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Cerebrovascular events after herpes zoster infection: a risk that should be not underestimated

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Abstract

The occurrence of a cerebrovascular event after a herpes zoster (HZ) infection represents a nightmare in clinical practice, especially in those patients with concomitant cardiovascular comorbidities/risk factors and disease related per se to a higher risk of zoster infection. Moreover, the absence of a consensus opinion regarding a specific and adequate prevention of cerebrovascular events in these patients further complicates the treatment. Accumulating evidences demonstrated that HZ and HZ ophtalmicus (HZO) increase the risk of cerebrovascular events in the short-and long-term periods. Moreover, patient’s ages < 40 years old, despite having fewer traditional cardiovascular comorbidities, demonstrated a higher risk of cerebrovascular events after both HZ and HZO infection. Further prospective studies are needed to analyse the role of antiviral treatments and vaccination in these subjects to clarify if they could be able to reduce the risk of stroke after a zoster infection. In the meanwhile, physicians must be aware of a higher risk of cerebrovascular events, especially in younger patients, with few cardiovascular risk factors, after an HZ infection.

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References

  • Arboix A (2015) Cardiovascular risk factors for acute stroke: risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 3(5):418–429

    Article  PubMed  PubMed Central  Google Scholar 

  • Breuer J, Pacou M, Gauthier A, Brown MM (2014) Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. Neurology. 82(3):206–212

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Carvalho-Pinto BP, Faria CD (2016) Health, function and disability in stroke patients in the community. Braz J Phys Ther 20(4):355–366

    Article  PubMed  PubMed Central  Google Scholar 

  • Erskine N, Tran H, Levin L, Ulbricht C, Fingeroth J, Kiefe C, Goldberg RJ, Singh S (2017) A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One 12(7):e0181565

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Feller L, Jadwat Y, Bouckaert M (2005) Herpes zoster post-herpetic neuralgia. SADJ. 60(10):432 436-7

    CAS  PubMed  Google Scholar 

  • Gilden D (2015) Varicella-zoster virus infections. Continuum (Minneap Minn) 21(6 Neuroinfectious Disease):1692–1703

    Google Scholar 

  • Gnann JW Jr, Whitley RJ (2002) Clinical practice. Herpes zoster. N Engl J Med 347(5):340–346

    Article  PubMed  Google Scholar 

  • Grose C (2018) Heightened risk of ischemic stroke after recent herpes zoster ophthalmicus. J Med Virol 90(8):1283–1284

    Article  PubMed  PubMed Central  Google Scholar 

  • Hosamirudsari H, Rashed P, Afsari F, Akbarpour S, Bagherzadeh A (2018) Correlation between herpes zoster and stroke—a case-control study. J Med Virol 90(8):1370–1374

    Article  PubMed  Google Scholar 

  • Kang JH, Ho JD, Chen YH, Lin HC (2009) Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Stroke 40(11):3443–3448

    Article  CAS  PubMed  Google Scholar 

  • Kelly-Hayes M (2010) Influence of age and health behaviors on stroke risk: lessons from longitudinal studies. J Am Geriatr Soc 58(Suppl 2):S325–S328

    Article  PubMed  PubMed Central  Google Scholar 

  • Khan N, Patel D, Trivedi C, Shah Y, Lichtenstein G, Lewis J, Yang YX (2018) Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: a Nationwide cohort study. Clin Gastroenterol Hepatol 16:1919-1927.e3. https://doi.org/10.1016/j.cgh.2017.12.052

  • Kim MC, Yun SC, Lee HB, Lee PH, Lee SW, Choi SH, Kim YS, Woo JH, Kim SH, Kwon SU (2017) Herpes zoster increases the risk of stroke and myocardial infarction. J Am Coll Cardiol 70(2):295–296

    Article  PubMed  Google Scholar 

  • Kwon SU, Yun SC, Kim MC, Kim BJ, Lee SH, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2016) Risk of stroke and transient ischaemic attack after herpes zoster. Clin Microbiol Infect 22(6):542–548

    Article  CAS  PubMed  Google Scholar 

  • Langan SM, Minassian C, Smeeth L, Thomas SL (2014) Risk of stroke following herpes zoster: a self-controlled case-series study. Clin Infect Dis 58(11):1497–1503

    Article  PubMed  PubMed Central  Google Scholar 

  • Levin MJ, Smith JG, Kaufhold RM, Barber D, Hayward AR, Chan CY, Chan IS, Li DJ, Wang W, Keller PM, Shaw A, Silber JL, Schlienger K, Chalikonda I, Vessey SJ, Caulfield MJ (2003) Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis 188(9):1336–1344

    Article  PubMed  Google Scholar 

  • Liao CH, Chang CS, Muo CH, Kao CH (2015) High prevalence of herpes zoster in patients with depression. J Clin Psychiatry 76(9):e1099–e1104 https://doi.org/10.4088/JCP.14m09311

  • Liao TL, Lin CH, Chen HH, Chen YM, Lin CC, Chen DY (2017) Significant associations of neurological complications of herpes zoster with stroke in rheumatoid arthritis patients. J Am Heart Assoc 6(7) 6:pii:e006304. https://doi.org/10.1161/JAHA.117.006304

  • Lin HC, Chien CW, Ho JD (2010) Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study. Neurology 74(10):792–797

    Article  PubMed  Google Scholar 

  • Manzi S, Kuller LH, Kutzer J, Pazin GJ, Sinacore J, Medsger TA Jr, Ramsey-Goldman R (1995) Herpes zoster in systemic lupus erythematosus. J Rheumatol 22(7):1254–1258

    CAS  PubMed  Google Scholar 

  • Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA (2010) Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol 56(11):827–837

    Article  PubMed  Google Scholar 

  • Marra F, Ruckenstein J, Richardson K (2017) A meta-analysis of stroke risk following herpes zoster infection. BMC Infect Dis 17(1):198

    Article  PubMed  PubMed Central  Google Scholar 

  • Maurya PK, Kulshreshtha D, Singh AK, Thacker AK (2017 Mar) Stroke associated with varicella zoster vasculopathy: a clinicoradiological profile of 3 patients. Neurologist 22(2):64–67

    Article  PubMed  Google Scholar 

  • Minassian C, Thomas SL, Smeeth L, Douglas I, Brauer R, Langan SM (2015) Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med 12(12):e1001919

    Article  PubMed  PubMed Central  Google Scholar 

  • Muñoz-Quiles C, López-Lacort M, Díez-Domingo J (2018) Risk and impact of herpes zoster among COPD patients: a population-based study, 2009–2014. BMC Infect Dis 18(1):203

    Article  PubMed  PubMed Central  Google Scholar 

  • Nagel MA, Gilden D (2015) The relationship between herpes zoster and stroke. Curr Neurol Neurosci Rep 15(4):16

    Article  PubMed  PubMed Central  Google Scholar 

  • Nagel MA, Traktinskiy I, Azarkh Y, Kleinschmidt-DeMasters B, Hedley-Whyte T, Russman A, VanEgmond EM, Stenmark K, Frid M, Mahalingam R, Wellish M, Choe A, Cordery-Cotter R, Cohrs RJ, Gilden D (2011) Varicella zoster virus vasculopathy: analysis of virus-infected arteries. Neurology 77(4):364–370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Papagianni M, Metallidis S, Tziomalos K (2018) Herpes zoster and diabetes mellitus: a review. Diabetes Ther 9(2):545–550 https://doi.org/10.1007/s13300-018-0394-4

  • Pavan-Langston D, Pavan-Langston D (2008) Herpes zoster antivirals and pain management. Ophthalmology. 115(2 Suppl):S13–S20

    Article  PubMed  Google Scholar 

  • Schink T, Behr S, Thöne K, Bricout H, Garbe E (2016 Nov 23) Risk of stroke after herpes zoster—evidence from a German self-controlled case-series study. PLoS One 11(11):e0166554

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sreenivasan N, Basit S, Wohlfahrt J, Pasternak B, Munch TN, Nielsen LP, Melbye M (2013) The short- and long-term risk of stroke after herpes zoster—a nationwide population-based cohort study. PLoS One 8(7):e69156

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sundström K, Weibull CE, Söderberg-Löfdal K, Bergström T, Sparén P, Arnheim-Dahlström L (2015) Incidence of herpes zoster and associated events including stroke—a population-based cohort study. BMC Infect Dis 15:488

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yawn BP, Wollan PC, Nagel MA, Gilden D (2016) Risk of stroke and myocardial infarction after herpes zoster in older adults in a US community population. Mayo Clin Proc 91(1):33–44

    Article  PubMed  Google Scholar 

  • Yun H, Xie F, Delzell E, Chen L, Levitan EB, Lewis JD, Saag KG, Beukelman T, Winthrop K, Baddley JW, Curtis JR (2015) Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. Arthritis Care Res (Hoboken) 67(5):731–736

    Article  CAS  Google Scholar 

  • Zuin M, Rigatelli G, Picariello C, Carraro M, Zonzin P, Roncon L (2017) Prognostic role of a new risk index for the prediction of 30-day cardiovascular mortality in patients with acute pulmonary embolism: the Age-Mean Arterial Pressure Index (AMAPI). Heart Vessel 32(12):1478–1487

    Article  Google Scholar 

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Correspondence to Gianluca Rigatelli.

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Zuin, M., Rigatelli, G. & Adami, A. Cerebrovascular events after herpes zoster infection: a risk that should be not underestimated. J. Neurovirol. 25, 439–447 (2019). https://doi.org/10.1007/s13365-019-00748-9

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