title: Clinical Characteristics and Outcomes in a Population With Disseminated Herpes Zoster: A Retrospective Cohort Study.
abstract: BACKGROUND
  Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients.
  
  
  OBJECTIVE
  To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients.
  
  
  METHODS
  We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015.
  
  
  RESULTS
  Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P<.01). The 8 immunocompetent patients with no detectable trigger factors were older (mean age, 85 years). In 95% of cases, DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated. Thrombocytopenia was detected in 56% of cases. Complication rates were similar in immunocompromised and immunocompetent patients (54% vs 59%, P>.01). Six patients died; there was no difference in mortality between the 2 groups.
  
  
  CONCLUSIONS
  This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients.
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: luz.bollea@hospitalitaliano.org.ar.
authors.forename: M L
authors.initials: ML
authors.lastname: Bollea-Garlatti
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: L A
authors.initials: LA
authors.lastname: Bollea-Garlatti
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: A S
authors.initials: AS
authors.lastname: Vacas
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: A C
authors.initials: AC
authors.lastname: Torre
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: A M
authors.initials: AM
authors.lastname: Kowalczuk
authors.affiliation: Departamento de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Cátedra de Dermatología, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: R L
authors.initials: RL
authors.lastname: Galimberti
authors.affiliation: Departamento de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Cátedra de Farmacología, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: B L
authors.initials: BL
authors.lastname: Ferreyro
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013315:Stress, Psychological / Q000150:complications; D015163:Superinfection / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: Disseminated herpes zoster; Herpes zoster; Herpes zoster diseminado; Huésped inmunocomprometido; Immunocompromised host; Varicella zoster virus; Virus varicela zoster