Infect Chemother. 2025 Jan;31(1):102469. doi: 10.1016/j.jiac.2024.07.009. Epub 2024 Jul 11.
Disseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies.
We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients.
Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower.
This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.
播散性带状疱疹（DHZ）是一种严重感染，在免疫功能低下患者中发病率和死亡率较高。尽管已有研究表明其在免疫功能正常患者中也会发生，但其在该人群中的流行病学、临床表现及治疗结果仍不明确。因此，本研究旨在探讨免疫功能正常患者中DHZ的临床表现、治疗、并发症及结局，并将这些结果与既往研究进行比较。
我们纳入了本机构20例免疫功能正常的DHZ患者，并回顾了42例既往发表的病例。然后我们调查了所有病例的临床特征、诱发因素、实验室检查结果、治疗及结局，包括住院死亡率、出院时神经功能障碍及带状疱疹后神经痛。我们将免疫功能正常的DHZ患者与免疫功能低下的DHZ患者进行了比较。
患者的中位年龄为71.5岁，以男性为主。三叉神经区域是最初皮疹最常见的部位，平均播散时间为6.5天。疼痛是最常见的症状，其次是发热（约40%的病例）；阿昔洛韦是最常用的治疗药物。此外，住院死亡率为0%，约10%的患者出院时出现神经病变，约40%的患者出现带状疱疹后神经痛。在免疫功能低下的病例中，死亡率为12%，高于我们的病例；然而，神经病变和带状疱疹后神经痛的发生率较低。
本研究为免疫功能正常患者中DHZ病例的临床表现、治疗及结局提供了新的见解，突出了其尽管死亡率较低但仍有残留神经损伤的倾向。
