Información del artículo
Resumen
El herpes zoster (HZ) se manifiesta clínicamente como consecuencia de una reactivación de la primoinfección por el virus varicela-zoster. Los pacientes asocian clínicamente la presencia de dolor neurítico agudo, junto con lesiones vesiculosas cutáneas con una distribución dermatómica. Recientemente han aparecido nuevos fármacos antivirales que permiten tratar de forma eficaz el HZ, evitando muchas de las complicaciones secundarias a la infección que pueden aparecer. También, el uso racional y precoz de estos fármacos puede disminuir la virulencia de la neuralgia postherpética en muchos de los casos. Así, es necesario establecer unas pautas claras y definidas de la actuación en cada caso. En concreto, debemos conocer de forma especial qué pautas de actuación debemos tener en pacientes con HZ que están incluidos en grupos de riesgo para presentar una evolución clínica más atípica o grave, como es la que suele ocurrir en pacientes inmunodeprimidos (trasplantados, infección por el virus de la inmunodeficiencia humana o sida, pacientes sometidos a quimioterapia), o también en grupos especiales, como son las mujeres embarazadas o pacientes en edad infantil. Además, junto al tratamiento antiviral, tenemos que instaurar esquemas terapéuticos de analgesia, capaces de controlar el dolor en cada caso, bien en forma aguda, bien en forma de neuralgia postherpética.
Palabras clave:
Virus de la varicela-zoster
Fármacos antivirales
Herpes zoster
Abstract
Herpes zoster (HZ) is a clinical manifestation of the reactivation of latent varicella zoster virus infection. Patients may have acute neuritic pain, together with cutaneous vesicular lesions in a dermatomal distribution. Recently, new antiviral drugs have been highly useful in the treatment of patients with HZ, avoiding many of the secondary complications that can appear after this herpetic infection. In addition, the rational and early use of these antiviral drugs may reduce the virulence of postherpetic neuralgia in a substantial proportion of patients. Consequently, guidelines for the management and treatment of patients with HZ should be established. Specifically, guidelines should be established for certain patient groups at risk for an atypical or severe clinical course, such as immunosuppressed patients (those with solid organ transplants, HIV infection or AIDS, or patients under immunosuppressive treatment) or pregnant and pediatric patients. In addition, antiviral treatment must be administered with analgesic drugs to control neuritic pain in all patients with HZ, whether in the acute phase or in the form of postherpetic neuralgia.
Keywords:
Varicella zoster virus
Antiviral drugs
Herpes zoster
El Texto completo está disponible en PDF
Bibliografía
[1.]
J.G. Donahue, P.W. Choo, J. Manson, R. Platt.
The incidence of herpes zoster.
Arch Intern Med, 155 (1995), pp. 1605-1609
[2.]
A. Gil, M. San Martín, P. Carrasco, A. González.
Epidemiology of severe varicella-zoster virus infection in Spain.
Vaccine, 22 (2004), pp. 3947-3951
[3.]
C.C. Ku, J.A. Padilla, C. Grose, E.C. Butcher, A.M. Arvin.
Tropism of varicella-zoster virus for human tonsillar CD4+ T lymphocytes that express activation, memory, and skin homing markers.
J Virol, 76 (2002), pp. 11425-11433
[4.]
C.C. Ku, J. Besser, A. Abendroth, C. Grose, A.M. Arvin.
Varicella-zoster virus pathogenesis and immunobiology: new concepts emerging from investigations with the SCIDhu mouse model.
J Virol, 79 (2005), pp. 2651-2658
[5.]
J.J. Chen, A.A. Gershon, Zs. Li, O. Lungu, M.D. Gershon.
Latent and lytic infection of isolated of guinea pig enteric ganglia by varicella zoster virus.
J Med Virol, 70 (2003), pp. S71-S78
[6.]
K. Wang, T.Y. Lau, M. Morales, E.K. Mont, S.E. Strauss.
Laser-capture microdissection: refining estimates of the quantity and distribution of latent herpes simplex virus and varicella-virus DNA in human trigeminal ganglia at the single-cell level.
J Virol, 79 (2005), pp. 14079-14087
[7.]
A. Arvin.
Aging, immunity and the varicella-zoster virus.
N Engl J Med, 352 (2005), pp. 2266-2267
[8.]
M. Brisson, N.J. Gay, W.J. Edmunds, N.J. Andrews.
Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chickenpox.
Vaccine, 20 (2002), pp. 2500-2507
[9.]
R.H. Dwokin, R.W. Johnson, J. Breuer, J.W. Gnann, M.J. Levin, M. Backonja, et al.
Recommendations for the management of herpes zoster.
Clin Infect Dis, 44 (2007), pp. S1-S26
[10.]
M.J. Wood, R. Kay, R.H. Dworkin, S.J. Soong, R.J. Whitley.
Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebocontrolled trials.
Clin Infect Dis, 22 (1996), pp. 341-347
[11.]
J.L. Jackson, R. Gibbons, G. Meyer, L. Inouye.
The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: a meta-analysis.
Arch Intern Med, 157 (1997), pp. 909-912
[12.]
R.J. Crooks, D.A. Jones, A.P. Fiddian.
Zoster-associated chronic pain: an overview of clinical trials with acyclovir.
Scand J Infect Dis Suppl, 78 (1991), pp. 62-68
[13.]
H. Degreef.
Famciclovir, a new oral antiherpes drug: results of the first controlled clinical study demonstrating its efficacy and safety in the treatment of uncomplicated herpes zoster in immunocompetent patients.
Int J Antimicrob Agents, 4 (1994), pp. 241-246
[14.]
S. Tyring, R.A. Barbarash, J.E. Hahilik, A. Cunningham, J. Marley, M. Heng, et al.
Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a ramdomized, double-blind, placebo-controlled trial.
Ann Intern Med, 123 (1995), pp. 89-96
[15.]
R.H. Dworkin, R.J. Boon, D.R. Griffin, D. Phung.
Postherpetic neuralgia: impacto f famciclovir, age, rash severity anda cute pain in herpes zoster patients.
J Infect Dis, 178 (1998), pp. S76-S80
[16.]
M.W. McKendrick, J.I. McGrill, J.E. White, M.J. Wood.
Oral acyclovir in acute herpes zoster.
BMJ, 293 (1986), pp. 1529-1532
[17.]
J.C. Huff, J.L. Drucker, A. Clemmer, O.L. Laskin, J.D. Connor, Y.J. Bryson, et al.
Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis.
J Med Virol, (1993), pp. 93-96
[18.]
P. Morton, A.N. Thompson.
Oral acyclovir in the treatment of herpes zoster in general practice.
N Z Med J, 102 (1989), pp. 93-95
[19.]
M.J. Wood, S. Shukla, A.P. Fiddian, R.J. Crooks.
Treatment of acute herpes zoster: effect of early (<48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain.
J Infect Dis, 178 (1998), pp. S81-S84
[20.]
I. Kurokawa, K. Kumano, K. Murakawa.
Clinical correlates of prolonged pain in Japanese patients with herpes zoster.
J Int Med Res, 30 (2002), pp. 56-65
[21.]
M.W. McKendrick, J.I. McGrill, M.J. Word.
Lack of effect of acyclovir on postherpetic neuralgia.
BMJ, 298 (1989), pp. 431
[22.]
K.R. Beutner, D.J. Friedman, C. Forszpaniak, P.L. Andersen, M.J. Wood.
Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults.
Antimicrob Agents Chemother, 39 (1995), pp. 1546-1553
[23.]
S.W. Wassilew, P. Wutzler.
Oral brivudin in comparison with acyclovir for herpes zoster: a survey study on postherpetic neuralgia.
Antiviral Res, 59 (2003), pp. 57-60
[24.]
S.W. Wassilew, P. Wutzler.
Oral brivudin in comparison with acyclovir for improved therapy of herpes zoster in immunocompetent patients: results of a randomized, double-blind, multicentered study.
Antiviral Res, 59 (2003), pp. 49-56
[25.]
S.K. Tyring, K.R. Beutner, B.A. Tucker, W.C. Anderson, R.J. Crooks.
Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older.
Arch Fam Med, 9 (2000), pp. 863-869
[26.]
S.W. Wassilew.
Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients. A randomized, double-blind, multinational study.
J Eur Acad Dermatol Venereol, 19 (2005), pp. 47-55
[27.]
G. Gross, H. Schöfer, S. Wassilew, K. Friese, A. Timm, R. Guthoff, et al.
Herpes zoster guideline of the German Dermatologt Society (DDG).
J Clin Virol, 26 (2003), pp. 277-289
[29.]
Board of the Australian Herpes Management Forum. Disponible en: http://www.ahmf.com
[29.]
Internacional Herpes Management Forum p. 33-45, 58-68, 69-78 y 77-99. Disponible en: http://IHMF.org
[30.]
Management of herpes zoster and post-herpetic neuralgia American Family Physician. Disponible en: http://aafp.org/afp/20000415/2437.html.
[31.]
Varicella Zoster Virus Research Foundation Disponible en: http://www.vzvfoundation.org
[32.]
Guidelines for the management of shingles.
Report of a working group of the British Society for the Study of Infection (BSSI).
J Infect, 30 (1995), pp. 193-200
[33.]
International Herpes Management Forum: Regional Management Forums (on line) Disponible en: http://www.ihmf.org/globallinks/wld-ita.asp
[34.]
R.J. Whitley, H. Weiss, J.W. Gnann, S. Trying, G.J. Mertz, P.G. Pappas, et al.
Acyclovir with and without prednisone for the therapy of herpes zoster: a randomized, placebocontrolled trial.
Ann Intern Med, 125 (1996), pp. 376-383
[35.]
M.J. Wood, R.W. Johnson, M.W. McKendrick, J. Taylor, B.K. Mandal, J. Crooks.
A randomized trial of acyclovir for 7 days or 21 days with and without prednisone for treatment of acute herpes zoster.
N Engl J Med, 330 (1994), pp. 896-900
[36.]
D. Bowsher.
The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial.
J Pain Symptom Manage, 13 (1997), pp. 327-331
[37.]
R.H. Dworkin.
Prevention of postherpetic neuralgia.
Lancet, 353 (1999), pp. 1636-1637
[38.]
Dworkin RH. Strategies for the prevention of neuropathic pain. In: Program and abstract of Expanding Vistas in neuropathic pain, an official satellite of the 11th World Congress on Pain (Uluru, Australia). Seattle: International Association for the Study of Pain Nauropathic Pain Special Interest Group; 2005. p. 39.
[39.]
F. Boureau, P. Legallicier, M. Kabir-Ahmadi.
Tramadol in post-herpetic neural-gia: a randomized, double-blind, placebo-controlled trial.
Pain, 104 (2003), pp. 323-331
[40.]
J.D. Berry, K.L. Petersen.
A single dose of gabapentin reduces acute pain and allodynia in patients with herpes zoster.
Neurology, 65 (2005), pp. 444-447
[41.]
Brentjens MH, Torres G, He J, Lee PC, Tyring SK. Reduction of postherpetic neuralgia in herpes zoster: a study of the effects of gabapentin with valacyclovir during acute zoster outbreaks. Presented at: Annual Meeting of the American Academy of Dermatology. San Francisco; March, 2003.
[42.]
J.E. Frampton, R.H. Foster.
Pregabalin in the treatment of postherpetic neuralgia.
Drugs, 65 (2005), pp. 111-118
[43.]
K.A. Nelson, K.M. Park, E. Rabinovitz, C. Tsigos, M.B. Max.
High-dose oral detromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia.
Neurology, 48 (1997), pp. 1212-1218
[44.]
A.J.M. Van Wijck, W. Opstelten, K.G.M. Moons, G.A. Van Essen, R.J. Stolker, C.J. Kalkman, et al.
The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: a randomized controlled trial.
Lancet, 367 (2006), pp. 219-224
[45.]
A. Pasqualucci, V. Pasqualucci, F. Galla, V. De Angelis, V. Marzocchi, R. Colussi, et al.
Prevention of post-herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone.
Acta Anaesthesiol Scand, 44 (2000), pp. 910-918
[46.]
C.F. Terrence, G.H. Fromm, R. Teniclo.
Baclofen as an analgesic in chronic peripheral nerve disease.
Eur Neurol, 24 (1985), pp. 380-385
[47.]
K.L. Petersen, F.L. Rice, F. Suess, M. Berro, M.C. Rowbotham.
Relief of post-herpetic neuralgia by surgical renoval of painful skin.
Pain, 98 (2002), pp. 119-126
[48.]
H. Harke, P. Gretenkort, H.U. Ladleif, P. Koester, S. Rahman.
Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain.
Anesth Analg, 94 (2002), pp. 694-700
[49.]
F.C. Kang, P.J. Chang, H.P. Chen, Y.C. Tsai.
Patient-controlled epidural analgesia for postherpetic neuralgia in an HIV-infected patient as a therapeutic an ambulatory modality.
Acta Anaesthesiol Sin, 36 (1998), pp. 235-238
[50.]
K.L. Petersen, H.L. Fields, J. Breunnum, P. Sandrini, M.C. Rowbotham.
Capsaicin evoked pain and allodynia in post-herpetic neuralgia.
Pain, 88 (2000), pp. 125-133
[51.]
S.W. Coniam, J. Hunton.
A study of benzydamine cream in postherpetic neuralgia.
Res Clin Forums, 10 (1988), pp. 65-67
[52.]
M.C. Rowbotham, P.S. Davies, H.L. Fields.
Topical lidocaine gel relieves postherpetic neuralgia.
Ann Neurol, 37 (1995), pp. 246-253
[53.]
N.P. Katz, A.R. Gammaitoni, M.W. Davis, R.H. Dworkin, The Lidoderm Match Study Group.
Lidocaine patch 5% reduces pain intensity and interference with quality of life in patients with postherpetic neuralgia: an effectiveness trial.
Pain Med, 3 (2002), pp. 324-332
[54.]
A. Meno, H. Arita, K. Hanoka.
Preliminary report: the efficacy of clonidine hydrochloride ointment for postherpetic neuralgia.
Masuri, 50 (2001), pp. 160-163
[55.]
C.L. Wu, A. Marsh, R.H. Dworkin.
The role of sympathetic nerve blocas in herpes zoster and postherpetic neuralgia.
Pain, 87 (2000), pp. 121-129
[56.]
P. Hügler, P. Siebrecht, K. Hoffmann, M. Stücker, J. Windeler, P. Altmeyer, et al.
Prevention of postherpetic neuralgia with varicella-zoster hyperimmune globulin.
Eur J Pain, 6 (2002), pp. 435-445
[57.]
T.J. Liesegang.
Herpes zoster ophthalmicus.
Ophthalmology, 115 (2008), pp. S3-S12
[58.]
S.C. Kaufman.
Anterior segment complications of herpes zoster ophthalmicus.
Ophthalmology, 115 (2008), pp. S24-S32
[59.]
J. Colin, O. Prisant, B. Cochener, O. Lescale, B. Rolland, T. Hoang-Xuan.
Comparison of the efficacy and safety of valaciclovir and acyclovir for the treatment of herpes zoster opthalmicus.
Ophthalmology, 107 (2000), pp. 1507-1511
[60.]
T. Hoang-Xuan, R. Büchi, C.P. Herbort, J. Denis, P. Frot, S. Thenault, et al.
Oral acyclovir for herpes zoster ophthalmicus.
Ophthalmology, 99 (1992), pp. 1062-1070
[61.]
S. Tyring, R. Engst, C. Corriveau, N. Robillard, S. Trottier, S. Van Slycken, et al.
Famciclovir for ophthalmic zoster: a randomized aciclovir controlled study.
Br J Ophtalmol, 85 (2001), pp. 576-581
[62.]
Sundmacher R. Therapie der viruserkrankungen des vorderen augenabschnittes. En: Kampik A, editor. Das äussere auge: hauptreferate der XXXI-Essener Forbildung für Augenärzte. Bücherei des Augenarztes. 1996;137:121-5.
[63.]
C. Lagarde, A.E. Steen, T. Bieber, K.H. Steen.
Zoster in chilhood after inapparent varicella.
Acta Derm Venereol (Stockh), 81 (2001), pp. 212-213
[64.]
M. Rothe, H. Feder, J. Grant-Kels.
Oral acyclovir therapy for varicella and zoster infection in pediatric and pregnant patients: a brief review.
Pediatr Dermatol, 8 (1991), pp. 236-242
[65.]
B.K. Kelinschmidt-DeMasters, C. Amilie-Lefond, D.H. Gilden.
The pattern of varicella zoster virus encephalitis.
Hum Pathol, 27 (1996), pp. 927-938
[66.]
J.W. Gnann.
Varicella-zoster virus: atypical presentations and inusual complications.
J Infect Dis, 186 (2002), pp. S91-S98
[68.]
M.J. Glesby, R.D. Moore, R.E. Chaisson.
Clinical spectrum of herpes zoster in adults infected with human immunodeficiency virus.
Clin Infect Dis, 21 (1995), pp. 370-375
[69.]
I. Dunic, O. Djurkovic-Djakovic, S. Vesic, S. Zerjav, D. Jevtovic.
Herpes zoster as an immune restoration disease in AIDS patients during therapy including protease inhibitors.
Int J STD AIDS, 16 (2005), pp. 475-478
[70.]
J.W. Gnann Jr, C.S. Crumpacker, J.P. Lalezari, J.A. Smith, S.K. Tyring, K.F. Baum, et al.
Sorivudine versus acyclovir for treatment of dermatomal herpes zoster in human immunodeficiency virus-infected patients: results from a randomized, controlled clinical trial.
Antimicrob Agents Chemother, 42 (1998), pp. 1139-1145
[71.]
M. Sullivan, D. Skiest, D. Signs, C. Young.
Famciclovir in the management of acute herpes zoster in HIV+ patients.
Presented at: Fourth Conference on Retroviruses and Opportunistic Infections,
[72.]
M.H. Brentjens, G. Torres, J. He, P.C. Lee, S.K. Tyring.
A double-blind randomized study of the use of 2 grams vs. 1 gram valacyclovir TID for 7 days in the treatment of acute herpes zoster in immunocompromised individuals.
Presented at: Annual Meeting of the American Academy of Dermatology,
[73.]
H.H. Balfour, B. Bean, O.L. Laskin, R.F. Ambinder, J.D. Meyers, J.C. Wade, et al.
Acyclovir halts progression of herpes zoster in immunocompromised patients.
N Engl J Med, 308 (1983), pp. 1448-1453
[74.]
D.H. Shepp, P.S. Dandliker, J.D. Meyers.
Treatment of varicella-zoster infection in severely immunocompromised patients: a randomized comparison of acyclovir and vidarabine.
N Engl J Med, 314 (1986), pp. 208-212
[75.]
P. Ljungman, B. Lonnqvist, O. Ringden, P. Skinhoj, G. Gahrton.
A randomized trial of oral versus intravenous acyclovir for treatment of herpes zoster in bone marrow transplant recipients.
Bone Marrow Transplant, 4 (1989), pp. 613-615
[76.]
S. Trying, R. Belanger, W. Bezwoda, P. Ljungman, R. Bonn, R.L. Saltzman.
A randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients.
Cancer Invest, 19 (2001), pp. 13-22
[77.]
P. Wutzler, E. De Clercq, K. Wutke, I. Fäber.
Oral brivudin vs intravenous acyclovir in the treatment of herpes zoster in immunocompromised patients: a randomized double-blind trial.
J Med Virol, 46 (1995), pp. 252-257
[78.]
E. Saint-Leger, E. Caumes, G. Breton, D. Douard, P. Saiag, J.M. Huraux, et al.
Clinical and virological characterization of acyclovir-resistant varicella-zoster virases isolated from 11 patients with acquired immunodeficiency syndrome.
Clin Infect Dis, 33 (2001), pp. 2061-2067
[79.]
P. Reusser.
Management of viral infections in immunocompromised cancer patients.
Swiss Med Wkly, 132 (2002), pp. 374-378
[80.]
R. Snoeck, G. Andrei, E.D. Clerq.
Novel agents for the therapy of varicella-zoster infections.
Exp Opin Investig Drugs, 9 (2000), pp. 1743-1751
[81.]
D.W. Kimberlin, R.J. Whitley.
Varicella-zoster vaccine for the prevention of herpes zoster.
N Engl J Med, 356 (2008), pp. 1338-1343
[82.]
C.L. Wu, S.N. Raja.
An update on the treatment of postherpetic neuralgia.
J Pain, 9 (2008), pp. S19-S30
Copyright © 2009. Sociedad Española de Reumatología