Ann Dermatol.  2017 Jun;29(3):283-287. 10.5021/ad.2017.29.3.283.

Risk Factors for Aseptic Meningitis in Herpes Zoster Patients

Affiliations
  • 1Department of Neurology, Chonnam National University Medical School, Gwangju, Korea. byeong.kim7@gmail.com
  • 2Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.

Abstract

BACKGROUND
Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. HZ-associated aseptic meningitis, a rare complication of HZ, can require hospitalization and a long treatment period.
OBJECTIVE
A retrospective study was performed to identify potential factors associated with HZ-associated aseptic meningitis development.
METHODS
We included all outpatients and patients admitted in the neurology and dermatology departments of a single tertiary center, who were diagnosed with HZ for two years. Among 818 patients, 578 patients were eligible for analysis.
RESULTS
The demographics and potential risk factors were compared between the uncomplicated HZ group (n=554) and aseptic meningitis group (n=24). Among the potential factors, the dermatological distribution of skin rash and gender showed statistically significantly different between the two groups. Patients with craniocervical distribution of HZ accounted for 87.5% (n=21) of the aseptic meningitis group and 54.3% (n=301) of the uncomplicated HZ group (p=0.043). The aseptic meningitis group had more men (66.7%, n=16) than the uncomplicated HZ group (42.8%, n=237, p=0.033). Patients with craniocervical distribution had an odds ratio (OR) of 5.884 (p=0.001) for developing aseptic meningitis when compared with the other dermatome involvements. Additional logistic regression analysis resulted in a fading between gender difference (p=0.050) and craniocervical involvement having an OR of 5.667 for aseptic meningitis (p=0.006).
CONCLUSION
In HZ patients, skin rash with craniocervical distribution and male gender were associated with a higher risk of aseptic meningitis.

Keyword

Herpes zoster; Herpesvirus 3; human; Meningitis; aseptic; Risk factors

MeSH Terms

Demography
Dermatology
Exanthema
Herpes Zoster*
Herpesvirus 3, Human
Hospitalization
Humans
Logistic Models
Male
Meningitis
Meningitis, Aseptic*
Neurology
Odds Ratio
Outpatients
Retrospective Studies
Risk Factors*

Reference

1. Ku CC, Padilla JA, Grose C, Butcher EC, Arvin AM. Tropism of varicella-zoster virus for human tonsillar CD4(+) T lymphocytes that express activation, memory, and skin homing markers. J Virol. 2002; 76:11425–11433.
Article
2. Chen JJ, Gershon AA, Li ZS, Lungu O, Gershon MD. Latent and lytic infection of isolated guinea pig enteric ganglia by varicella zoster virus. J Med Virol. 2003; 70:Suppl 1. S71–S78.
Article
3. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007; 82:1341–1349.
Article
4. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 2000; 342:635–645.
Article
5. Galil K, Choo PW, Donahue JG, Platt R. The sequelae of herpes zoster. Arch Intern Med. 1997; 157:1209–1213.
Article
6. Hughes BA, Kimmel DW, Aksamit AJ. Herpes zoster-associated meningoencephalitis in patients with systemic cancer. Mayo Clin Proc. 1993; 68:652–655.
Article
7. Kleinschmidt-Demasters BK, Mahalingam R, Shimek C, Marcoux HL, Wellish M, Tyler KL, et al. Profound cerebrospinal fluid pleocytosis and Froin's syndrome secondary to widespread necrotizing vasculitis in an HIV-positive patient with varicella zoster virus encephalomyelitis. J Neurol Sci. 1998; 159:213–218.
Article
8. Haanpää M, Dastidar P, Weinberg A, Levin M, Miettinen A, Lapinlampi A, et al. CSF and MRI findings in patients with acute herpes zoster. Neurology. 1998; 51:1405–1411.
Article
9. Becerra JC, Sieber R, Martinetti G, Costa ST, Meylan P, Bernasconi E. Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study. Int J Infect Dis. 2013; 17:e529–e534.
Article
10. Studahl M, Petzold M, Cassel T. Disease burden of herpes zoster in Sweden--predominance in the elderly and in women-a register based study. BMC Infect Dis. 2013; 13:586.
11. Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis. 2013; 13:170.
Article
12. Antonelli MA, Moreland LW, Brick JE. Herpes zoster in patients with rheumatoid arthritis treated with weekly, low-dose methotrexate. Am J Med. 1991; 90:295–298.
Article
13. Korelitz BI, Fuller SR, Warman JI, Goldberg MD. Shingles during the course of treatment with 6-mercaptopurine for inflammatory bowel disease. Am J Gastroenterol. 1999; 94:424–426.
Article
14. Miller GG, Dummer JS. Herpes simplex and varicella zoster viruses: forgotten but not gone. Am J Transplant. 2007; 7:741–747.
Article
15. Kim DH, Messner H, Minden M, Gupta V, Kuruvilla J, Wright J, et al. Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low-dose acyclovir prophylaxis and pre-transplant diagnosis of lymphoproliferative disorders. Transpl Infect Dis. 2008; 10:90–98.
Article
16. Kuo CC, Lee CT, Lee IM, Ho SC, Yang CY. Risk of herpes zoster in patients treated with long-term hemodialysis: a matched cohort study. Am J Kidney Dis. 2012; 59:428–433.
Article
17. Wu MY, Hsu YH, Su CL, Lin YF, Lin HW. Risk of herpes zoster in CKD: a matched-cohort study based on administrative data. Am J Kidney Dis. 2012; 60:548–552.
Article
18. Kupila L, Vuorinen T, Vainionpää R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006; 66:75–80.
Article
Full Text Links
  • AD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr