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Herpes zoster infection and postherpetic neuralgia

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Abstract

Varicella-zoster virus (VZV), the cause of chicken pox, establishes latent infection in sensory ganglia. Reactivation results in zoster (shingles), sometimes complicated by encephalitis (myelitis). Postherpetic neuralgia (PHN) is the major morbidity of zoster. PHN typically increases in frequency with age. The VZV vaccine, which was developed for children, may be effective in enhancing VZV immune reactivity and decreasing zoster in adults. Early antiviral treatment may be effective in decreasing PHN onset. Several other medications may be useful in treating established PHN. A recent report discussed intrathecal steroid use.

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References and Recommended Reading

  1. Gilden DH, Mahalingam R, Dueland A, Cohrs R: Herpes zoster: pathogenesis and latency. Prog Med Virol 1992, 39:19–75.

    PubMed  CAS  Google Scholar 

  2. Liesegang T: Varicella zoster viral disease. Mayo Clin Proc 1999, 74:983–998. A discussion of varicella-zoster viral (VZV) disease and biology. Acute VZV infection and recurrent zoster clinical presentation and treatment are discussed.

    PubMed  CAS  Google Scholar 

  3. Burgoon CF Jr, Burgoon JS, Baldridge GD: The natural history of herpes zoster. JAMA 1957, 164:265–269.

    Google Scholar 

  4. Thomas JE, Howard FM Jr: Segmental zoster paresis—a disease profile. Neurology 1972, 22:459–466.

    PubMed  CAS  Google Scholar 

  5. Schmidbauer M, Budka H, Pilz P, et al.: Presence, disturbance and spread of productive varicella zoster virus infection in nervous tissues. Brain 1992, 115:383–398.

    Article  PubMed  Google Scholar 

  6. Muder R, Lumish R, Corsello G: Myelopathy after herpes zoster. Arch Neurol 1983, 40:445–446.

    PubMed  CAS  Google Scholar 

  7. De Silva SM, Mark AS, Gilden DH, et al.: Zoster myelitis: improvement with antiviral therapy in two cases. Neurology 1996, 47:929–931.

    PubMed  Google Scholar 

  8. Hilt DC, Buchholz D, Krumholz A, et al.: Herpes zoster ophthalmicus and delayed contralateral hemiparesis caused by cerebral angitis: diagnosis and management approaches. Ann Neurol 1983, 14:543–553.

    Article  PubMed  CAS  Google Scholar 

  9. Amlie-Lefond C, Kleinschmit-Demaster BK, Mahalingam R, et al.: The vasculopathy of varicella-zoster virus encephalopathy. Ann Neurol 1995, 37:784–790.

    Article  PubMed  CAS  Google Scholar 

  10. Gilden DH, Wright RR, Schneck SA, et al.: Zoster sine herpete, a clinical variant. Ann Neurol 1994, 35:530–533.

    Article  PubMed  CAS  Google Scholar 

  11. Mahalingam R, Wellish M, Cohrs R, et al.: Expression of protein encoded by varicella-zoster virus open reading frame 63 in latently infected human ganglionic neurons. Proc Natl Acad Sci U S A 1996, 93:2122–2124.

    Article  PubMed  CAS  Google Scholar 

  12. Lungu O, Panagiotidis C, Annunziato P, et al.: Aberrant intracellular localization of varicella-zoster virus regulatory proteins during latency. Proc Natl Acad Sci U S A 1998, 95:7080–7085.

    Article  PubMed  CAS  Google Scholar 

  13. Croen KD, Ostrove JM, Dragovic LJ, Straus SE: Patterns of gene expression and sites of latency in human nerve ganglia are different for varicella-zoster virus and herpes simplex viruses. Proc Natl Acad Sci U S A 1988, 85:9773–9777.

    Article  PubMed  CAS  Google Scholar 

  14. Kennedy P, Grinfeld E, Gow J: Latent varicella-zoster virus is located predominantly in neurons in human trigeminal ganglia. Proc Natl Acad Sci U S A 1998, 95:4658–4662.

    Article  PubMed  CAS  Google Scholar 

  15. Meier J, Holman R, Croen K, et al.: Varicella-zoster virus transcription in human trigeminal ganglia. Virology 1993, 193:193–200.

    Article  PubMed  CAS  Google Scholar 

  16. Cohrs R, Barbour M, Gilden D: Varicella-zoster virus (VZV) transcription during latency in human ganglia: detection of transcripts mapping to genes 21, 29, 62, and 63 in a cDNA library enriched for VZV RNA. J Virology 1996, 70:2789–2796.

    PubMed  CAS  Google Scholar 

  17. Kost RG, Straus SE: Postherpetic neuralgia—pathogenesis, treatment and prevention. N Engl J Med 1996, 335:32–42.

    Article  PubMed  CAS  Google Scholar 

  18. Wood MJ, Shukla S, Fiddian AP, Crooks RJ: Treatment of acute herpes zoster: effect of early (<48h) versus late (48-72h) therapy with acyclovir and valacyclovir on prolonged pain. J Infect Dis 1998, 178:S81-S84.

    PubMed  CAS  Google Scholar 

  19. Cohen J, Brunnell P, Straus S, Krause P: Recent advances in varicella-zoster virus infection. Ann Intern Med 1999, 130:922–932. A discussion of multiple aspects of varicella-zoster virus (VZV) infection. Included is discussion of the VZV vaccine and the treatment of acute VZV infection and postherpetic neuralgia.

    PubMed  CAS  Google Scholar 

  20. Lawrence R, Gershon AA, Holtzman R, et al.: The risk of zoster after varicella vaccination in children with leukemia. N Engl J Med 1988, 318:543–548.

    Article  PubMed  CAS  Google Scholar 

  21. Tenser RB: Trigeminal neuralgia. Neurology 1998, 51:17–19.

    PubMed  CAS  Google Scholar 

  22. Watson CP: Postherpetic neuralgia. Neurol Clin 1989, 7:231–248.

    PubMed  CAS  Google Scholar 

  23. Rowbotham MC, Fields HL: Post-herpetic neuralgia: the relation of pain complaint, sensory disturbance, and skin temperatures. Pain 1989, 39:129–144.

    Article  PubMed  CAS  Google Scholar 

  24. Nurmikko T, Bowsher D: Somatosensory findings in postherpetic neuralgia. J Neurol Neurosurg Psychiatry 1990, 53:135–141.

    Article  PubMed  CAS  Google Scholar 

  25. Rusthoven JJ, Ahlgren P, Elhakim T, et al.: Varicella-zoster infection in adult cancer patients: a population study. Arch Intern Med 1988, 148:1561–1566.

    Article  PubMed  CAS  Google Scholar 

  26. Balfour HH: Varicella zoster virus infections in immunocompromised hosts: a review of the natural history and management. Am J Med 1988, 85:68–73.

    Article  PubMed  Google Scholar 

  27. Whitley RJ, Shukla S, Crooks RJ: The identification of risk factors associated with persistent pain following herpes zoster. J Infect Dis 1998, 178 (suppl 1):S41-S42. Discussion of risk factors for the development of postherpetic neuralgia. Prodromal pain, severity of zoster pain, and age were the greatest risk factors.

    Google Scholar 

  28. Mahalingham R, Wellish M, Brucklie J, Gilden DH: Persistence of varicella-zoster virus DNA in elderly patients with postherpetic neuralgia. J Neurovirol 1995, 1:130–133.

    Google Scholar 

  29. Haanpääs M, Dastidar P, Weinberg A, et al.: CSF and MRI findings in patients with acute herpes zoster. Neurology 1998, 51:1405–1411.

    Google Scholar 

  30. Watson CP, Deck JH, Morshead C, et al.: Postherpetic neuralgia: further post-mortem studies of cases with and without pain. Pain 1991, 44:105–117.

    Article  PubMed  CAS  Google Scholar 

  31. Portenoy RK, Duma C, Foley KM: Acute herpetic and postherpetic neuralgia: clinical review and current management. Ann Neurol 1986, 20:651–664.

    Article  PubMed  CAS  Google Scholar 

  32. Gupta SK, Helal BH, Kiely P: The prognosis in zoster paralysis. J Bone Joint Surg 1969, 51B:593–603.

    Google Scholar 

  33. Gardner-Thorpe C, Foster JB, Barwick DD: Unusual manifestations of herpes zoster. J Neurol Sci 1976, 28:427–447.

    Article  PubMed  CAS  Google Scholar 

  34. Ruppenthal M: Changes of the central nervous system in herpes zoster. Acta Neuropathol 1980, 52:59–68.

    Article  PubMed  CAS  Google Scholar 

  35. Reimer LG, Reller LB: CSF in herpes zoster meningoencephalitis. Arch Neurol 1981, 38:668.

    PubMed  CAS  Google Scholar 

  36. Wood MJ, Shukla S, Fiddian AP, Crooks RJ: Treatment of acute herpes zoster: effect of early (<48h) versus late (8-72 h) therapy with acyclovir and valacyclovir on prolonged pain. J Infect Dis 1998, 178:S81-S84. Early antiviral treatment is important in decreasing varicella-zoster virus-associated pain.

    PubMed  CAS  Google Scholar 

  37. Whitley RJ, Weiss H, Gnann JW Jr, et al.: Acyclovir with and without prednisone for the treatment of herpes zoster. Ann Intern Med 1996, 125:376–383.

    PubMed  CAS  Google Scholar 

  38. Beutner KR, Friedman DJ, Forszpaniak C, et al.: Valacyclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995, 39:1546–1553.

    PubMed  CAS  Google Scholar 

  39. Tyring S, Barbarash RA, Nahlik JE, et al.: Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. Ann Intern Med 1995, 123:89–96.

    PubMed  CAS  Google Scholar 

  40. Wood MJ, Johnson RW, Mckenchick MW, et al.: A randomized trial of acyclovir for 7 or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 1994, 330:896–900.

    Article  PubMed  CAS  Google Scholar 

  41. Hardy I, Gershon AA, Steinberg SP, LaRussa P: The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. N Engl J Med 1991, 325:1545–1550.

    Article  PubMed  CAS  Google Scholar 

  42. Watson CP: A new treatment for postherpetic neuralgia. N Engl J Med 2000, 343:1563–1565. An editorial in response to Kotani et al. [47]. This is an authoritative discussion of postherpetic neuralgia.

    Article  PubMed  CAS  Google Scholar 

  43. Bowsher D: The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline. J Pain Symptom Management 1997, 13:327–331.

    Article  CAS  Google Scholar 

  44. Rowbotham MC, Harden N, Stacey B, et al.: Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998, 280:1837–1842.

    Article  PubMed  CAS  Google Scholar 

  45. Rowbotham MC, Davies PS, Verkempinck C, et al.: Lidocaine patch: double blind controlled study of a new treatment method for postherpetic neuralgia. Pain 1996, 65:39–44.

    Article  PubMed  CAS  Google Scholar 

  46. Jessell TM, Iversen LL, Cuello AC: Capsaicin-induced depletion of substance P from primary sensory neurones. Brain Res 1978, 152:183–188.

    Article  PubMed  CAS  Google Scholar 

  47. Kotani N, Kushikata T, Hashimoto H, et al.: Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med 2000, 343:1514–1519. A report of effective treatment of postherpetic neuralgia. Efficacy of treatment also suggests possible mechanisms of postherpetic neuralgia.

    Article  PubMed  CAS  Google Scholar 

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  1. Division of Neurology, Pennsylvania State University College of Medicine, 500 University Drive, 17033, Hershey, PA, USA

    Richard B. Tenser MD

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  1. Richard B. Tenser MD
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Tenser, R.B. Herpes zoster infection and postherpetic neuralgia. Curr Neurol Neurosci Rep 1, 526–532 (2001). https://doi.org/10.1007/s11910-001-0057-z

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  • DOI: https://doi.org/10.1007/s11910-001-0057-z

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