Herpes zoster increased risk of neuralgic amyotrophy: a retrospective, population-based matched cohort study
Although neuralgic amyotrophy (NA) has occasionally been reported to be associated with reactivated herpes zoster, their associated risk remains unknown. The aim of this study was to assess the risk of developing NA following preceding herpes zoster. The authors used the National Health Insurance Research Database of Taiwan to select 41,548 patients with newly diagnosed herpes zoster during the period 2000 to 2010 and randomly extracted 166,192 matched control subjects. All participants in the study and control groups were followed for 3 months after the diagnosis to identify those who developed NA. Cox proportional hazards regression analyses were performed to evaluate the subsequent risk of NA. Twenty-one subjects from the group with herpes zoster (0.05%) developed NA over the 3-month period and 46 from the group without herpes zoster (0.03%). The patients with herpes zoster had a higher risk of developing NA (adjusted hazard ratio = 1.408, 95% confidence interval = 1.013–2.319, P = 0.030). In the patients with herpes zoster, female sex, age ≥ 65, hepatitis E virus (HEV), and having had a recent infectious event including pneumonia and influenza were risk factors for developing NA (adjusted HR 2.746, 1.998, 2.735, 2.016, and 1.718, respectively, all P < 0.05). Patients with herpes zoster attack have a higher risk of developing NA over a 3-month period after diagnosis, especially those who are female, age ≥ 65, HEV, or have experienced a recent infectious event or pneumonia and influenza.
KeywordsHerpes zoster Neuralgic amytrophy Taiwan Hazard ratio Hepatitis E virus
This study was funded by Tri-Service General Hospital Research Foundation (TSGH-C107-004). The funder has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
All authors claim that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The Institutional Review Board of Tri-Service General Hospital approved this study (TSGHIRB No.2-105-05-082).
Conflict of interest
The authors declare that they have no conflict of interest.
- Dalton HR, van Eijk JJJ, Cintas P, Madden RG, Jones C, Webb GW, Norton B, Pique J, Lutgens S, Devooght-Johnson N, Woolson K, Baker J, Saunders M, Househam L, Griffiths J, Abravanel F, Izopet J, Kamar N, van Alfen N, van Engelen BGM, Hunter JG, van der Eijk AA, Bendall RP, McLean BN, Jacobs BC (2017) Hepatitis E virus infection and acute non-traumatic neurological injury: a prospective multicentre study. J Hepatol 67:925–932CrossRefGoogle Scholar
- Fabian VA, Wood B, Crowley P, Kakulas BA (1997) Herpes zoster brachial plexus neuritis. Clin Neuropathol 16:61–64Google Scholar
- Harpaz R, Ortega-Sanchez IR, Seward JF (2008) Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 57:1–30 quiz CE2–4Google Scholar
- Jaaskelainen AJ, Viitala SM, Kurkela S, Hepojoki S, Sillanpaa H, Kallio-Kokko H, Bergstrom T, Suni J, Narvanen A, Vapalahti O, Vaheri A (2014) Performance of a multiplexed serological microarray for the detection of antibodies against central nervous system pathogens. J Microbiol Methods 100:27–31CrossRefGoogle Scholar
- Kang JH, Sheu JJ, Lin HC (2010) Increased risk of Guillain-Barre Syndrome following recent herpes zoster: a population-based study across Taiwan. Clin Infect Dis 51:525–530Google Scholar
- Martinez-Salio A, Penas M, Blanco A, Miranda P, Porta-Etessam J, Posada I (2001) Brachial plexopathy in varicella of the adults. A case report. Rev Neurol 33:599–600Google Scholar
- Neubauer K, Bockelmann D, Koehler U, Kracht J, Kirschner J, Pendziwiat M, Zieger B (2018). Hereditary neuralgic amyotrophy in childhood caused by duplication within the SEPT9 gene: a family study. Cytoskeleton (Hoboken)Google Scholar
- Ohtake T, Komori T, Hirose K, Tanabe H (1991) Monoparesis due to the brachial plexus neuritis by herpes zoster virus—report of a case. Rinsho Shinkeigaku 31:1245–1247Google Scholar
- Shih C-J, Chu H, Chao P-W, Lee Y-J, Kuo S-C, Li S-Y, Tarng D-C, Yang C-Y, Yang W-C, Ou S-M (2014) Long-term clinical outcome of major adverse cardiac events in survivors of infectious endocarditis: a nationwide population-based study. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.114.012717
- van Eijk JJJ, Dalton HR, Ripellino P, Madden RG, Jones C, Fritz M, Gobbi C, Melli G, Pasi E, Herrod J, Lissmann RF, Ashraf HH, Abdelrahim M, Masri O, Fraga M, Benninger D, Kuntzer T, Aubert V, Sahli R, Moradpour D, Blasco-Perrin H, Attarian S, Gerolami R, Colson P, Giordani MT, Hartl J, Pischke S, Lin NX, McLean BN, Bendall RP, Panning M, Peron JM, Kamar N, Izopet J, Jacobs BC, van Alfen N, van Engelen BGM (2017) Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy. Neurology 89:909–917CrossRefGoogle Scholar
- Verma AK, Maheshwari MC (1985) Brachial monoparesis following herpes zoster. Acta Neurol (Napoli) 7:32–34Google Scholar