Abstract：
BACKGROUND: Disseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies.
METHODS: We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients.
RESULTS: Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower.
CONCLUSIONS: This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.
METHODS: We included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients.
RESULTS: Patients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower.
CONCLUSIONS: This study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.
摘要：
背景：播散性带状疱疹（DHZ）是一种严重的感染，与免疫功能低下患者的高发病率和高死亡率相关。尽管研究表明其在免疫功能正常的患者中发生，它的流行病学，临床表现,并且该队列的治疗结果仍然未知.因此，这项研究旨在检查临床表现，治疗,并发症,和DHZ在免疫功能正常患者中的结果，并将这些发现与以前的研究进行比较。
方法：我们纳入了我们机构的20名免疫功能正常的DHZ患者，并回顾了42例以前发表的病例。然后我们调查了临床特征，诱发因素,实验室发现,治疗,以及所有病例的结果，包括住院死亡率，出院时神经功能障碍,和带状疱疹后神经痛.我们将DHZ免疫功能正常的患者与DHZ免疫功能低下的患者进行了比较。
结果：患者的中位年龄为71.5岁，主要为男性。三叉神经区是最初皮疹最常见的部位，平均传播时间为6.5天。疼痛是最常见的症状，其次是发热(约40%的病例);阿昔洛韦是最常用的治疗方法.此外,住院死亡率为0%，约10%的患者在出院时出现神经病变,大约40%的患者出现带状疱疹后神经痛。在免疫受损的病例中，死亡率为12%,高于我们的案例；然而，神经病变和带状疱疹后神经痛的发生率较低。
结论：这项研究为临床表现提供了新的见解，治疗,以及免疫功能正常患者的DHZ病例的结果，尽管死亡率较低，但仍有残留神经损伤的趋势。
方法：我们纳入了我们机构的20名免疫功能正常的DHZ患者，并回顾了42例以前发表的病例。然后我们调查了临床特征，诱发因素,实验室发现,治疗,以及所有病例的结果，包括住院死亡率，出院时神经功能障碍,和带状疱疹后神经痛.我们将DHZ免疫功能正常的患者与DHZ免疫功能低下的患者进行了比较。
结果：患者的中位年龄为71.5岁，主要为男性。三叉神经区是最初皮疹最常见的部位，平均传播时间为6.5天。疼痛是最常见的症状，其次是发热(约40%的病例);阿昔洛韦是最常用的治疗方法.此外,住院死亡率为0%，约10%的患者在出院时出现神经病变,大约40%的患者出现带状疱疹后神经痛。在免疫受损的病例中，死亡率为12%,高于我们的案例；然而，神经病变和带状疱疹后神经痛的发生率较低。
结论：这项研究为临床表现提供了新的见解，治疗,以及免疫功能正常患者的DHZ病例的结果，尽管死亡率较低，但仍有残留神经损伤的趋势。
