Herpes zoster: current approaches to diagnosis and treatment

DOI: https://doi.org/10.29296/25877305-2022-10-04
Issue: 
10
Year: 
2022

A. Ignatovsky, Candidate of Medical Sciences
Saint Petersburg State University

The paper considers the clinical characteristics of herpes zoster (HZ) and its complications in different patient categories. It gives the pharmacokinetics and pharmacodynamics of unusual nucleoside agents in the treatment of varicella-zoster virus infection. The authors show the advantages of famciclovir in the therapy of HZ, particularly the effect of the drug on the manifestations of acute herpetic neuralgia and its ability to reduce the risk of post-herpetic neuralgia.

Keywords: 
dermatology
neurology
herpes zoster
post-herpetic neuralgia
famciclovir



References: 
  1. Heininger U., Seward J.F. Varicella. Lancet. 2006; 368: 1365e76. DOI: 10.1016/S0140-6736(06)69561-5
  2. Афонина Н., Михеева И. Современная эпидемиологическая характеристика ветряной оспы в России. One Health & Risk Management. 2020; 1 (1): 12–21 [Afonina N., Mikheeva I. Modern epidemiological characteristics of chickenpox in Russia. One Health & Risk Management. 2020; 1 (1): 12–21 (in Russ.)]. DOI: 10.5281/zenodo.3700955
  3. John A.R., Canaday D.H. Herpes zoster in the older adult. Infect Dis Clin North Am. 2017; 31 (4): 811–26. DOI: 10.1016/j.idc.2017.07.016
  4. Опоясывающий герпес. Федеральные клинические рекомендации. Дерматовенерология [интернет]. М., 2016; с. 305–14 [Federal clinical guidelines. Dermatovenereology [Internet]. M., 2016; рр. 305–14 (in Russ.)]. URL: http://www.cnikvi.ru/docs/2335_maket_30.pdf
  5. Колоколов О.В., Бакулев А.Л., Шульдяков А.А. и др. Поражение нервной системы, ассоциированное с герпесвирусом человека третьего типа: акценты на профилактику боли и инсульта. Клиническая практика. 2019; 10 (2): 74–84 [Kolokolov O.V., Bakulev A.L., Shuldyakov A.A. et al. Nervous system damage associated with human herpesvirus of the third type: emphasis on the prevention of pain and stroke. Clinical practice. 2019; 10 (2): 74–84 (in Russ.)]. DOI: 10.17816/clinpract10274–84
  6. Цукер М.Б. Поражения нервной системы, вызываемые вирусами группы герпеса. Клиническая медицина. 1976; 54 (9): 90–7 [Zucker MB. Defeats of the nervous system caused by viruses of the herpes group. Klinicheskaia meditsina. 1976; 54 (9): 90–7 (in Russ.)].
  7. Wang Z., Ye J., Han Y.H. Acute pancreatitis associated with herpes zoster: case report and literature review. World J Gastroenterol. 2014; 20 (47): 18053–6. DOI: 10.3748/wjg.v20.i47.18053
  8. Таха Т.В. Опоясывающий герпес: клиника, диагностика, принципы терапии. РМЖ. 2012; 20 (34): 1644–8 [Taha T.V. Herpes zoster: clinic, diagnosis, principles of therapy. RMJ. 2012; 20 (34): 1644–8 (in Russ.)].
  9. Dworkin R., Gnann G., Oaklander A. et al. Diagnosis and assessment of pain associated with herpes zoster and postgerpetic neuralgia. J Pain. 2008; 9(1 Suppl 1): S37–44. DOI: 10.1016/j.jpain.2007.10.008
  10. Деконенко Е.П. Клинические проявления, частота и лечение заболеваний, вызываемых вирусом варицелла-зостер. Альманах клинической медицины. 2001; 4: 271–5 [Dekonenko E.P. Clinical manifestations, frequency and treatment of diseases caused by varicella-zoster virus. Almanah of clinical medicine. 2001; 4: 271–5 (in Russ.)].
  11. Saru S., Gupta R., Kaur S. et al. Post-herpetic neuralgia: review of current management strategies. Indian J Pain. 2013; 27 (1): 12–21. DOI: 10.4103/0970-5333.114857
  12. Schmader K.E. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002; 18 (6): 350–4. DOI: 10.1097/00002508-200211000-00002
  13. Dworkin R.H. et al. Acute pain in herpes zoster: the famciclovir database project. Pain. 2001; 94 (1): 113–9. DOI: 10.1016/S0304-3959(01)00347-5
  14. Whitley R.J. Varicella-zuster virus infections. In: Galasso G.J., Whitley R.J., Merigan T.C., eds. Antiviral agents and virus diseases of man, 3rd edn. 1990; рр. 235–63.
  15. Kost R.G., Straus S.E. Postherpetic neuralgia-pathogenesis, treatment, and prevention [review]. N Engl J Med. 1996; 335 (1): 32–42. DOI: 10.1056/NEJM199607043350107
  16. Волкова Л.В. Современные аспекты лечения и профилактики постгерпетической невралгии. Вестник фармации. 2009; 6: 34–7. [Volkova L.V. Modern aspects of treatment and prevention of postherpetic neuralgia. Bulletin of Pharmacy. 2009; 6: 34–7 (in Russ.)].
  17. Sampathkumar P., Drage L.A., Martin D.P. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009; 84 (3): 274–80. DOI: 10.4065/84.3.274
  18. Truini A., Galeotti F., Haanpaa M. et al. Pathophysiology of pain in postherpetic neuralgia:a clinical and neurophysiological study. Pain. 2008; 140 (3): 405–10. DOI: 10.1016/j.pain.2008.08.018
  19. Opstelten W., McElhaney J., Weinberger B. et al.The impact of varicella zoster virus: chronic pain. J Clin Virol. 2010; 48 (Suppl 1): S8–13. DOI: 10.1016/S1386-6532(10)70003-2
  20. Ruocco V., Sangiuliano S., Brunetti G. et al. Beyond zoster: sensory and immune changes in zoster-affected dermatomes: a review. Acta Derm Venereol. 2012; 92 (4): 378–82. DOI: 10.2340/00015555-1284
  21. Grahn A., Studahl M. Varicella-zoster virus infections of the central nervous system – prognosis, diagnostics and treatment. J Infect. 2015; 71 (3): 281–93. DOI: 10.1016/j.jinf.2015.06.004
  22. Wu P.H., Chuang Y.S., Lin Y.T. Does Herpes Zoster increase the risk of stroke and myocardial infarction? A comprehensive review. J Clin Med. 2019; 8 (4): pii: E547. DOI: 10.3390/jcm8040547
  23. Johnson R.W., Dworkin R.H. Treatment of herpes zoster and postherpetic neuralgia. BMJ. 2003; 326 (7392): 748–50. DOI: 10.1136/bmj.326.7392.748
  24. Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis. 2016; 35: 723e34. DOI: 10.1007/s10096-016-2605-0
  25. O’Brien J.J., Campoli-Richards D.M. Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs. 1989; 37 (3): 233–309. DOI: 10.2165/00003495-198937030-00002
  26. Wood M.J. et al. Efficacy of oral acyclovir treatment of acute herpes zoster. Am J Med. 1988; 85 (2A): 79–83.
  27. Huff J.C. et al. Therapy of herpes zoster with oral acyclovir // The Am J Med. 1988; 85 (2A): 84–9.
  28. Huff J.C. et al. Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis. J Med Virol. 1993; 41 (S1): 93–6. DOI: 10.1002/jmv.1890410518
  29. Chen N. et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014; 2: CD006866. DOI: 10.1002/14651858.CD006866.pub3
  30. Lilie H.M., Wassilew S.W. The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster. Drugs Aging. 2003; 20 (8): 561–70. DOI: 10.2165/00002512-200320080-00002
  31. Шаков И.М. Опоясывающий лишай. Лечащий врач. 2011; 10: 14. [Shakov I.M. Shingles. Lechaschi Vrach. 2011; 10: 14 (in Russ.)].
  32. Beutner K.R. et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. 1995; 39 (7): 1546–53. DOI: 10.1128/AAC.39.7.1546
  33. Segarra-Newnham M., Tagoff S.S. Valacyclovir and postherpetic neuralgia. J Pharm Technol. 2004; 20 (4): 229–32.
  34. Opstelten W. et al. Treatment of herpes zoster. Can Fam Physician. 2008; 54 (3): 373–7.
  35. Crumpacker C. The pharmacological profile of famciclovir. Semin Dermatol. 1996; 15 (2 Suppl 1): 14–26.
  36. Tyring S.K. Advances in the treatment of herpesvirus infection: the role of famciclovir. Clin Ther. 1998; 20 (4): 661–70. DOI: 10.1016/s0149-2918(98)80129-x
  37. Pue M.A. et al. Linear pharmacokinetics of penciclovir following administration of single oral doses of famciclovir 125, 250, 500 and 750 mg to healthy volunteers. J Antimicrob Chemother. 1994; 33 (1): 119–27. DOI: 10.1093/jac/33.1.119
  38. Bacon T.H. et al. Herpes simplex virus resistance to acyclovir and penciclovir after two decades of antiviral therapy. Clin Microbiol Rev. 2003; 16 (1): 114–28. DOI: 10.1128/CMR.16.1.114-128.2003
  39. Data on file. Philadelphia, Pa: Smith Kline Beecham, 1998.
  40. Dworkin R.H. et al. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis. 1998; 178 (Suppl 1): S76–S80. DOI: 10.1086/514260
  41. Earnshaw D.L. et al. Mode of antiviral action of penciclovir in MRC-5 cells infected with herpes simplex virus type 1 (HSV-1), HSV-2, and varicella-zoster virus. Antimicrob Agents Chemother. 1992; 36 (12): 2747–57. DOI: 10.1128/AAC.36.12.2747
  42. Perry C.M., Wagstaff A.J. Famciclovir. A review of its pharmacological properties and therapeutic efficacy in herpesvirus infections. Drugs. 1995; 50 (2): 396–415. DOI: 10.2165/00003495-199550020-00011
  43. Pue M.A., Benet L.Z. Pharmacokinetics of famciclovir in man. Antiviral Chem Chemother. 1993; 4 (6 suppl): 47–55. DOI: 10.1177/09563202930040S602
  44. Cirelli R. et al. Famciclovir: review of clinical efficacy and safety. Antiviral Res. 1996; 29 (2-3): 141–51. DOI: 10.1016/0166-3542(95)00941-8
  45. Sacks S.L. Famciclovir (FAMVIR®). Infect Dis Obstet Gynecol. 1997; 5 (1): 3–7. DOI: 10.1155/S1064744997000033
  46. Boyd M.R., Safrin S., Kern E.R. Penciclovir: a review of spectrum of activity, selectivity, and cross-resistance pattern. Antiviral Chem Chemother. 1993; 4 (Suppl 1): 3–11. DOI: 10.1177/095632029300401S01
  47. Bacon T., Schinazi R. An overview of the further evaluation of penciclovir against herpes simplex virus and varicella-zoster virus in cell culture, highlighting contrasts with acyclovir. Antiviral Chem Chemother. 1993; 4 (Suppl 1): 25–36. DOI: 10.1177/09563202930040S603
  48. Standring-Cox R., Bacon T.H., Howard B. et al. Prolonged activity of penciclovir in cell culture against varicella-zoster virus [Abstract]. Antiviral Res. 1994; 23 (Suppl 1): 96.
  49. Tyring S. et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995; 123 (2): 89–96. DOI: 10.7326/0003-4819-123-2-199507150-00002
  50. Ono F. et al. Comparison between famciclovir and valacyclovir for acute pain in adult Japanese immunocompetent patients with herpes zoster. J Dermatol. 2012; 39 (11): 902–8. DOI: 10.1111/j.1346-8138.2012.01584.x
  51. Tyring S.K., Beutner K.R., Tucker B.A. et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000; 9: 863–9. DOI: 10.1001/archfami.9.9.863
  52. Bacon T.H. et al. Inhibition of varicella-zoster virus by penciclovir in cell culture and mechanism of action. Antiviral Chem Chemother. 1996; 7 (2): 71–8. DOI.: 10.1177/095632029600700203
  53. Johnson R.W. Herpes zoster – predicting and minimizing the impact of post-herpetic neuralgia. J Antimicrob Chemother. 2001; 47 (suppl 1): 1–8. DOI: 10.1093/jac/47.suppl_1.1
  54. Krieble B.F., Rudy D.W., Glick M.R. et al. Case report: acyclovir neurotoxicity and nephrotoxicity e the role for hemodialysis. Am J Med Sci. 1993; 305: 36e9. DOI: 10.1097/00000441-199301000-00007
  55. Becker B.N., Fall P., Hall C. et al. Rapidly progressive acute renal failure due to acyclovir: case report and review of the literature. Am J Kidney Dis. 1993; 22: 911e5. DOI: 10.1016/s0272-6386(12)80939-5
  56. Sodhi P.K., Ratan S.K. A case of chronic renal dysfunction following treatment with oral acyclovir. Scand J Infect Dis. 2003; 35 (10): 770–2. DOI: 10.1080/00365540310016574-1
  57. Yavuz B.B., Cankurtaran M., Halil M. et al. Renal dysfunction after oral acyclovir treatment in a geriatric woman: a case report. Scand J Infect Dis. 2005; 37 (8): 611–3.
  58. Htwe T.H., Bergman S., Koirala J. Famciclovir substitution for patients with acyclovir-associated renal toxicity. J Infect. 2008; 57 (3): 266–8. DOI: 10.1016/j.jinf.2008.06.008
  59. Linnemann C.C. Jr., Biron K.K., Hoppenjans W.G. et al. Emergence of acyclovir-resistant varicella zoster virus in an AIDS patient on prolonged acyclovir therapy. AIDS. 1990; 4: 577–9. DOI: 10.1097/00002030-199006000-00014
  60. Shimizu R., Ohwada C., Nagao Y. et al. The successful treatment of a cord blood transplant recipient with varicella zoster virus meningitis, radiculitis and myelitis with foscarnet. Intern Med. 2017; 56: 353–6. DOI: 10.2169/internalmedicine.56.6930
  61. Manzano V. et al. Severe pneumonia by aciclovir-resistant varicella-zoster virus during etanercept therapy. Rheumatology. 2010; 49 (9): 1791–3. DOI: 10.1093/rheumatology/keq110
  62. Tomomi Oka, Masakatsu Hishizawa, Kouhei Yamashita et al. Successful treatment with famciclovir for varicella zoster virus infection resistant to acyclovir. J Infect Chemother. 2021; 27 (5): 755–8. DOI: 10.1016/j.jiac.2020.12.013
  63. Werner R.N. et al. European consensus-based (S2k) Guideline on the Management of Herpes Zoster–guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment. J Eur Acad Dermatol Venereol. 2017; 31 (1): 20–9. DOI: 10.1111/jdv.13957
  64. Rivaud E. et al. Valacyclovir hydrochloride therapy and thrombotic thrombocytopenic purpura in a HIV-infected patient. Arch Intern Med. 2000; 160 (11): 1705–6. DOI: 10.1001/archinte.160.11.1705
  65. Bukhari S. et al. Valacyclovir-Induced Thrombotic Thrombocytopenic Purpura. Cureus. 2020; 12 (5): e8156. DOI: 10.7759/cureus.8156
  66. Becker S. et al. HIV-associated thrombotic microangiopathy in the era of highly active antiretroviral therapy: an observational study. Clin Infect Dis. 2004; 39 (Suppl 5): S267–S275. DOI: 10.1086/422363
  67. Oxman M.N., Levin M.J., Johnson G.R. et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352 (22): 2271–84. DOI: 10.1056/NEJMoa051016