Herpes zoster, what are the complications of not detecting it on time?

MADRID, 30 April. (EDITIONS) -

In recent years there has been a reactivation of herpes zoster disease, an infectious pathology that is due to the reactivation of the latent varicella-zoster virus. This affects the peripheral nerves and the skin, where it can produce small and painful ring-shaped blisters, and grouped along the distribution area of ​​the nerve called 'dermatoma', as described by the Spanish Society of Internal Medicine.

From the National Epidemiology Center (CNE) they recall that the varicella zoster virus is a 'herpesvirus' that causes two diseases, in both cases preventable thanks to vaccination: chickenpox, common in childhood, and for which for a few years a vaccine is administered in the pediatric age; and then herpes zoster, which arises because the same virus that caused chickenpox remains latent in the body, reactivates and can cause this infection in adulthood.

Precisely, researchers from the CNE, the Carlos III Health Institute and the CIBER of Epidemiology and Public Health (CIBERESP), have published a scientific study in the magazine 'Eurosurveillance', belonging to the European Center for Disease Prevention and Control (or ECDC, for its acronym in English), on hospitalization for herpes zoster in Spain.

In it they state that hospitalizations in our country due to herpes zoster have increased between 1998 and 2018, and that "vaccination in Spain is well aligned with its clinical consequences", since it has been confirmed that the most serious cases, in In terms of mortality and hospital readmission, they correspond to the specific population groups in which vaccination is recommended.

We interviewed in Infosalus one of the authors of the study, Josefa Masa, a researcher at the National Epidemiology Center, who remarks that "it is not that there is a boom" in cases of herpes zoster in these years, but that it is an infectious pathology that it is increasing, "that it is growing", and fundamentally he attributes it to the aging of the population.

This infection, according to the researcher, although it can occur at any age, and even in healthy people, is more frequent after 50 years of age, "especially after 60-65 when the immune system begins to be a little more weak", as well as in immunosuppressed people, in people with transplants, or with chemotherapy treatments, as well as in those with HIV or AIDS.

From the CNE they point out that herpes zoster is characterized by a painful skin eruption, which can sometimes be complicated by prolonged neuralgia, the dreaded 'post-herpetic neuralgia', with encephalitis, pneumonia, hearing problems and eye complications with temporary or permanent loss of vision.

"The clinical form is different from chickenpox. It is like a shingles, an eruption of vesicles, which continues in a dermatome, generally in the lower back and thoracic area, and is accompanied by pain that can be intense, prolonged and resistant. ", explains to Infosalus the specialist in Dermatology of the Hospital Universitari i Politècnic La Fe de Valencia, Dr. Javier López.

Specifically, among its complications, apart from post-herpetic neuralgia, which is usually the most frequent, Dr. López states that there may be symptoms such as fever, chills; and then there are more serious cases such as pancreatitis, encephalitis, motor paralysis, pneumonia, but only in more exceptional cases. In turn, he points out that special caution must be taken with this disease if it affects the facial region, if it is in the eye and ear area, because in a few cases it has produced blindness or deafness, but only very exceptionally. .

He says that in principle it is a mild and self-resolving disease, which can occur at any age, although more frequently in those over 50 and in the case of immunosuppressed or elderly people, as we have mentioned, and in those who, in addition Yes, there can be complications, although he points out that they are not very frequent.

In this sense, this dermatologist points out that in the case of children the infection is usually milder, a more self-limited condition, and is generally not treated: "It is less frequent and less serious and more self-limited and the rate of complications increases exponentially with age.

"It is not very clear why it reactivates, but it is seen that it does so in older people, after 50, so there is surely an influence of cellular immunity, so that with age you begin to lose the immunity and makes it more common after the fifth decade of life, as happens with other autoimmune diseases", emphasizes Dr. López.

It is true that some triggers such as infections can also cause reactivation, says this specialist. Regarding whether herpes zoster is contagious, the specialist from the Hospital Universitari i Politècnic La Fe in Valencia states that in principle it is not, but what is contagious, and a lot, is a chickenpox infection, as he points out, and in the case of Herpes zoster, unless the vesicles are touched, is very difficult to spread, as he acknowledges.

On the other hand, this dermatologist points out that it is important to detect herpes zoster infection on time because the treatment is more effective if it is applied in the first 72-96 hours of infection: "The earlier, the more effective the treatment, since when It already has an evolution of one or two weeks, it is not effective; therefore, if the treatment is applied before, it will be more effective, especially when it comes to minimizing side effects such as post-herpetic neuralgia, which greatly reduces the quality of life of the people".

"The herpes zoster vaccine, which is financed by Social Security, decreases the frequency of reactivation of the virus. It is quite effective and safe and today in our health system it is received by bone marrow transplant recipients, solid organ transplant recipients, those who receive cancer treatment, or for HIV, among others, where it has been seen that herpes zoster can have a higher incidence," he remarks.

In fact, Josefa Masa, from the National Epidemiology Center, indicates at this point that the use of the herpes zoster vaccine is useful because it prevents infection, as well as one of its main complications that we have discussed, post-herpetic neuralgia. .