brivudine and Neuralgia--Postherpetic

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

The overall incidence of herpes zoster in Europe is approximately 3 per 1000 people per year and more than 10 per 1000 people per year in those aged >80 years. Post herpetic neuralgia (PHN) is a common debilitating complication of herpes zoster, particularly in patients aged >50 years, in persons with severe pain or rash at presentation, and in those with significant prodromal symptoms. Antiviral drugs can effectively control acute symptoms and, if used early enough in the course of the illness, can help prevent the development of PHN and other complications. However, despite this, many patients do not receive such treatment. The economic impact of zoster and PHN is largely underestimated in Europe. Furthermore, there is considerable variation throughout Europe in the management of herpes zoster. Use of antiviral therapy including the newer potent antiviral agents such as brivudin, which requires less frequent administration than acyclovir, is improving patient outcomes in some European countries. However, in many countries, patient awareness of herpes zoster and, as a result, overall antiviral use is low. Guidelines recommending the use of antiviral agents, particularly in patients at risk of developing PHN, are available but are not widely used. More needs to be done to educate the general public and increase awareness among primary healthcare providers of the benefits of timely and appropriate pharmacological therapy in patients with herpes zoster.

Topics: Age Distribution; Aged; Aged, 80 and over; Antiviral Agents; Bromodeoxyuridine; Dose-Response Relationship, Drug; Drug Administration Schedule; Europe; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Prognosis; Recurrence; Risk Assessment; Severity of Illness Index; Sex Distribution; Treatment Outcome

Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclusion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Biomarkers; Biopsy; Bromodeoxyuridine; Famciclovir; Female; Herpes Zoster; Humans; Immunohistochemistry; Male; Middle Aged; Nerve Fibers; Neuralgia, Postherpetic; Skin; Ubiquitin Thiolesterase; Valacyclovir; Valine

Mielitis cervicodorsal secundaria a infeccion por el virus varicela zoster en un paciente inmunocompetente.

Topics: Acyclovir; Antiviral Agents; Arm; Athetosis; Bromodeoxyuridine; Drug Therapy, Combination; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyperalgesia; Immunocompetence; Male; Methylprednisolone; Middle Aged; Movement Disorders; Myelitis; Neck; Neuralgia, Postherpetic; Somatosensory Disorders; Thorax; Virus Activation