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]

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

[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]

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

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]

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

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]

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

[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]

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

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]

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

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]

8: J Environ Sci (China). 2006;18(6):1193-8. 

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]

9: J Hum Lact. 2007 Feb;23(1):70-1. 

Herpes zoster in the T4 dermatome: a possible cause of breastfeeding strike.

Mathers LJ, Mathers RA, Brotherton DR.

University of Pittsburgh School of Medicine, Waukesha Family Practice Residency
Program, Pittsburgh, PA, USA.

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]

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

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]

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

[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]

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

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]

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

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 44240, USA.
docshakir@hotmail.com

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]

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

[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]

15: Georgian Med News. 2006 Dec;(141):50-3. 

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]

16: Neurology. 2007 Jan 30;68(5):E4. 

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]

17: Manag Care. 2006 Dec;15(12):57-8. 

Herpes zoster vaccine brings relief for the elderly.

Morrow T.

Genentech Inc.

PMID: 17260848 [PubMed - indexed for MEDLINE]

18: Rinsho Shinkeigaku. 2006 Sep;46(9):664-7. 

[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]

19: Pharmacoeconomics. 2007;25(2):155-69. 

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 </=19 years to $US805 (SE
106.30) among those 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]

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

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]