RESUMO
Immunosuppressed patients are at higher risk for developing herpes zoster (HZ), and neurological complications are frequent in them. However, the influence of immunosuppression (IS) on the severity and prognosis of neurological complications of varicella-zoster virus (VZV) reactivation is unknown. We studied retrospectively patients with neurological complications due to VZV reactivation who attended our hospital between 2004 and 2019. We aimed to assess the clinical spectrum, potential prognostic factors, and the influence of the immune status on the severity of neurological symptoms. A total of 98 patients were included (40% had IS). Fifty-five patients (56%) had cranial neuropathies which included Ramsay-Hunt syndrome (36 patients) and cranial multineuritis (23 patients). Twenty-one patients developed encephalitis (21%). Other diagnosis included radiculopathies, meningitis, vasculitis, or myelitis (15, 10, 6, and 4 patients, respectively). Mortality was low (3%). At follow-up, 24% of patients had persistent symptoms although these were usually mild. IS was associated with severity (defined as a modified Rankin scale greater than 2) (odds ratio, 4.23; 95% confidence interval, 1.74-10.27), but not with prognosis. Shorter latency between HZ and neurologic symptoms was the only factor associated with an unfavorable course (death or sequelae) (odds ratio, 0.82; 95% confidence interval, 0.71-0.95). In conclusion, the clinical spectrum of neurological complications in VZV reactivation is wide. Mortality was low and sequelae were mild. The presence of IS may play a role on the severity of neurological symptoms, and a shorter time between HZ and the onset of neurological symptoms appears to be a negative prognostic factor.
Assuntos
Encefalite por Varicela Zoster/imunologia , Herpes Zoster da Orelha Externa/imunologia , Herpes Zoster/imunologia , Herpesvirus Humano 3/patogenicidade , Imunossupressores/efeitos adversos , Neurite (Inflamação)/imunologia , Radiculopatia/imunologia , Idoso , Idoso de 80 Anos ou mais , Encefalite por Varicela Zoster/complicações , Encefalite por Varicela Zoster/diagnóstico , Encefalite por Varicela Zoster/mortalidade , Feminino , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/mortalidade , Herpes Zoster da Orelha Externa/diagnóstico , Herpes Zoster da Orelha Externa/etiologia , Herpes Zoster da Orelha Externa/mortalidade , Humanos , Terapia de Imunossupressão , Masculino , Meningite Viral/diagnóstico , Meningite Viral/etiologia , Meningite Viral/imunologia , Meningite Viral/mortalidade , Pessoa de Meia-Idade , Mielite/diagnóstico , Mielite/etiologia , Mielite/imunologia , Mielite/mortalidade , Neurite (Inflamação)/diagnóstico , Neurite (Inflamação)/etiologia , Neurite (Inflamação)/mortalidade , Prognóstico , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Radiculopatia/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/mortalidade , Ativação Viral/efeitos dos fármacos , Latência Viral/efeitos dos fármacosRESUMO
Neuritis in leprosy cases is responsible for deformities and disability. The objective of this historical cohort study was to investigate the risk factors associated with the time taken for neuritis to occur. This study followed up 595 patients from 1993 to 2003. The life table technique and the Kaplan-Meier method for survival curves were used. The log-rank test was used to test differences between groups regarding the time take for neuritis to occur, and the Cox regression model was used to estimate the hazard ratios. Just over half (54%) of the sample had neuritis, which had mostly taken 0 to 11.9 months to appear. The degree of disability at admission and the bacillary index were strongly associated with the occurrence of neuritis, thus confirming the need for early diagnosis of leprosy, as well as regular neurological follow-up and appropriate interventions.
Assuntos
Hanseníase/complicações , Neurite (Inflamação)/etiologia , Adulto , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Hanseníase/mortalidade , Masculino , Neurite (Inflamação)/epidemiologia , Neurite (Inflamação)/mortalidade , Fatores de TempoRESUMO
A neurite na hanseníase é responsável pelas deformidades e incapacidades. O objetivo desta coorte histórica foi investigar os fatores de risco associados ao tempo até a ocorrência da neurite. Foram acompanhados 595 pacientes, no período de 1993 a 2003. Empregou-se a técnica de tabela de vida e o método de Kaplan-Meier para a curva de sobrevida. Para testar diferenças entre os grupos quanto ao tempo até a ocorrência de neurite, foi usado o log-rank e para estimar as razões de risco, o modelo de regressão de Cox. Pouco mais da metade (54 por cento) da amostra teve neurite, sendo o principal intervalo de tempo de zero a 11,9 meses. O grau de incapacidade na admissão e o índice baciloscópico associaram-se fortemente à ocorrência de neurite, confirmando a necessidade do diagnóstico precoce da hanseníase, bem como do acompanhamento neurológico regular e intervenções adequadas.
Neuritis in leprosy cases is responsible for deformities and disability. The objective of this historical cohort study was to investigate the risk factors associated with the time taken for neuritis to occur. This study followed up 595 patients from 1993 to 2003. The life table technique and the Kaplan-Meier method for survival curves were used. The log-rank test was used to test differences between groups regarding the time take for neuritis to occur, and the Cox regression model was used to estimate the hazard ratios. Just over half (54 percent) of the sample had neuritis, which had mostly taken 0 to 11.9 months to appear. The degree of disability at admission and the bacillary index were strongly associated with the occurrence of neuritis, thus confirming the need for early diagnosis of leprosy, as well as regular neurological follow-up and appropriate interventions.
