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1: Rheumatology (Oxford). 2007 Feb 22; [Epub ahead of print]


Long-term effects of combination treatment with fludarabine and low-dose pulse cyclophosphamide in patients with lupus nephritis.

Illei GG, Yarboro CH, Kuroiwa T, Schlimgen R, Austin HA, Tisdale JF, Chitkara P, Fleisher T, Klippel JH, Balow JE, Boumpas DT.

Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA and Division of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, 711 10 Heraklion, Greece.

Objectives. To determine the safety and efficacy of a short course of fludarabine combined with cyclophoshamide in lupus nephritis. Methods. A phase I/II open label pilot study. Thirteen patients with active proliferative lupus nephritis received monthly oral boluses of low-dose cyclophoshamide (0.5 gm/m(2) on day 1) and subcutaneous fludarabine (30 mg/m(2) on days 1-3) for 3-6 cycles. Concomitant prednisone was aggressively tapered from 0.5 mg/kg/day to a low-dose, alternate-day schedule. Patients were followed for at least 24 months after therapy. The primary outcome was the number of patients achieving renal remission defined as stable creatinine, proteinuria <1 gm/day and inactive urine sediment for at least 6 months. Results. The study was terminated early because of bone marrow toxicity. Eleven patients who received at least three cycles were evaluated for efficacy. Ten patients improved markedly with seven patients achieving complete remission and three patients achieving partial remission. There were three serious haematological adverse events during the treatment with one death due to transfusion-associated graft vs host disease. Profound and prolonged CD4 (mean CD4: 98/microl at 7 months and 251/microl at 12 months) and CD20 lymphocytopenia was noted in most patients. Three patients developed Herpes zoster infections. Conclusions. A short course of low-dose fludarabine and cyclophoshamide can induce long-lasting remissions in patients with proliferative lupus nephritis, but severe myelosuppression limits its widespread use.

PMID: 17317716 [PubMed - as supplied by publisher]

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2: Neurologia. 2007 Jan;22(1):46. Related Articles


[Trigeminal herpes zoster. Pons hypersignal in magnetic resonance imaging.]

[Article in Spanish]

Perez Navarro J, Escamilla Sevilla F, Pastor Rull J.

Servicio de Neurologia.

Publication Types:
Editorial

PMID: 17315102 [PubMed - in process]

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3: J Eur Acad Dermatol Venereol. 2007 Mar;21(3):431-2. Related Articles, Links


Occurrence of acne comedones over healed linear scar of herpes zoster: a neurogenic perception.

Sardana K, Relhan V, Sehgal V, Garg V, Kochhar A.

Department of Dermatology and STD, Maulana Azad Medical College and associated Log Nayal Jay Prakesh Narayan Hospital and Chacha Nehru Children Hospital, New Delhi, India.

PMID: 17309494 [PubMed - in process]

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4: Bull World Health Organ. 2007 Feb;85(2):116-123. Related Articles, Links


Progression to WHO criteria for antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Cote d'Ivoire: cohorte de siete anos de seroconvertidos para el VIH-1.

Minga A, Danel C, Abo Y, Dohoun L, Bonard D, Coulibaly A, Duvignac J, Dabis F, Salamon R, Anglaret X.

Programme PAC-CI, Abidjan, Cote d'Ivoire.

OBJECTIVE: To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Cote d'Ivoire. METHODS: We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was < 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. FINDINGS: 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. CONCLUSION: Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa.

PMID: 17308732 [PubMed - as supplied by publisher]

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5: Rev Neurol (Paris). 2007 Jan;163(1):89-92. Related Articles, Links


[VZV-related myelitis: a pathophysiological hypothesis.]

[Article in French]

Outteryck O, Deramecourt V, Bombois S, Mackowiak-Cordoliani MA, Pasquier F.

Clinique neurologique, Hopital Roger Salengro, CHRU de Lille, 59037 Lille Cedex. Recu le: 13/04/2006; Recu en revision le: 15/05/2006; Accepte le 09/06/2006.

Introduction. Complications of VZV infection in the central nervous system are multiple. VZV-related myelitis is an uncommon complication of herpes zoster. Observation. We report the case of a 55-year old man with intercostal herpes zoster who presented a subacute medullar syndrome. MRI demonstrated an extended cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal fluid (CSF) analysis showed 100 leukocytes/mm3, 0.94 g/L protein, negative VZV PCR, elevated rate of anti-VZV IgG and no oligoclonal bands. Clinical, biological and radiological presentations were compatible with the diagnosis of VZV-related myelitis with three potential pathophysiological mechanisms: infectious, immune post-infectious, vascular. The course was partially favorable after a 3-day regimen of corticosteroid and 3 weeks of acyclovir infusions. DISCUSSION: Parainfectious myelitis is often the consequence of a viral infection with a post-infectious pathogenesis. Most often, the clinical outcome is good. In this case report, we highlight the VZV vascular tropism and its more severe outcome. CONCLUSION: VZV-related myelitis should be diagnosed early. The combination of aciclovir and corticoids infusions seems to be beneficial.

Publication Types:
English Abstract

PMID: 17304177 [PubMed - in process]

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6: Iran J Allergy Asthma Immunol. 2005 Jun;4(2):95-8. Related Articles


The Seroepidemiology of Varicella Zoster Virus (VZV) in Different Age Groups in Tehran, Iran.

Sharifi Z, Emadi Ghanjin S.

Research Center of Iranian Blood Transfusion Organization (IBTO), Tehran, Iran. sharifiz@yahoo.com.

Varicella zoster virus (VZV), the causative agent of chicken pox and shingles, can cause severe systemic infections of the CNS and the respiratory tract in immunocompetent individuals as well as in immunocompromized patients.The aim of this cross-sectional study was to assess the prevalence of antibody Varicella zoster virus in different age groups.The enzyme linked immunosorbent assay (ELISA) method was used to assess the presence of anti -VZV antibody.A total of 635 serum samples were collected. Age specific prevalence of IgG antibody to VZV showed a progressive increase with age in both males and females. The overall seroprevalence rate was 83.6%. Prevalence of antibodies was 59.7% in the age group of less than 10 years, 60.4 % in 10-14 years, 87.5 % in 15-19 years, 88 % in 20-24 years, 89.4 % in 25-29 years and 87.9 % in 30-39 years.The data show that children should be considered as a target group for prevention programs against VZV infection.

PMID: 17301429 [PubMed - in process]

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7: Hum Vaccin. 2007 Mar 23;3(2) [Epub ahead of print] Related Articles, Links


Vaccination to Prevent Herpes Zoster and Postherpetic Neuralgia.

Oxman MN.

University of California San Diego, San Diego, California, USA; The VA San Diego Healthcare System, San Diego, California, USA.

PMID: 17299270 [PubMed - as supplied by publisher]

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8: J Environ Sci (China). 2006;18(6):1193-8. Related Articles, Links


Investigation on Fe, Mn, Zn, Cu, Pb and Cd fractions in the natural surface coating samples and surficial sediments in the Songhua River, China.

Guo SH, Wang XL, Li Y, Chen JJ, Yang JC.

Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016, China. shuhaiguo@iae.ac.cn

Natural surface coating samples (NSCSs) from the surface of shingles and surficial sediments (SSs) in the Songhua River, China were employed to investigate the relationship between NSCSs and SSs in fractions of heavy metals (Fe, Mn, Zn, Cu, Pb, and Cd) using the modified sequential extraction procedure (MSEP). The results show that the differences between NSCSs and SSs in Fe fractions were insignificant and Fe was dominantly present as residual phase (76.22% for NSCSs and 80.88% for SSs) and Fe-oxides phase (20.33% for NSCSs and 16.15% for SSs). Significant variation of Mn distribution patterns between NSCSs and SSs was observed with Mn in NSCSs mainly present in Mn-oxides phase (48.27%) and that in SSs present as residual phase (45.44%). Zn, Cu, Pb and Cd were found dominantly in residual fractions (>48%), and next in solid oxides/hydroxides for Zn, Pb and Cd and in easily oxidizable solids/compounds form for Cu, respectively. The heavy metal distribution patterns implied that Fe/Mn oxides both in NSCSs and SSs were more important sinks for binding and adsorption of Zn, Pb and Cd than organic matter (OM), and inversely, higher affinity of Cu to OM than Fe/Mn oxides in NSCSs and SSs was obtained. Meanwhile, it was found that the distributions of heavy metals in NSCSs and SSs were similar to each other and the pseudo-total concentrations of Zn, Cu, Pb and Cd in NSCSs were greater than those in SSs, highlighting the more importance for NSCSs than SSs in controlling behaviours of heavy metals in aquatic environments.

Publication Types:
Research Support, Non-U.S. Gov't

PMID: 17294964 [PubMed - in process]

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9: J Hum Lact. 2007 Feb;23(1):70-1. Related Articles, Links


Herpes zoster in the t4 dermatome: a possible cause of breastfeeding strike.

Mathers LJ, Mathers RA, Brotherton DR.

University of Pittsburgh School of Medicine and Waukesha Family Practice Residency Program.

The authors report a case of breastfeeding strike temporally related to the onset of a herpes zoster prodrome involving the left breast.

PMID: 17293553 [PubMed - in process]

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10: Epidemiol Infect. 2007 Feb 12;:1-6 [Epub ahead of print] Related Articles, Links


Secular trends in the epidemiology of shingles in Alberta.

Russell ML, Schopflocher DP, Svenson L, Virani SN.

Department of Community Health Sciences, University of Calgary, Calgary, Canada.

Varicella vaccine was licensed in Canada in 1998, and a publicly funded vaccination programme introduced in the province of Alberta in 2001. In theory the vaccination programme might increase the burden of disease from shingles, making it important to develop baseline data against which future comparisons can be made. The study's aim was to describe the epidemiology of non-fatal cases of shingles for which publicly funded health services were utilized for the period 1986-2002. Shingles cases were identified from the records of Alberta's universal, publicly funded health-care insurance system for 1986-2002. The earliest dated health service utilizations for ICD-9-CM codes of 053 or ICD-10-CA codes of B02 were classified as incident. Diagnostic codes at least 180 days after the first were classified as recurrent episodes. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Annual age- and sex-specific rates were estimated. We explored the pattern of rates for sex, age and year effects and their interactions. Shingles rates increased between 1986 and 2002. There was a sex effect and evidence of an age-sex interaction. Females had higher rates than males at every age; however, the difference between females and males was greatest for the 50-54 years age group and declined for older age groups. The increased rate of shingles in Alberta began before varicella vaccine was licensed or publicly funded in Alberta, and thus cannot be attributed to vaccination.

PMID: 17291380 [PubMed - as supplied by publisher]

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11: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2006 Nov;41(11):821-4. Related Articles


[Bilateral facial nerve paralysis-diagnosis and treatment]

[Article in Chinese]

Wang H, Gao ZQ, Li YL, Liu W, Quan SM.

Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

OBJECTIVE: To observe the ways of diagnosis and treatment of bilateral facial nerve palsy. METHODS: Seven cases of bilateral facial nerve paralysis in 1996 - 2003 were retrospectively reviewed, and then the ways of diagnosis and therapies of these cases were analyzed. There were 6 patients with doubtless diagnosis. They were diagnosed as acute leukaemia, Vogt-Koyanagi-Harada disease (VKH), Machado-Jesoph disease, bilateral mandible fractures, Guillain-Barre syndrome, and Bell's palsy. The last one was diagnosed as Herpes zoster virus infection or Lyme disease. In all these cases, there were 4 of 5 positive cerebrospinal fluids test, 1 of 6 positive lyme antibody test, 2 of 5 positive images test, 7 of 7 EMG and Br test showed that the paralysis was peripheral palsy. All the 7 cases were treated with steroid and vitamin. RESULTS: House-Brackmann I was defined as complete recovery, after up to 2 months follow up, there were four cases got completely recovery while 2 cases incomplete recovery, and 1 case was not reacted to the therapy. CONCLUSIONS: Bilateral facial nerve paralysis was rare, and it was difficult to diagnosis and differentiation, while diagnostic mistakes would be serious. More attention should be paid to it in clinic.

Publication Types:
English Abstract

PMID: 17283534 [PubMed - in process]

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12: Otolaryngol Head Neck Surg. 2007 Feb;136(2):313-4. Related Articles, Links


Hutchinson sign and herpes zoster.

Murrell GL, Hayes BH.

Naval Hospital Camp Pendleton California, Camp Pendleton, CA, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA. glmurrell@cpen.med.navy.mil

PMID: 17275563 [PubMed - in process]

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13: Arch Phys Med Rehabil. 2007 Feb;88(2):255-8. Related Articles, Links


Postherpetic neuralgia involving the right c5 dermatome treated with a cervical transforaminal epidural steroid injection: a case report.

Shakir A, Kimbrough DA, Mehta B.

Western Reserve Spine and Pain Institute, Kent, OH.

Shakir A, Kimbrough DA, Mehta B. Postherpetic neuralgia involving the right C5 dermatome treated with a cervical transforaminal epidural steroid injection: a case report. A 66-year-old woman presented with 2 weeks of debilitating right upper-limb pain with a vesicular rash over the right C5 dermatome secondary to herpes zoster. Her pain failed to improve with: oral narcotics, divalproex, gabapentin, pregabalin, and topical 2% lidocaine cream. Six weeks postonset, a right C5 transforaminal epidural steroid injection (TESI) under fluoroscopic guidance was performed. Prior to the injection, her numeric pain intensity was rated as 9 to 10/10, and 15 minutes after the injection, it was reduced to 3/10. At 2 weeks, her pain had maintained an intensity of 3/10 and over another 2 weeks had resolved. She remained pain-free 3 months later. In this case, the use of a cervical TESI provided dramatic results in the treatment of debilitating postherpetic neuralgia (PHN). Further investigation is needed to determine the efficacy of TESI in the early management of PHN.

PMID: 17270526 [PubMed - in process]

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14: Rev Med Interne. 2007 Jan 17; [Epub ahead of print] Related Articles, Links


[Immunization of adults against varicella and herpes zoster.]

[Article in French]

Hanslik T, Blanchon T, Alvarez FP.

Service de medecine interne, hopital Ambroise-Pare, universite Versailles-Saint-Quentin-en-Yvelines, Assistance publique-Hopitaux de Paris, 9, avenue Charles-de-Gaulle, 92104 Boulogne Billancourt cedex, France; Inserm, U707, universite Pierre-et-Marie-Curie, UMR S 707, 75012 Paris, France.

PURPOSE: Following the commercialisation in France of the varicella vaccine and the European marketing authorization for a vaccine against zoster, this article intends to review the epidemiology of varicella and herpes zoster, to expose the characteristics of the available vaccines, and to consider the advantages and caveats of the different immunisation strategies. CURRENT KNOWLEDGE AND KEY POINTS: In France, from 550.000 to 750.000 cases of varicella are reported each year, which result in more than 3.500 hospitalizations and about 20 deaths. Subjects>/=15 years old represent 8.3% of the total number of cases of varicella, 26% of varicella-related hospitalisations and 69% of all varicella-related deaths. The susceptibility rate for the 15 years old is 10,3 and 79% of these non-immune subjects are expected to contract varicella. The vaccines currently marketed against varicella are safe, have a good immunogenicity and remain effective over the evaluated periods. Two vaccination strategies are considered: a generalized vaccination of the infants and children, or a vaccination targeted against high-risk populations and non-immune teenagers and adults. The incidence of herpes zoster is estimated in France at 235.000 new cases per year, from which 1% is hospitalized. A live attenuated vaccine using the same strain as the varicella vaccine, but at a much higher dose, proved its efficacy in terms of reducing shingles and postherpetic neuralgia incidences, of 51 and 67% respectively. This vaccine received a marketing authorisation in France, for adults>/=60 years old. FUTURE PROSPECTS: Uncertainties about the impact of vaccination on varicella and herpes zoster epidemiology have yet to be solved, such as the potential increase in herpes zoster incidence or in the absolute number of diagnosed varicella cases in older age groups, or the loss of vaccination-induced immunity with time. These questions demonstrate the need for an operational real-time surveillance network to monitor varicella and herpes zoster incidence in the setting of general population immunisation.

PMID: 17270316 [PubMed - as supplied by publisher]

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15: Georgian Med News. 2006 Dec;(141):50-3. Related Articles, Links


Peculiarities of herpes zoster in immunocompetent and immunocompromised hosts.

Sharvadze L, Tsertsvadze T, Gochitashvili N, Bolokadze N, Dolmazashvili E.

Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.

The aim of five years (2000-2005) study was to investigate the peculiarities of Herpes Zoster in immunocompromised and immunocompetent patients. For this purpose we have investigated the clinical course of Herpes Zoster, disease duration, complications of disease, as in acute phase as well as postherpetic neuralgia in 74 HIV positive (1st group) and 74 HIV negative (2nd group) groups of patients. In both group of patients we have studied the prevalence of the following complications: 1. Acute complications of Herpes Zoster: a) Neurological: motor neuropathy, cranial neuritis, meningoencephalitis, transverse myelitis. b) Ophthalmic: keratitis, iritis, retinitis, visual impairment c) Cutaneous: bacterial superinfection, scarring, disfigurement. d) Visceral: pneumonitis, hepatitis. e) Multidermatomal. 2. The complications of after resolution of infection: a) Postherpetic neuralgia and various duration of pain associated with postherpetic neuralgia such as : < month, 1-6 months, 6-12 months and >1 year durations. b) Recurrent herpes zoster. Herpes Zoster infection was diagnosed based on clinical symptoms and by detection of VZV specific IgM and IgG by ELISA. HIV infection was diagnosed by ELISA method and was confirmed by Western Blot. We found that Herpes Zoster may develop as in HIV positive as well as HIV negative population. Study showed that severe cases of disease (Herpes Zoster), long duration and rate of complications are much higher in HIV/AIDS than in HIV negative group patients. Rate of hospitalization is also higher in HIV/AIDS patients with Herpes Zoster than in HIV negative patients with Herpes Zoster. Frequency of recurrent Herpes Zoster is much higher in HIV/AIDS patients than in HIV negative patients. The postherpetic neuralgia is very frequent complication for both group (HIV positive and HIV negative) Herpes Zoster patients, but its duration longer in HIV/AIDS patients in comparison HIV negative group. There were no significant difference in disease severity, duration and complications among male and female patients.

PMID: 17261887 [PubMed - in process]

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16: Neurology. 2007 Jan 30;68(5):E4. Related Articles, Links


Spinal myoclonus following herpes zoster radiculitis.

Estraneo A, Saltalamacchia AM, Loreto V.

Salvatore Maugeri Foundation, IRCCS Via Bagni Vecchi, 82037 Telese Terme (BN), Italy. aestraneo@fsm.it

Publication Types:
Case Reports

PMID: 17261675 [PubMed - indexed for MEDLINE]

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17: Manag Care. 2006 Dec;15(12):57-8. Related Articles, Links


Herpes zoster vaccine brings relief for the elderly.

Morrow T.

Genentech Inc.

PMID: 17260848 [PubMed - indexed for MEDLINE]

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18: Rinsho Shinkeigaku. 2006 Sep;46(9):664-7. Related Articles, Links


[A case of herpes zoster associated Guillain-Barre syndrome with a relapse of eruptions after intravenous immunoglobulin therapy]

[Article in Japanese]

Nagane Y, Utsugisawa K, Obara D.

Department of Neurology, Hanamaki General Hospital.

A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness in four extremities immediately after improvement of herpes zoster in the left Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an increase in protein concentrations. Evidence of demyelinating polyneuropathy was demonstrated by nerve conduction studies. Her hypesthesia and weakness in the extremities were gradually improved following intravenous immunoglobulin therapy (IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was not detectable. These findings suggested autoimmune Guillain-Barre syndrome (GBS) associated with herpes zoster. An interesting finding in the present patient is that one day after the completion of IVIg, when the neurological symptoms in the extremities were apparently ameliorating, the herpes zoster eruptions again emerged in the left L3 dermatome area. By treatment with intravenous acyclovir, the vesicular eruptions were improved. We assume that IVIg might suppress the immune response against VZV and promote the recurrence of eruptions.

Publication Types:
English Abstract

PMID: 17260813 [PubMed - in process]

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19: Pharmacoeconomics. 2007;25(2):155-69. Related Articles, Links


Acute/Subacute Herpes Zoster: Healthcare Resource Utilisation and Costs in a Group of US Health Plans.

Insinga RP, Itzler RF, Pellissier JM.

Department of Health Economic Statistics, Merck Research Laboratories, North Wales, Pennsylvania, USA.

BACKGROUND: Although there are estimated to be nearly 1 million cases of herpes zoster diagnosed in the US each year, the economic costs associated with herpes zoster in the US have not been well described. OBJECTIVE: To describe the healthcare resource utilisation and costs associated with physician-diagnosed acute/subacute herpes zoster, from a payer perspective, using a large US healthcare claims database. METHODS: Data for the period 2000-1 were obtained from the Medstat Marketscan healthcare claims database. The duration of acute/subacute herpes zoster was considered to include the 21 days preceding, and 90 days following, the initial herpes zoster diagnosis. Resource utilisation was examined for individuals with newly diagnosed acute/subacute herpes zoster (n = 8741) and compared, through regression analyses, with that observed for control individuals from the same population (n = 50 000). Similar analyses were conducted for costs; the costs included reflected healthcare payments from patients, insurers and other sources.Regression analyses controlled for demographics (age, gender), conditions that have been observed with greater frequency among patients with acute/subacute herpes zoster in prior studies (cancer, HIV infection, organ transplantation, other immunosuppressive conditions and therapies) and the number of billed services within each of seven categories of care that were potentially related to acute/subacute herpes zoster and that were utilised within the 30-180 days prior to the diagnosis for affected patients, and over an analogous period for controls. RESULTS: The acute/subacute phase of herpes zoster was estimated to result in an average of 1.7 (standard error [SE] 0.02) additional physician and hospital outpatient visits, 0.05 (SE 0.003) additional emergency room visits, 0.03 (SE 0.003) additional inpatient hospital admissions, 2.1 (SE 0.03) additional prescriptions filled and $US431 (SE 17.60) in additional healthcare costs per patient. Among patients with acute/subacute herpes zoster, 21.1% had a diagnosis code with a designation for a herpes zoster-related complication, and 9.4% had three or more outpatient visits with a diagnosis code for herpes zoster. The average estimated incremental costs per patient with acute/subacute disease increased with age, ranging from $US258 (SE 37.70) among patients aged /=80 years. The numbers of additional outpatient visits, inpatient admissions, prescriptions filled for pain medications and coded complications were also substantially higher among older than younger patients with acute/subacute herpes zoster. CONCLUSIONS: The management of acute/subacute herpes zoster was found to result in substantial healthcare costs, with outpatient care and prescription drugs comprising the majority of the cost burden. To more fully understand the overall cost of herpes zoster disease to society, future studies should examine the healthcare costs associated with post-herpetic neuralgia and productivity losses due to herpes zoster and post-herpetic neuralgia.

PMID: 17249857 [PubMed - in process]

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20: Singapore Med J. 2007 Jan;48(1):e16-8. Related Articles, Links


Herpes zoster complicating imatinib mesylate for gastrointestinal stromal tumour.

Durosinmi MA, Ogbe PO, Salawu L, Oyekunle AA.

Departments of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. mdurosin@yahoo.com

Varicella zoster virus (VZV) infection is uncommon in patients with gastrointestinal stromal tumour (GIST) and who have not been exposed to extensive radiotherapy and/or high-dose chemotherapy. We report a 56-year-old Nigerian man with GIST who developed VZV infection while on imatinib mesylate therapy. From August 2003 to November 2005, 64 patients (GIST/CML = 6/58) were enrolled into an ongoing Glivec (imatinib mesylate) international patient-assistance programme therapy for Philadelphia/bcr-abl-positive chronic myeloid leukaemia (CML) and CD117-positive GIST patients at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The patient developed herpes zoster (HZ) infection 23 months into therapy with Glivec. With his absolute lymphocyte count at 2,774 cells per microlitre and CD4 count at 950 cells per microlitre, no obvious immunological defect was observed. Prompt resolution of symptoms without sequelae was achieved by treating with acyclovir, analgesic and dressing of lesions with desiccant. To our knowledge, this is the first reported case of HZ infection in a patient with GIST on Glivec therapy, and the response is similar to that of CML patients who developed VZV while on similar therapy.

Publication Types:
Case Reports

PMID: 17245498 [PubMed - indexed for MEDLINE]