Опоясывающий герпес – современные подходы к диагностике и лечению

DOI: https://doi.org/10.29296/25877305-2022-10-04
Номер журнала: 
10
Год издания: 
2022

А.В. Игнатовский, кандидат медицинских наук
Санкт-Петербургский государственный университет
E-mail: derm@list.ru

В статье рассматриваются особенности клинической картины и осложнения опоясывающего герпеса (ОГ) у различных категорий пациентов. Представлены особенности фармакокинетики и фармакодинамики препаратов аномальных нуклеозидов при лечении VZV-инфекции. Показаны преимущества фамцикловира в терапии ОГ, в частности, воздействие препарата на проявления острой герпетической невралгии и способность снижать вероятность развития постгерпетической невралгии.

Ключевые слова: 
дерматология
неврология
опоясывающий герпес
постгерпетическая невралгия
фамцикловир

Для цитирования
Игнатовский А.В. Опоясывающий герпес – современные подходы к диагностике и лечению . Врач, 2022; (10): 22-32 https://doi.org/10.29296/25877305-2022-10-04


Список литературы: 
  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