RESUMO
OBJECTIVES: To assess the effectiveness of live zoster vaccine during more than 10 years after vaccination; and to describe methods for ascertaining vaccine effectiveness in the context of waning. DESIGN: Real world cohort study using electronic health records. SETTING: Kaiser Permanente Northern California, an integrated healthcare delivery system in the US, 1 January 2007 to 31 December 2018. POPULATION: More than 1.5 million people aged 50 years and older followed for almost 9.4 million person years. MAIN OUTCOME MEASURE: Vaccine effectiveness in preventing herpes zoster, postherpetic neuralgia, herpes zoster ophthalmicus, and admission to hospital for herpes zoster was assessed. Change in vaccine effectiveness by time since vaccination was examined using Cox regression with a calendar timeline. Time varying indicators were specified for each interval of time since vaccination (30 days to less than one year, one to less than two years, etc) and adjusted for covariates. RESULTS: Of 1 505 647 people, 507 444 (34%) were vaccinated with live zoster vaccine. Among 75 135 incident herpes zoster cases, 4982 (7%) developed postherpetic neuralgia, 4439 (6%) had herpes zoster ophthalmicus, and 556 (0.7%) were admitted to hospital for herpes zoster. For each outcome, vaccine effectiveness was highest in the first year after vaccination and decreased substantially over time. Against herpes zoster, vaccine effectiveness waned from 67% (95% confidence interval 65% to 69%) in the first year to 15% (5% to 24%) after 10 years. Against postherpetic neuralgia, vaccine effectiveness waned from 83% (78% to 87%) to 41% (17% to 59%) after 10 years. Against herpes zoster ophthalmicus, vaccine effectiveness waned from 71% (63% to 76%) to 29% (18% to 39%) during five to less than eight years. Against admission to hospital for herpes zoster, vaccine effectiveness waned from 90% (67% to 97%) to 53% (25% to 70%) during five to less than eight years. Across all follow-up time, overall vaccine effectiveness was 46% (45% to 47%) against herpes zoster, 62% (59% to 65%) against postherpetic neuralgia, 45% (40% to 49%) against herpes zoster ophthalmicus, and 66% (55% to 74%) against admission to hospital for herpes zoster. CONCLUSIONS: Live zoster vaccine was effective initially. Vaccine effectiveness waned substantially yet some protection remained 10 years after vaccination. After 10 years, protection was low against herpes zoster but higher against postherpetic neuralgia. TRIAL REGISTRATION: ClinicalTrials.gov number NCT01600079; EU PAS register number EUPAS17502.
Assuntos
Herpes Zoster Oftálmico , Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Humanos , Pessoa de Meia-Idade , Idoso , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Estudos de Coortes , Registros Eletrônicos de Saúde , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , VacinaçãoRESUMO
PURPOSE: To investigate differences in outcomes of acute retinal necrosis with confirmed viral polymerase chain reaction between viral types and highlight different treatment options. METHODS: The study evaluated 22 eyes in 18 patients of polymerase chain reaction-positive acute retinal necrosis at the University of Pittsburgh Medical Center from 2007 to 2018. Outcome measures included final visual acuity, treatment paradigms, and retinal detachment rate. RESULTS: Eight eyes were polymerase chain reaction-positive for varicella zoster virus, two eyes for herpes simplex virus Type 1 (HSV-1), and 12 eyes for herpes simplex virus Type 2 (HSV-2). Final Snellen best-corrected visual acuity averaged 20/51 for varicella zoster virus, 20/25 for HSV-1, and 20/814 for HSV-2. Retinal detachment occurred in 2 (25%) of varicella zoster virus eyes and 8 (75%) of HSV-2 eyes. One eye with HSV-1 and three eyes with HSV-2 received cidofovir for treatment of refractory retinitis. CONCLUSION: Acute retinal necrosis secondary to HSV-2 tended to have persistent active retinitis with a higher rate of retinal detachment despite similar treatment protocols, suggesting that in some cases combination intravenous acyclovir and adjuvant intravitreal foscarnet injections are not sufficient. Despite the risk of renal toxicity, intravenous cidofovir may be a consideration in select patients.
Assuntos
Aciclovir/uso terapêutico , Infecções Oculares Virais/tratamento farmacológico , Foscarnet/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , DNA Viral/análise , Infecções Oculares Virais/diagnóstico , Feminino , Seguimentos , Herpes Zoster Oftálmico/diagnóstico , Herpesvirus Humano 3/genética , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Necrose Retiniana Aguda/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
RESUMEN El herpes zoster oftálmico es la infección producida por el virus varicela zoster (culebrilla) que afecta el ojo; se caracteriza por exantema en el dermatoma de la frente e inflamación dolorosa de todos los tejidos del segmento anterior, rara vez del posterior. Se presentó un paciente de 64 años de edad, raza blanca, con un herpes zoster oftálmico que le causaba dolor agudo. Las lesiones vesiculosas deformaron la mitad izquierda de su cara. El terapeuta empleó la acupuntura como método de tratamiento y se le colocaron agujas en los puntos IG-4 (Hegu) e IG-11 (Quchi) bilateral; en el proceso se colocó al paciente en posición decúbito supino con sesiones de media hora y estimulación cada cinco minutos de las agujas, de forma sedativa. Se apreció la reducción de la intensidad del dolor desde el primer día y la curación de las lesiones a los seis días de tratamiento.
ABSTRACT Herpes zoster ophthalmicus is the infection caused by the varicella-zoster virus (shingles) that affects the eye; it is characterized by rash in a dermatomal distribution of the forehead and painful inflammation of all the tissues of the anterior segment, rarely of the posterior one. A 64-year-old white patient was presented with a herpes zoster ophthalmicus causing acute pain. Vesicular lesions deformed the left half of his face. The therapist used acupuncture as a treatment method and placed needles in points IG-4 (Hegu) and bilateral IG-11 (Quchi); the patient was placed in supine position during the process, with half-hour sessions and stimulation of the needles every five minutes, in a sedative form. A reduction in pain intensity was appreciated from the first day, as well as, the healing of the lesions after six days of treatment.
Assuntos
Herpes Zoster Oftálmico , Terapia por AcupunturaAssuntos
Antibacterianos/efeitos adversos , Ciprofloxacina/efeitos adversos , Córnea/patologia , Ceratite/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Idoso , Antibacterianos/análise , Antibacterianos/farmacocinética , Precipitação Química , Ciprofloxacina/análise , Ciprofloxacina/farmacocinética , Córnea/química , Cristalização , Feminino , Distrofia Endotelial de Fuchs/cirurgia , Herpes Zoster Oftálmico/complicações , Humanos , Concentração de Íons de Hidrogênio , Ceratite/microbiologia , Ceratoplastia Penetrante , Conservantes Farmacêuticos , Tomografia de Coerência ÓpticaRESUMO
BACKGROUND: Skin lesions and pain are the most distinctive features of herpes zoster. Light-emitting diode (LED) therapy is an effective treatment known for its wound-healing effects. OBJECTIVE: To determine whether the LED treatment affects wound healing and acute pain in acute herpes zoster ophthalmicus. METHODS: We recruited 28 consecutive Korean patients with acute herpes zoster ophthalmicus for the study. In the control group (group A), 14 subjects received oral famcyclovir. In the experimental group (group B), 14 subjects received oral famcyclovir and 830 nm LED phototherapy on days 0, 4, 7, and 10. In order to estimate the time for wound healing, we measured the duration from the vesicle formation to when the lesion crust fell off. The visual analogue scale (VAS) was used for the estimation of pain on days 4, 7, 10, and 14. RESULTS: The mean time required for wound healing was 13.14+/-2.34 days in group B and 15.92+/-2.55 days in group A (p=0.006). From day 4, the mean VAS score showed a greater improvement in group B, compared with group A. A marginal but not statistically significant difference in the VAS scores was observed between the two groups (p=0.095). CONCLUSION: LED treatment for acute herpes zoster ophthalmicus leads to faster wound healing and a lower pain score.
Assuntos
Humanos , Dor Aguda , Herpes Zoster , Herpes Zoster Oftálmico , Fototerapia , Projetos Piloto , Pele , CicatrizaçãoRESUMO
Keloid scar complicating herpes zoster ophthalmicus (HZO) has not been much reported among Africans despite the African population having dark skin. We report on a middle-aged Nigerian with HZO who developed keloid scar following use of traditional herbs to the herpetic rashes. A 52-year-old immune-competent Nigerian male presented with a 2-week history of vesicular rashes involving the left side of the forehead down to the tip of the nose. He initially presented to an African traditional healer who had advised application of various herbs to the lesion. When he presented to the eye clinic, he was treated for the associated uveitis with significant improvement. The cicatricial skin change gradually became raised with clinical appearance of keloid at 1 year of follow-up. Cicatricial skin changes in HZO are not unusual, but keloid formation among Africans has not been much described. Late presentation, use of traditional herbs some of which have corrosive effect and secondary bacterial infection are the possible factors that may encourage such abnormal wound healing. The myth associated with HZO in the local African setting as well as the fact that African traditional healers are still widely accepted among most African communities may play a role in increasing the risk of keloid formation among our population following HZO infection.
Assuntos
Herpes Zoster Oftálmico/complicações , Queloide/complicações , Medicinas Tradicionais Africanas , Uveíte/etiologia , Antivirais/uso terapêutico , Seguimentos , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/virologia , Herpesvirus Humano 3 , Humanos , Imunocompetência , Masculino , Medicinas Tradicionais Africanas/efeitos adversos , Pessoa de Meia-Idade , Resultado do Tratamento , Uveíte/tratamento farmacológicoRESUMO
Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente(AU)
Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Herpes Zoster Oftálmico/tratamento farmacológico , Terapia a Laser/métodos , Terapias ComplementaresRESUMO
Se presentó el caso remitido a nuestro servicio de rehabilitación de la especialidad de oftalmología, con el diagnóstico de herpes zóster oftálmico, por presentar dolor y lesiones maculares, vesículas sobre una base eritematosa en la región periorbitaria y frontal derecha, acompañado de intenso edema. Tratado, además, en primera instancia, por dermatología con: aciclovir, antiinflamatorios (prednisona), vitaminoterapia y colirios. A los 7 días comenzó tratamiento de fisioterapia con radiación láser durante 15 sesiones, y continuó con 20 aplicaciones del campo magnético continuo, lo cual garantizó, con la interrelación de varias especialidades médicas y un enfoque multidisciplinario, la evolución satisfactoria del paciente
Present case was referred to our rehabilitation service of Ophthalmology specialty diagnosed with ophthalmic herpes zoster, pain and macular lesions, vesicles on an erythematous basis in right frontal periorbital region, accompanied of intense edema. The first treatment was applied in the Dermatology service with acyclovir, anti-inflammatory drugs (Prednisone), vitamin-therapy and eyedrops. At 17 days was treated with physiotherapy with laser radiation for 15 sessions continuing 20 applications of continuous magnetic field guarantying with the interrelation of some medical specialties and a multidisciplinary approach, the satisfactory evolution of patient
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Terapias Complementares , Herpes Zoster Oftálmico/tratamento farmacológico , Terapia a Laser/métodosRESUMO
Many conditions can mimic the presentation of burns. We present an interesting case in which the initial diagnosis of a chemical burn was later confirmed to be herpes zoster ophthalmicus.
Assuntos
Queimaduras Químicas/diagnóstico , Erros de Diagnóstico , Herpes Zoster Oftálmico/diagnóstico , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Feminino , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , FitoterapiaRESUMO
This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Aciclovir/uso terapêutico , Adulto , Catarata/complicações , Progressão da Doença , Quimioterapia Combinada , Angiofluoresceinografia , Ganciclovir/uso terapêutico , Herpes Zoster Oftálmico/etiologia , Humanos , Masculino , Facoemulsificação , Síndrome de Necrose Retiniana Aguda/etiologia , Acuidade VisualRESUMO
The Bioptron light therapy system acts naturally, upholding the capacity of regeneration of the body. Since the discovery of the therapeutical effects of the Bioptron light, over 20 years ago, its use as treatment has been developed for a large variety of diseases, among which also the eye-diseases (simplex and zoster herpes, conjunctivitis).
Assuntos
Oftalmopatias/terapia , Fototerapia/instrumentação , Fototerapia/métodos , Conjuntivite/terapia , Desenho de Equipamento , Herpes Zoster Oftálmico/terapia , Humanos , Ceratite Herpética/terapia , Resultado do TratamentoRESUMO
This is a report of an atypical case of progressive outer retinal necrosis (PORN) and the effect of highly active antiretroviral therapy (HAART) on the clinical course of viral retinitis in an acquired immunodeficiency syndrome (AIDS) patient. A 22-year-old male patient infected with human immunodeficiency virus (HIV) presented with unilaterally reduced visual acuity and a dense cataract. After cataract extraction, retinal lesions involving the peripheral and macular areas were found with perivascular sparing and the mud-cracked, characteristic appearance of PORN. He was diagnosed as having PORN based on clinical features and was given combined antiviral treatment. With concurrent HAART, the retinal lesions regressed, with the regression being accelerated by further treatment with intravenous acyclovir and ganciclovir. This case suggests that HAART may change the clinical course of PORN in AIDS patients by improving host immunity. PORN should be included in the differential diagnosis of acute unilateral cataract in AIDS patients.
Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/complicações , Aciclovir/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Catarata/complicações , Progressão da Doença , Quimioterapia Combinada , Angiofluoresceinografia , Ganciclovir/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Facoemulsificação , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Acuidade VisualRESUMO
AIMS: To describe the successful treatment of varicella zoster virus retinitis (VZVR) using intravenous cidofovir as part of an aggressive management strategy. CASE REPORTS: Two patients with bilateral VZVR were treated with a combination of intravenous cidofovir and ganciclovir with adjuvant intravitreal foscarnet or ganciclovir. Both patients maintained good vision in the less severely affected eye. Retinal detachment did not occur in either patient. CONCLUSIONS: VZVR should be treated aggressively with a combination of intravenous and intravitreal therapy to improve visual prognosis. Intravenous cidofovir, in the absence of contra-indications, should be considered as part of this aggressive therapeutic approach, especially in patients with AIDS in whom the prognosis is particularly poor.
Assuntos
Antivirais/administração & dosagem , Citosina/análogos & derivados , Citosina/administração & dosagem , Foscarnet/administração & dosagem , Ganciclovir/administração & dosagem , Herpes Zoster Oftálmico/tratamento farmacológico , Organofosfonatos , Compostos Organofosforados/administração & dosagem , Retinite/tratamento farmacológico , Retinite/virologia , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Antivirais/uso terapêutico , Cidofovir , Citosina/uso terapêutico , Quimioterapia Combinada , Feminino , Foscarnet/uso terapêutico , Ganciclovir/uso terapêutico , Humanos , Injeções Intravenosas , Masculino , Compostos Organofosforados/uso terapêutico , Retinite/complicações , Corpo VítreoRESUMO
Piel y ojo comparten un origen común a partir del neuroectodermo (en el ojo, estructurales pricilpalmente esclerocorneanas) (1). La similitud de los epitelios de superficie y de sitios pigmentarios, la contiguidad palpebroconjuntival, la exposición idéntica a microorganismos o alergenos y factores del medio ambiente, los mecanismos de defensa similares, y mecanismos autoinmunes (escleroconjuntiva y úvea), son factores que pueden explicar la patologías comunes, llevando a una sintomatología a la vez dermatológica y oftalmológica; así, enfermedades tales como neurofibromatosis, dermatosis bulosa, vasculitis, Behcet, dermatis atópica y rosácea, son ejemplos de patologías compartidas. El objetivo de esta revisión es definir y explicar cuándo el dermatólogo debe solicitar la evaluación de un oftalmologo
Assuntos
Humanos , Fármacos Dermatológicos/efeitos adversos , Dermatite , Oftalmopatias , Tropismo , Corticosteroides , Antimaláricos/efeitos adversos , Catarata , Clofazimina , Conjuntivite , Conjuntivite Alérgica/etiologia , Dermatite Esfoliativa , Dermatopatias Vesiculobolhosas/complicações , Técnicas de Diagnóstico Oftalmológico , Ectrópio , Edema , Oftalmopatias , Herpes Zoster Oftálmico/complicações , Antagonistas dos Receptores Histamínicos H1 , Neurofibromatoses , Terapia PUVA , Retinoides , Rosácea , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome de Stevens-Johnson/complicações , Síndrome de Sturge-Weber/diagnóstico , Dermatopatias , Uveíte , XeroftalmiaRESUMO
The treatment of neuralgia which occurs during and following herpes zoster ophthalmicus is often unsatisfactory. Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is a drug which depletes substance P and may be effective in inhibiting pain. We utilized topical capsaicin to the affected dermatome five times daily for 4 weeks in 6 patients with acute and post herpetic neuralgia. In four cases pain was markedly relieved and narcotic medications were either discontinued or significantly reduced. In two cases, pain was not reduced. Four patients had side effects including burning sensation at the site of the drug administration (4 cases), dermatitis as a result of overuse of the drug (2 cases) and hyperesthesia (1 case). Our results suggest that capsaicin may be a useful therapy for the alleviation of pain in some individuals with herpes zoster ophthalmicus. However, controlled studies are needed to establish these results.
Assuntos
Capsaicina/uso terapêutico , Herpes Zoster Oftálmico/tratamento farmacológico , Neuralgia/tratamento farmacológico , Administração Tópica , Idoso , Capsaicina/administração & dosagem , Capsaicina/efeitos adversos , Feminino , Seguimentos , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/metabolismo , Pomadas , Substância P/efeitos dos fármacos , Substância P/metabolismoRESUMO
Herpes zoster ophthalmicus (HZO) may occur spontaneously, but can be precipitated by stress, trauma, debility or systemic illness. A case is here reported of Herpes zoster involving the contralateral eye, associated with a midline skin rash, following cataract extraction under local anaesthesia.
Assuntos
Extração de Catarata/efeitos adversos , Doenças da Córnea/virologia , Herpes Zoster Oftálmico/etiologia , Idoso , Anestesia Local , Doenças da Córnea/tratamento farmacológico , Ciclopentolato/administração & dosagem , Ciclopentolato/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Quimioterapia Combinada , Feminino , Herpes Zoster/tratamento farmacológico , Herpes Zoster/etiologia , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Lentes Intraoculares , Soluções Oftálmicas , Dermatopatias Virais/tratamento farmacológico , Dermatopatias Virais/etiologia , Trifluridina/administração & dosagem , Trifluridina/uso terapêutico , Acuidade VisualRESUMO
A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulative treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Antivirais/uso terapêutico , Herpes Zoster Oftálmico/terapia , Adolescente , Adulto , Idoso , Antígenos Virais/uso terapêutico , Ácido Araquidônico/uso terapêutico , Biguanidas , Criança , Pré-Escolar , Terapia Combinada , Corynebacterium , Quimioterapia Combinada , Seguimentos , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Lactente , Pessoa de Meia-Idade , Morfolinas/uso terapêutico , Recidiva , Resultado do Tratamento , Vitamina A/uso terapêuticoRESUMO
A group of 16 patients with ophthalmic zona zoster received antiviral and immunostimulating treatment with Romanian specific products. Results were spectacular. The problem of the identity of the varicella and zoster viruses is discussed.