JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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Year : 2020 Month : September Volume : 7 Issue : 36 Page : 1980-1983.

A Study of Clinico-Epidemiologic Profile of Herpes Zoster in Central India

Chaitanya Namdeo1, Kailash Bhatia2, Deepa Saini3, Pravesh Yadav4, Sumit Chauhan5

1Department of Skin and VD, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. 2Department of Skin and VD, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. 3Department of Skin and VD, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. 4Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. 5Department of Skin and VD, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India.

CORRESPONDING AUTHOR

Dr. Pravesh Yadav, Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospital, New Delhi, India.
Email : rao.pravesh@gmail.com

ABSTRACT

Background

Herpes zoster is a viral infection which occurs as a result of reactivation of varicella zoster virus lying dormant in dorsal root and cranial nerve ganglia. The complications can be severe. The pattern and complications keep changing in the population due to various factors like immunosuppression and comorbidities. We planned to study the clinical characteristics, complications, and risk factors in patients of herpes zoster.

 

Methods

This was a prospective, hospital based, observational study involving 170 clinically diagnosed patients of herpes zoster. A detailed clinical evaluation regarding the demography, segment of involvement, pattern of lesions, risk factors, and complications was performed and recorded. Data was coded and entered in SPSS version 16. Qualitative data was expressed in proportions / percentage. Chi-square test and t - test were applied wherever applicable. A p - value of < 0.05 was considered statistically significant.

 

Results

Male to female ratio was 2.1 : 1. Maximum cases were seen in the age group of 51 - 60 years (22.9 %), followed by 31 - 40 and 61 - 70 (18.8 % each). Left side involvement was more common. Pain in the affected dermatome was the most common prodromal symptom. Fever and myalgia were the most commonly reported constitutional symptoms. Only 80 patients had past history of varicella. Thoracic dermatomes were the most commonly involved followed by cranial, cervical, lumbar and sacral dermatomes. Fourty eight patients had associated risk factors for herpes zoster infection. Complications secondary to herpes zoster infection developed in 40 patients. Patients who developed complications had a significantly higher mean age than those who didn’t.

 

Conclusions

Herpes zoster was seen more commonly in males. Most commonly affected age group was 51 - 60 years. Thoracic dermatomes were most commonly involved. Risk factors were seen in 28.2 % patients. Complications were seen in 23.5 % patients including post herpetic neuralgia in 14.2 % patients. Patients of higher age group are at higher risk of complications.

 

Keywords

Herpes Zoster, Epidemiology, India

BACKGROUND

Herpes zoster also known as shingles, is a viral disease which occurs as a result of reactivation of varicella zoster virus lying dormant in dorsal root and cranial nerve ganglia.1,2 This concept was suggested by Garland in 1943. Dysfunction of cell mediated immunity and increasing age are well established risk factors for varicella zoster virus reactivation.2 Other risk factors are psychological stress, diabetic mellitus, hypertension, old age, family history.3,4 The present study was undertaken to find out the age, incidence, prevalence of prodromal symptoms, pattern of dermatomal involvement, association with HIV, other cutaneous disease and systemic disease.

We wanted to study the clinical characteristics, complications, and risk factors in patients of herpes zoster.

METHODS

This was a prospective, hospital based, observational study conducted from September 2018 to Jan 2020 in the Department of Dermatology and STD in Sri Aurobindo Institute of Medical College and Hospital. A total of 170 clinically diagnosed patients of herpes zoster attending our department in the study duration were enrolled in the study.

Clinical details of the patients were recorded in a pre - designed proforma. Patient’s age, sex, occupation and address were noted. A detailed history regarding the prodromal symptoms, skin lesions, nature of pain, provocative factors, history of varicella, associated cutaneous disorders, systemic disease, HIV and HCV infection was recorded. Detailed cutaneous and systemic examination of the patients was conducted by a dermatologist. Disease characteristics including morphology of skin lesions, side of involvement, cutaneous dissemination, mucosal lesions, and signs of other systemic and cutaneous diseases were recorded.

Relevant investigations (if needed) were carried out. Patients were treated as per the standard protocol and they were assessed with regard to the course of disease, time taken for resolution of lesions and for persistent pain and other complications.

Data was coded and entered in SPSS version 16. Qualitative data was expressed in proportions / percentage. Chi-square test and t - test were applied wherever applicable. A p - value of < 0.05 was considered statistically significant.

RESULTS

The mean age of the study population was 47.4 ± 16.1 years. Out of total 170 cases, 115 (67.6 %) were males and 55 (32.4 %) were females. Male to female ratio was 2.1 : 1. Maximum number of cases were seen in the age group of 51 - 60 years (22.9 %), followed by 31 - 40 and 61 - 70 (18.8 % each). Only one case each belonged to less than 10 years of age and more than 80 years of age. Oldest patient was of 81 years age and the youngest patient was 9 years old (Table 1).

Left side involvement was more common, seen in 98 patients (57.6 %) (67 males and 31 females) than right side involvement, seen in 72 patients (42.4 %) (48 males and 24 females) (Table 2). Pain in the affected dermatome was the most common symptom present in 157 (92.3 %) patients. Pain associated with burning sensation was reported in 30 (17.6 %) patients and along with itching in 10 (5.8 %) patients. Out of 170 patients, 126 patients (74.1 %) had onset of pain less than 4 days before the onset of symptoms.

Constitutional symptoms were present in only 106 patients (63.4 %). Fever and myalgia (85 patients, 50.0 %) were the most commonly reported constitutional symptoms followed by headache (15 patients, 8.8 %), eye and earache in (3 patients each, 1.8 %). Among 170 patients, only 80 (47.1 %) patients had past history of varicella.

 

Age Group

Male

Female

Total No. of Cases (%)

1 - 10

1

0

1 (0.6)

11 - 20

7

1

8 (4.7)

21 - 30

11

5

16 (9.4)

31 - 40

23

9

32 (18.8)

41 - 50

20

8

28 (16.5)

51 - 60

25

14

39 (22.9)

61 - 70

21

11

32 (18.8)

71 - 80

7

6

13 (7.6)

81 - 90

0

1

1 (0.6)

Total

115

55

170 (100)

Table 1. Age- and Sex-Wise Prevalence of                                      herpes Zoster Cases

 

Region

Sex

Side

Number of Cases (%)

Male

Female

Right

Left

Cranial

23

13

18

18

36 (21.2 %)

Cervical

15

6

10

11

21 (12.4 %)

Thoracic

71

29

40

60

100 (58.8 %)

Lumbar

9

8

7

10

17 (10.0 %)

Sacral

0

3

2

1

3 (1.8 %)

Cervico - thoracic

2

2

3

1

4 (2.3 %)

Thoraco - lumbar

0

1

1

0

1 (0.6 %)

Lumbo- sacral

1

1

1

1

2 (1.2 %)

Total

115

55

72

98

170 (100 %)

Table 2. Segmental Distribution of herpes Zoster

 

Risk Factor

Number of Patients (%)

Diabetes

13 (7.6 %)

Hypertension

12 (7.0 %)

Hypothyroidism

4 (2.3 %)

History of major surgeries

10 (5.8 %)

HIV

2 (1.1 %)

Psoriasis

2 (1.1 %)

Chronic alcoholic

14 (8.2 %)

HCV

3 (1.7 %)

Typhoid

5 (2.9 %)

Leprosy

2 (1.1 %)

Chemotherapy

1 (0.5 %)

Total

68 (40 %)

Table 3. Prevalence of Risk Factors in the Study Subjects

 

Thoracic dermatomes were the most commonly involved (100 patients, 58.8 %) followed by cranial (36 patients, 21.2 %), cervical (21 patients, 12.4 %), lumbar (17 patients, 10 %) and sacral dermatomes (3 patients, 1.8 %). Among cranial nerves, ophthalmic division was the most commonly involved (19 patients) followed by maxillary (11 patients) and mandibular division (6 patients). Among cervical dermatomes, C5 was most commonly involved (5 patients) followed by C4, C6 and C8 (4 patients each). Among thoracic dermatomes, T4 was the most common dermatome involved (22 patients) followed by T3 (15 patients), T10 (14 patients), T2 (13 patients) and T5 dermatome (10 patients). In lumber dermatomes, L4 was the most common dermatome involved (6 patients) followed by L2 and L3 (4 patients each). Three patients (1.7 %) had disseminated herpes.

 

 

 

 

 

Figure 1.

Ulceration Over              the Chest Associated with herpes                Zoster