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Incidence of post-herpetic neuralgia in treated and untreated patients with herpes zoster followed for 1 year in an Italian prospective cohort: preliminary results

Abstract number: O506

Parruti G., Sozio F., Rebuzzi C., Tontodonati M., Polilli E., Agostinone A., Manna A., Di Masi F., Consorte A., Congedo G., Cosentino L., D'Antonio D., Pippa L., Manzoli L., Granchelli C.

Objectives: A large prospective cohort of patients with herpes zoster (HZ) was enrolled between May 2006 and June 2008 in Pescara, Italy, with a planned 1-year follow-up after clinically and/or molecularly assessed diagnosis. Aim of the study was to evaluate predictors of prolonged acute course and/or incidence of Post-Herpetic Nevralgia (PHN).

Methods: Data from all enrolled patients were collected by a network of 51 general practitioners. Suspected cases and patients with intense acute pain were referred to our institution for immediate evaluation. Clinical and demographic information was mandatory at baseline, as photographs of enrolled patients. For uncertain cases, varicella-zoster virus (VZV) antibodies and VZV DNA PCR on plasma and/or vesicular eluates (whenever available) were performed. Follow-up data were collected at outpatient control visits or by phone calls at 1, 3, 6 and 12 months after onset of HZ. PHN was diagnosed when pain persisted or relapsed at least one month after complete clearing of dermatomeric lesions. Adverse events other than pain were classified according to WHO grading scale and reported if geqslant R: gt-or-equal, slanted2. All statistical calculations were performed by Stata 8.0 software package.

Results: 523 patients were enrolled, 306 (58.5%) females, with a mean age of 57.7 years, 1-year follow-up data being now available for 489. HZ was localised at thorax in 45.4% and head in 20.7%; pain in the acute phase was reported as intense or very intense by 127 (25.97%) patients; 54 (11.04%) patients were referred for molecular diagnosis as clinically uncertain, 37 (68.5%) being confirmed as VZV-related cases. Forty eight (9.82%) patients were not prescribed any antiviral drug at diagnosis by referring physicians, in spite of extensive support in the study plan. During follow-up, 163 (33.3%) patients reported any type of adverse event (at a mean of 91.2±74.8 days), including 93 (19.02%) patients reporting PHN. PHN was significantly more frequent in untreated vs treated patients (37.5% vs 17.0%, p = 0.001), as were total adverse events (54.2% vs 31.1%, p = 0.001). Untreated patients did not significantly differ from those treated by age (56.3% vs 57.7%, p = 0.66) and sex (females vs males 11.9% vs 6.9%, p = 0.056), whereas they complained for more intense pain (15.0% vs 8.0%, p = 0.024) at presentation.

Conclusion: Our study confirms the importance of early diagnosis and prompt antiviral treatment at the onset of HZ in order to minimise the risk of PHN.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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