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Herpes zoster

Senast uppdaterad: Senast reviderad:


Definition:
Reaktivering av varicella zoster-virus, kallas även bältros.
Förekomst:
Incidensen är cirka 2 per 1 000 invånare per år.
Symtom:
Symtomen börjar oftast med avgränsade, brännande smärtor. Efter några dagar får patienten vanligtvis vesikulärt utslag, eventuellt feber.
Kliniska fynd:
Ensidigt vesikulärt utslag inom ett dermatom.
Diagnostik:
Typisk klinisk bild. Kompletterande undersökningar är ofta inte nödvändiga.
Behandling:
Smärtbehandling i den akuta fasen. Systemisk antiviral behandling till personer med komplicerad zosterinfektion, immunsupprimerade och till personer >50 år. Antiviral behandling bör påbörjas medan det fortfarande finns färska lesioner, vanligtvis inom 2–3 dygn efter ett utbrott.
  1. Saguil A, Kane S, Mercado M, Lauters R. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017;96(10):656-663. PMID: 29431387 PubMed  
  2. Mounsey AL, Matthew LG, Slawson DC. Herpes zoster and postherpetic neuralgia: Prevention and management. Am Fam Physician 2005; 72: 1075-80. PubMed  
  3. Vaccination mot bältros – vägledning för hälso och sjukvårdspersonal. Folkhälsomyndigheten. Hämtad 2021-10-27. www.folkhalsomyndigheten.se  
  4. Yawn BP, Saddier P, Wollan PC, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007; 82: 1341. PubMed  
  5. Insinga RP, Itzler RF, Pellissier JM, et al. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med 2005; 20: 748-53. PubMed  
  6. Gnann JW, Whitley RJ. Herpes zoster. N Engl J Med 2002; 347: 340-6. PubMed  
  7. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352: 2271-84. PMID: 15930418 PubMed  
  8. Forbes HJ, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014; 348: g2911. BMJ (DOI)  
  9. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of post-herpetic neuralgia after a first episode of herpes zoster: a prospective study with long term follow up. BMJ 2000; 321: 794-6. PMID: 11009518. PubMed  
  10. Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007; 44 Suppl 1: S1.
  11. Jumaan AO, Yu O, Jackson LA, et al. Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002. J Infect Dis 2005; 191: 2002. PubMed  
  12. Albrecht MA. Clinical manifestations of varicella-zoster virus infection: Herpes zoster. UpToDate, last updated July 6, 2009. UpToDate  
  13. Bältros. Nationellt kliniskt kunskapsstöd (NKK) (hämtad 211025) nationelltklinisktkunskapsstod.se  
  14. Albrecht MA. Treatment of herpes zoster in the immunocompetent host. UpToDate, last updated Jul 21, 2016. www.uptodate.com  
  15. Berry JD, Petersen KL. A single dose of gabapentin reduces acute pain and allodynia in patients with herpes zoster. Neurology 2005; 65: 444-7. PMID: 16087911 PubMed  
  16. Varicella, herpes zoster and nonsteroidal anti-inflammatory drugs: serious cutaneous complications. Prescrire Int. 2010;19(106):72-73. PMID: 20568491 PubMed  
  17. Inaba I, Kondo Y, Iwasaki S, et al. Risk Evaluation for Acute Kidney Injury Induced by the Concomitant Use of Valacyclovir, Analgesics, and Renin-Angiotensin System Inhibitors: The Detection of Signals of Drug-Drug Interactions. Front Pharmacol. 2019;10:874. PMID: 31440161 PubMed  
  18. Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD005582. DOI: 10.1002/14651858.CD005582.pub4. DOI  
  19. Chen N, Li Q, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;2:CD006866. PMID: 24500927 PubMed  
  20. Johnson BH, Palmer L, Gatwood J, et al. Annual incidence rates of herpes zoster among an immunocompetent population in the United States. BMC Infect Dis. 2015;15:502. PubMed  
  21. Wood MJ, Shukla S, FIddian AP, Crooks RJ. 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 1998; 178 (Suppl 1): S81-S84.
  22. McDonald EM, de Kock J, Ram FS. Antivirals for management of herpes zoster including ophthalmicus: a systematic review of high-quality randomized controlled trials. Antivir Ther 2011; : doi: 10.3851/IMP2011. DOI  
  23. Pasternak B, Hviid A. Use of acyclovir, valacyklovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA 2010; 304: 859-66. PMID: 20736469. PubMed  
  24. Wiffen PJ, Derry S, Moore RA, et al.Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Nov 11;11:CD010567. doi: 10.1002/14651858.CD010567.pub2. DOI  
  25. Vaccin mot bältros (herpes zoster). Folkhälsomyndigheten. Hämtad 2020-10-29 www.folkhalsomyndigheten.se  
  26. Harbecke R, Cohen JI, Oxman MN. Herpes Zoster Vaccines. J Infect Dis. 2021 Sep 30;224(Supplement_4):S429-S442. doi: 10.1093/infdis/jiab387. PMID: 34590136; PMCID: PMC8482024
  27. Gagliardi AM, Andriolo BN, Torloni MR, et al. Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev. 2019 Nov 7;2019(11). doi: 10.1002/14651858.CD008858.pub4. DOI  
  28. Johnson RW, Bouhassira D, Kassianos G, Leplège A, Schmader KE, Weinke T. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med. 2010 Jun 21;8:37. doi: 10.1186/1741-7015-8-37. PMID: 20565946 PubMed  
  29. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain. 2005 Jun;6(6):356-63. doi: 10.1016/j.jpain.2005.01.359. PMID: 15943957 PubMed  
  30. Breuer J, Pacoud M, Gauthier A, Brown MM. Herps zoster as a risk factor for stroke and TIA. Neurology 2014. PMID: 24384645.
  31. Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL. Natural history of pain following herpes zoster. Pain 2007; 128: 148-156. PMID: 17070998 PubMed  
  • Mikael Tarstedt Överläkare, Hudmottagningen, Karlskoga lasarett
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet