MB BCh BAO (NUI), Clinical Dermatology, Kingdom of Bahrain.

Corresponding Author: Manahel Mahmood AlSabbagh, MB BCh BAO (NUI), Clinical Dermatology, Kingdom of Bahrain.  Tel: 00973 39729242; E-Mail: [email protected]

Received Date: 31 May 2016   

Accepted Date: 07 Jun 2016   

Published Date: 17 Jun 2016

Copyright © 2016 AlSabbagh MM

Citation: AlSabbagh MM. (2016). Risk Factors and Complications of Herpes Zoster. Mathews J  Dermatol. 1(1): 006.

ABSTRACT

Herpes zoster is a viral infection that is prevalent among 20-30% of people. Though it is unclear, the underlying pathophysiology can be attributed to cellular immunity dysfunction. Potential risk factors may involve routine procedures like biopsies and teeth extraction. Herpes zoster usually follows a very benign course that is most commonly complicated with post herpetic neuralgia; however, serious systemic complications including heart block and cerebral angiitis are frequently reported in immunocompromised cases. This article reviews publications on this topic and aims to highlight the potential risk factors and documented complications.

INTRODUCTION

Herpes zoster is a reactivation of varicella-zoster virus, a member of the Herpesviridae that remains dormant within the dorsal root or cerebral nerve ganglion after a primary varicella infection [1-3]. (Herpes) and (Zoster) are Greek words mean Creeping Girdle [4].  This article aims to review publications on herpes zoster, with a special focus on potential risk factors and reported complications.

CLINICAL PRESENTATION

Herpes zoster typically presents as a vesicular eruption proceeded by pain, erythema, local edema or abnormal sensation. Pain might be burning, shooting, stapping, itching or aching. It usually follows a ganglion distribution, typically on the thoracic region; however, immunocompromised patients might have disseminated herpes zoster [1, 5-7]. Young patients usually present with an erythematous form, whereas elderly or ill patients present with hemorrhagic or necrotic forms [8].

EPIDEMIOLOGY

Herpes zoster is incident among one million, or 4 per 1000 population, per year in the United States and twenty to thirty percent of people will get herpes zoster in their life [6, 9, 10]. It dominates in old age; and rarely, it reactivates during infancy with primary foetal/early infantile infection or during childhood [11-29]. It is still controversial whether it has a sporadic reactivation or it is a seasonal disease [1, 30].

RISK FACTORS

Exact risk factors of reactivation are not well-known; yet, cellular immunity is thought to have a key role [31]. This role is well illustrated in old age due to normal age-related decline in cellular immunity; Plasmodium/malaria infection due to transient depression of cellular immunity and immune suppression in cases of immune deficiencies, human immunodeficiency infection or HIV disease and immunosuppressants [1, 2, 5, 32-44]. The role of genetics and family history is still controversial [41, 45-47].

Table 1: Potential Risk Factors of Herpes Zoster.

Publication	Potential Risk factors
(Hamaguchi, 2015) [48] (EVIK, 2013) [49] (Herrero, 2004) [50]	Abdominal	Liver transplant
(Moquete, 2012) [51]		Splenectomy
(Eryilmaz, 2008) [52]		Abdominoplasty/td>
(Levy, 2002) [53]		Routine liver biopsy
Sires, 2008) [54]	Dermatological	Radiesse injection
(Clayton, 2005) [55]		Pulsed-dye laser
(Lee, 2005) [56]		Post cryosurgery
(Gatti, 2010) [41] (Cvjetkovic, 1999) [1]	Psychological	Stress; psychological stress and hard work
(Korber, 2007) [57]	Ophthalmic	Cataract operation
(Jarade, 2002) [58]		Laser in situ keratomileusis
(Su, 2011) [59]	Others	Hematopoietic stem cell transplantation
(Gatti, 2010) [41]		Mechanical trauma; facial trauma
(Simms, 2007) [60]		Microvascular decompression
(Godfrey, 2006) [61]  (Weiss, 1989) [62]		Spinal surgery
(Ramchandani, 2004) [63]		Routine removal of third molars
(Su, 1976) [64]		Accidental inoculation

Risk of rheumatoid and connective tissue diseases is debateable. It is difficult to attribute the risk of reactivation to the disease per sae; especially that patients are frequently on immunosuppressant medications. Some publications suggest luck of association between herpes zoster and the disease and/or the medication, whereas other researchers propose a possible relationship [65-72].

Other co-existing diseases are diabetes mellitus, essential hypertension, dyslipidaemia, chronic venous diseases, other skin diseases, and malignancies including breast cancer, lung cancer, prostate cancer, lymphoma, lymphatic leukaemia, multiple myeloma and Hodgkins disease with bone marrow transplant [5, 11, 73-78].

COMPLICATIONS

Though it usually follows a benign course, herpes zoster is most commonly complicated by post herpetic neuralgia (Table 2). It is proposed that different organopathies are due to either direct infiltration of the virus or indirect hematogenous infection [79].

Table 2: Complications of Herpes Zoster.

Publication	Potential Risk factors
(Kalender, 2016) [80]	Cardiac	Heart block
(Ma, 2007) [81]		Pleuropericarditis
(Bricout, 2015) [82]	Psychological and functional	Decline in functionality and loss of independence
(Chen, 2014) [83]		Depression
(Albietz, 2014) [8]	Ophthalmic	Band keratopathy
(Khalafallah, 2013) [77] (Liesegang, 2008) [84] (McPherson, 1997) [85] (Krimmer, 1994) [86]		Herpes zoster ophthalmicus in 10-25%
(Cvjetkovic, 1999) [1]		Keratitis, iridocyclitis, secondary glaucoma and loss of sight
(Yeo, 1986) [87]		Acute retinal necrosis
(Ellis, 2014) [88] (Eskiizmir, 2009) [89] (Sigaloff, 2007) [90]	Neurological	Encephalitis in 0.1-0.2%
(Kayipmaz, 2013) [2] (Johnson, 2010) [10] (Brunton, 1995) [91]		ost herpetic neuralgia in 20% of patients and in 50% of those older than 60
(EVIK, 2013) [49] (Straube, 1996) [79]		Myelitis
(Bessho, 2010) [92] (Young-Barbee, 2009) [93]		rown-Sequard syndrome
(Braun-Falco, 2009) [94]		Meningoencephalitis
(Straube, 1996) [79]		Cerebral angiitis, meningitis
(Gondivkar, 2010) [61] (Bkenkamp, 1990) [23] (Yeo, 1986) [87]	Motor	Facial nerve palsy
(Jeevarethinam, 2009) [95]		Unilateral brachial plexitis
(Cvjetkovic, 1999) [1]		Guillain-Barre syndrome
(Flamholc, 1996) [96]		Focal muscle paralysis and contralateral hemiplegia
(Braverman, 1986) [97]		Focal limb muscle weakness
(Cvjetkovic, 1999) [1]	Dermatological	Secondary bacterial infection
(Leung, 1986) [98]		Scarring
(Spiess, 1986) [99]	Obstetric	Abortion, embryopathies and organic lesions
(Ellis, 2014) [88] (Nair, 2014) [100]	Dermatological	Disseminated zoster particularly in immunocompromised patients. It is defined as having greater than twenty vesicles outside the primary or adjacent dermatome or as involvement of three or more dermatomes.
(Ling, 2014) [101]		Hepatitis, viral pneumonia and neurogenic chronic cough
(Rudd, 2014) [102]		Osteonecrosis
(AlSardar, 2013) [103]		Cystitis and penile numbness
(Mahima, 2010) [104]		Alveolar bone necrosis and exfoliation of teeth
(Biddlestone, 2009) [105]		Acute urinary retention complicated by constipation
(Paudyal, 2006) [106]		Diaphragmatic motor weakness
(Tola-Arribas, 1997) [107]		Horners syndrome
(Straube, 1996) [79 ]		Myositis

DIFFERENTIAL DIAGNOSIS

Herpes zoster can be confused with similar skin lesions; varicella, erysipelas, impetigo, enteroviral infections, and herpes simplex infections. These diseases are excluded by detailed history-taking and physical examination, laboratory findings, virus isolation and commercially available serological tests. Other differentials are odontalgia, sciatica, and lateral pontomedullary syndrome [1, 108-110].

MANAGEMENT

Herpes zoster per sae is a benign disease in the majority of cases. The main aim of management is to control pain, to prevent new eruptions, to reduce duration and complications and to prevent dissemination [111]. It is commonly managed with anti-viral medication (acyclovir or famciclovir), preferably within 72 hours of rash eruption. Different types of pain associated with herpes should not be confused. Acute herpetic pain is managed with antivirals, non-steroidal anti-inflammatories, opioids and sympathetic nerve blockade. This is different to post herpetic neuralgia, a neuropathic pain commonly treated with antidepressants (amitriptyline, nortriptyline or desipramine,), anticonvulsants (pregabalin or gabapentin) or antiarrhythmic medications [112]. Antibiotics and corticosteroids can be used when required. Rehabilitation program and resting splints are of benefit if needed [1, 2, 6, 7, 92, 99, 113, 114].

On the other hands, surgical nerve decompression, which needs extensive research, was implied by some researchers [115].

CONCLUSION

Though it is thought to result from cellular immunity decline, herpes zoster was reported following routine procedures. It is classically a benign disease, where post herpetic neuralgia is the most common complication. Yet, physicians should suspect systemic complications in immunocompromised patients.

REFERENCES

1. Cvjetkovic D, Jovanovic J, Hrnjakovic-Cvjetkovic I, Brkic S, et al. (1999). Reactivation of herpes zoster infection by varicellazoster virus. Med Pregl. 52(3-5), 125-128.
2. Kayipmaz M, Basaran SH, Ercin E and Kural C. (2013). Isolated ulnar dorsal cutaneous nerve herpes zoster reactivation. Orthopedics. 36(9), e1217-1219.
3. Janniger CK and Elston DM. (2016). Herpes Zoster [Online]. Medscape.
4. Borro DJ. (1960). Dictionary of word roots and combining forms. California: Myfield Publishing Company.
5. Alakloby OM, AlJabre SH, Randhawa MA, Alzahrani AJ, et al. (2008). Herpes zoster in eastern Saudi Arabia: clinical presentation and management. J Drugs Dermatol. 7(5), 457-462.
6. Schmader KE and Dworkin RH. (2008). Natural history and treatment of herpes zoster. PAIN. 9(1), S3-9.
7. Gondivkar S, Parikh V and Parikh R. (2010). Herpes zoster oticus: A rare clinical entity. Contemp Clin Dent. 1(2), 127-129.
8. Albietz JM and Lenton LM. (2014). Late reactivation of herpes zoster keratitis results in band keratopathy. Optom Vision Sci. 91(6), e149-155.
9. Harpaz R, Ortega-Sanchez IR and Seward JF. (2008). Prevention of Herpes Zoster- Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 57(5), 1-29.
10. Johnson RW. (2009). Herpes Zoster and Postherpetic Neuralgia: a review of the effects of vaccination. Aging Clin Exp Res. 21(3), 236-243.
11. Branisteanu DE, Stoleriu G, Oanta A, Dorobat CM, et al. (2014). Clinical-epidemiological trends of herpes zoster: a 5-year study. Rev Med Chir Soc Med Nat Iasi. 118(3), 817-822.
12. Gilden DH. (1994). Herpes Zoster with Postherpetic Neuralgia - Persisting Pain and Frustration. N Engl J Med. 330(13), 932-934.
13. Jha A, Kumar A, Paudel U, Neupane S, et al. (2007). Herpes zoster in a five month old infant subsequent to intrauterine exposure to varicella infection. Nepal Med Coll J. 9(4), 281- 283.
14. Kurlan JG, Connelly BL and Lucky AW. (2004). Herpes zoster in the first year of life following postnatal exposure to varicella- zoster virus: four case reports and a review of infantile herpes zoster. Arch Dermatol. 140(10), 1268-1272.
15. Elmer KB and George RM. (1999). Herpes zoster in a 7-month-old infant: A case report and review. Cutis. 63(4), 217-218.
16. Huang JL, Sun PC and Hung IJ. (1994). Herpes zoster in infancy after intrauterine exposure to varicella zoster virus: report of two cases. J Formos Med Assoc. 93(1), 75-77.
17. Fernndez-Quiones Y and Snchez-Linares V. (2015). Herpes zoster in an infant. Dermatol Rev Mex. (59), 39-42.
18. Gupta L, Khare A, Mittal A and Kuldeep CM. (2013). Herpes zoster in infancy. Indian Dermatol Online J. 4(3), 252-254.
19. Zara I, Robbena F, Zakraoui H, Trojjet S, et al. (2010). Disseminated cutaneous herpes zoster in an immunocompetent infant. Pediatr Infect Dis J. 5(1), 95-98.
20. Devi GNP, Rathinam SN, Ramachandran R and Swaminathan S. (2007). Recurrent herpes zoster in early childhood. Indian J Pediatr. 74(8), 774-776.
21. Papadopoulos AJ, Birnkrant AP, Schwartz RA and Janniger CK. (2001). Childhood herpes zoster. Cutis. 68(1), 21-23.
22. Kakourou T, Theodoridou M, Mostrou G, Syriopoulou V, et al. (1998). Herpes zoster in children. J Am Acad Dermatol. 39(2 Pt 1), 207-210.
23. Bkenkamp A, Laubert A and Heyer R. (1990). Facial paralysis in a 2 1/2-year-old girl due to herpes zoster oticus. Results of the reactivation of a chickenpox infection in infancy. Klin Padiatr. 202(6), 430-432.
24. Yalaki Z, ztrk A, Tasar MA and Dallar Y. (2010). Herpes Zoster Infections in Healthy Children. J Pediatr Infect. 4(3), 96-99.
25. Kkam I and Dilek N. (2009). Herpes zoster in two healthy children. Turkish J Dermatol. 3(1), 19-21.
26. Terada K, Tanaka H, Kawano S and Kataoka N. (1998). Specific cellular immunity in immunocompetent children with herpes zoster. Acta Paediatr. 87(6), 692-694.
27. Sen S, Bayram N, Bal ZS, Yildiz KB, et al. (2013). Herpes zoster experience in two pediatric infection clinics. Turk Arch Ped. (48), 40-43.
28. Oladokun RE, Olomukoro CN and Owa AB. (2013). Disseminated herpes zoster ophthalmicus in an immunocompetent 8-year old boy. Clinics and Practice. 3(2), e16.
29. Prabhu S, Sripathi H, Gupta S and Prabhu M. (2009). Childhood herpes zoster: a cluster of ten cases. Indian J Dermatol. 54(1), 62-64.
30. Suhail M, Ejaz A, Abbas M, Naz S, et al. (2011). Herpes zoster: seasonal variations and morphological patterns in Pakistan. J Pak Assoc Derma. 21, 22-26.
31. Carbone V, Leonardi A, Pavese M, Raviola E, et al. (2004). Herpes zoster of the trigeminal nerve: A case report and review of the literature. Minerva Stomatol. 53(1-2), 49-59.
32. Oxman MN. (2009). Herpes zoster pathogenesis and cellmediated immunity and immunosenescence. Jaoa J Am Osteopath Assoc. 109(6), S13-17.
33. Weinberg JM. (2007). Herpes zoster: epidemiology, natural history, and common complications. J Am Acad Dermatol. 57(6 Suppl), S130-135.
34. Ikeda M, Hiroshige K, Abiko Y and Onoda K. (1996). Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus. J Laryngol Otol. 110(10), 918-921.
35. Gagliardi A. (2012). Vaccines for preventing herpes zoster in older adults. Journal of Evidence-Based Medicine. 5(4), 240.
36. Regunath H, Shivashankara KN, Sundeep KB and Bhaskar AP. (2008). Reactivation of Herpes zoster in an adult with Plasmodium infection. J Vector Borne Dis. 45(3), 251-253.
37. Cook IF. (1985). Herpes zoster in children following malaria. J Trop Med Hyg. 88(4), 261-264.
38. Mandal BK. (2006). Herpes Zoster in the Immunocompromized populations. Indian J Dermatol. 51(4), 235-243.
39. Gopalan V, Nair R, Pillai S and Oberholzer T. (2012). Genital herpes zoster as a consequence of cancer chemotherapy-induced immunosuppression: report of a case. Journal of Infection & Chemotherapy. 18(6), 9557.
40. Song JY, Cheong HJ, Kim WJ, Lee JS, et al. (2010). Herpes Zoster Among HIV-Infected Patients in the Highly Active Antiretroviral Therapy Era: Korean HIV Cohort Study. JAIDS. 53(3), 417-419.
41. Gatti A, Pica F, Boccia MT, Antoni DF, et al. (2010). No evidence of family history as a risk factor for herpes zoster in patients with post-herpetic neuralgia. J Med Virol. 82(6), 1007- 1011.
42. Barro-Traor F, Traor A, Ilboudo L, Oudraogo LT, et al. (2007). Herpes zoster and human imunodeficiency virus in the medical centers of Ouagadougou. Dakar Med. 52(3), 236-243.
43. Onunu AN and Uhunmwangho A. (2004). Clinical spectrum of herpes zoster in HIV-infected versus non-HIV infected patients in Benin City, Nigeria. West Afr J Med. 23(4), 300-304.
44. Fragoso YD, Brooks JB, Gomes S, de Oliveira FT, et al. (2013). Report of Three Cases of Herpes Zoster During Treatment with Natalizumab. CNS Neurosci. Ther. 19, 280-281.
45. Tseng HF, Smith N, Marcy SM, Sy LS, et al. (2010). Risk factors of herpes zoster among children immunized with varicella vaccine: results from a nested case-control study. Pediatr Infect Dis J. 29(3), 205-208.
46. Hernandez PO, Javed S, Mendoza N, Lapolla W, et al. (2011). Family history and herpes zoster risk in the era of shingles vaccination. J Clin Virol. 2011 Dec. 52(4), 344-348.
47. Hicks LD, Cook-Norris RH, Mendoza N, Madkan V, et al. (2008). Family history as a risk factor for herpes zoster: a casecontrol study. Arch Dermatol. 144(5), 603-608.
48. Hamaguchi Y, Mori A, Uemura T, Ogawa K, et al. (2015). Incidence and risk factors for herpes zoster in patients undergoing liver transplantation. Transpl Infect Dis. 17(5), 671-678.
49. evik B, Kurt S, Aksoy D, naldi H, et al. (2013). Polyradiculitis And Transverse Myelitis Secondary To Herpes Zoster In A Liver Transplant Patient. Noropsikiyatri Ars. 50, 193-194.
50. Herrero JI, Quiroga J, Sangro B, Pardo F, et al. (2004). Herpes zoster after liver transplantation: incidence, risk factors, and complications. Liver Transpl. 10(9), 1140-1143.
51. Moquete RA, Hartman B and Granstein RD. (2012). Herpes Zoster with Cutaneous Dissemination in a Patient 21 Years after Splenectomy for Idiopathic Thrombocytopenic Purpura. J Cutan Med Surg. 16(5), 368-371.
52. Eryilmaz T, Cukurluoglu O, Uygur S and Latifoglu O. (2008). Herpes zoster with a possible association to abdominoplasty.Eur J Plast Surg. 30(6), 301-302.
53. Levy JM and Smyth SH. (2002). Reactivation of herpes zoster after liver biopsy. J Vasc Interv Radiol. 13(2 Pt 1), 209-210.
54. Sires B, Laukaitis S and Whitehouse P. (2008). Radiesseinduced herpes zoster. Ophthal Plast Reconstr Surg. 24(3), 218-219.
55. Clayton TH and Stables GI. (2005). Reactivation of ophthalmic herpes zoster following pulsed-dye laser treatment for inflammatory acne vulgaris. Br J Dermatol. 152(3), 569-570.
56. Lee MR and Ryman W. (2005). Herpes zoster following cryosurgery. Aust J Derm. 46(1), 42-43.
57. Korber A, Franckson T, Grabbe S and Dissemond J. (2007). Ambilateral reactivation of herpes zoster V2 following cataract operation of both eyes. J Eur Acad Dermatol Venereol. 21(5), 712-713.
58. Jarade EF and Tabbara KF. (2002). Presumed reactivation of herpes zoster ophthalmicus following laser in situ keratomileusis. J Refract Surg. 18(1), 79-80.
59. Su SH, Martel-Laferrire V, Labb AC, Snydman DR, et al. (2011). High incidence of herpes zoster in nonmyeloablative hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 17(7), 1012-1017.
60. Simms HN and Dunn LT. (2007). Herpes zoster of the trigeminal nerve following microvascular decompression. BRIT J NEUROSURG. 20(6), 423-426.
61. Godfrey EK, Brown C and Stambough JL. (2006). Herpes zoster--varicella complicating anterior thoracic surgery: 2 case reports. J Spinal Disord Tech. 19(4), 299-301.
62. Weiss R. (1989). Herpes zoster following spinal surgery. Clin Exp Dermatol. (14), 56-57.
63. Ramchandani PL, Sabesan T and Peters WJ. (2004). Subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating removal of third molars. Br J Oral Maxillofac Surg. 42(1), 55-57.
64. Su WP and Muller SA. (1976). Herpes zoster. Case report of possible accidental inoculation. Arch Dermatol. 112(12), 1755-1756.
65. Winthrop KL, Baddley JW, Chen L, Liu L, et al. (2013). Association between the initiation of anti-tumor necrosis factor therapy and the risk of herpes zoster. JAMA. 309(9), 887-895.
66. Schou M and Andersen V. (1989). Herpes zoster in immunosuppressed patients with immuno-inflammatory disease. Ugeskr Laeger. 151(48), 3239-3241.
67. Strangfeld A, Listing J, Herzer P, Liebhaber A, et al. (2009). Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA. 301(7), 737-744.
68. Pappas DA, Hooper MM, Kremer JM, Reed G, et al. (2015). Herpes Zoster Reactivation in Patients with Rheumatoid Arthritis: Analysis of Disease Characteristics and Disease-Modifying Antirheumatic Drugs. Arthritis Care Res. 67(12), 1671- 1678.
69. Che H, Lukas C, Morel J and Combe B. (2014). Risk of herpes/ herpes zoster during anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Systematic review and meta-analysis. Joint Bone Spine. 81(3), 215-21.
70. Pope JE, Krizova A, Ouimet JM, Goodwin JL, et al. (2004). Close association of herpes zoster reactivation and systemic lupus erythematosus (SLE) diagnosis: case-control study of patients with SLE or noninflammatory nusculoskeletal disorders. J Rheumatol. 31(2), 274-279.
71. Nagasawa K, Yamauchi Y, Tada Y, Kusaba T, et al. (1990). High incidence of herpes zoster in patients with systemic lupus erythematosus: an immunological analysis. Ann Rheum Dis. 49(8), 630-633.
72. Chakravarty EF, Michaud K, Katz R and Wolfe F. (2013). Increased incidence of herpes zoster among patients with systemic lupus erythematosus. Lupus. (22), 238-244.
73. Kurtaran B, Paydas S, Candevir A, Komur S, et al. (2009). Disseminated herpes zoster infection in a patient with lymphoma. Turk J Med Sci. 39(3), 479-482.
74. Martic V. (2014). Recurrent herpes zoster with segmental paresis and postherpetic. Vojnosanit Pregl. 71(2), 214-217.
75. Cihan YB and Turasan A. (2013). Herpes zoster in cancer patients after radiotherapy. Turkderm. (47), 170-175.
76. Zotti DF, Guglielmetti L, Conti M, Valentinotti R, et al. (2011). Herpes zoster in general medicine: experience of the Italian group Netaudit. Infez Med. 19(2), 106-112.
77. Khalafallah AA, Woodgate M, Koshy K and Patrick A. (2013). Ophthalmic manifestations of herpes zoster virus in patients with multiple myeloma following bone marrow transplantation. BMJ Case Rep.
78. Christiansen NP, Haake RJ and Hurd DD. (1991). Early herpes zoster infection in adult patients with Hodgkins disease undergoing autologous bone marrow transplant. Bone Marrow Transplant. 7(6), 435-437.
79. Straube A and Padovan CS. (1996). Herpes zoster: followup, complications and therapy. Nervenarzt. 67(8), 623-629.
80. Kalender E, Sensoy B and ay S. (2016). Heart block after herpes zoster reactivation. IJCARD. 203, 549-550.
81. Ma T, Collins TC, Habib G, Bredikis A, et al. (2007). Herpes zoster and its cardiovascular complications in the elderly--another look at a dormant virus. Cardiology. 107(1), 63-67.
82. Bricout H, Haugh M, Olatunde O and Prieto R. (2015). Herpes zoster-associated mortality in Europe: a systematic review. BMC Public Health. 15, 466.
83. Chen MH, Taipei T, Wei HT, Su TP, et al. (2014). Risk of depressive disorder among patients with herpes zoster: A nationwide population-based prospective study. Psychosomatic Medicine. 76(4), 285-291.
84. Liesegang TJ. (2008). Herpes Zoster Ophthalmicus: Natural History, Risk Factors, Clinical Presentation, and Morbidity. Ophthalmology. 115(2), S3-S12.
85. McPherson RE. (1997). Herpes zoster ophthalmicus and the immunocompromised host: a case report and review. J Am Optom Assoc. 68(8), 527-538.
86. Krimmer JE. (1994). Recognition of herpes zoster ophthalmicus. Insight. 19(2), 14-16.
87. Yeo JH, Pepose JS, Stewart JA and Sternberg P Jr. (1986). Acute retinal necrosis syndrome following herpes zoster dermatitis. Ophthalmology. 93(11), 1418-1422.
88. Ellis DL, Barsell A, Riahi RR and Stumpf B. (2014). Varicella zoster virus encephalitis in a patient with disseminated herpes zoster: report and review of the literature. Dermatol Online J. 21(3).
89. Eskiizmir G, Uz U, Taskiran E and Unl H. (2009). Herpes zoster oticus associated with varicella zoster virus encephalitis. Laryngoscope. 119(4), 628-630.
90. Sigaloff KC and de Fijter CW. (2007). Herpes zoster-associated encephalitis in a patient undergoing CAPD: case report and literature review. Perit Dial Int. 27(4), 391-394.
91. Brunton SA. (1995). Herpes zoster: A management update. Fam Pract Recertif. 17(9), 14-22.
92. Bessho M, Nakajima H, Ito T and Kitaoka H. (2010). Case of incomplete brown-Squard syndrome after thoracic herpes zoster infection. Rinsho Shinkeigaku. 50(3), 175-177.
93. Young-Barbee C, Hall DA, LoPresti JJ, Schmid DS, et al. (2009). Brown-Squard syndrome after herpes zoster. Neurology. 72(7), 670-671.
94. Braun-Falco M and Hoffmann M. (2009). Herpes zoster with progression to acute varicella zoster virus-meningoencephalitis. Int J Dermatol. 48(8), 834-839.
95. Jeevarethinam A, Ihuoma A and Ahmad N. (2009). Herpes zoster brachial plexopathy with predominant radial nerve palsy. Clin Med. 9(5), 500-501.
96. Flamholc L. (1996). Neurological complications in herpes zoster. Scand J Infect Dis Suppl. (100), 35-40.
97. Braverman DL, Ku A and Nagler W. (1997). Herpes zoster polyradiculopathy. Arch Phys Med Rehabil. 78(8), 880-882.
98. Leung AK, Robson WL and Leong AG. (2006). Herpes zoster in childhood. J Pediatr Health Care. 20(5), 300-333.
99. Spiess H. (1986). Varicella and herpes zoster. Monatsschr Kinderheilkd. 134(3), 118-121.
100. Nair P, Gharote H, Singh P and Jain-Choudhary P. (2014). Herpes zoster on the face in the elderly. BMJ Case Rep.
101. Ling B, Novakovic D and Sulica L. (2014). Cough after laryngeal herpes zoster: a new aspect of post-herpetic sensory disturbance. J Laryngol Otol. 128(2), 209-211.
102. Rudd T, Chai BY, Gurunluoglu, R and Glasgow M. (2014). Mandibular osteonecrosis and ramsay hunt syndrome following a case of herpes zoster. J Oral Maxillofac Surg. 72(10), e1-6.
103. AlSardar H. (2013). A Case of Almost Painless Herpes Zoster Presenting with Symptoms of Cystitis, Penile Numbness and Acute Vestibular Failure. Case Rep Dermatol Med.
104. Mahima VG, Patil K and Srikanth HS. (2010). Herpes zoster induced alveolar necrosis in an immunocompetent patient. Iran J Clinic Infect Dis. 5(4), 235-238.
105. Biddlestone J, Suraparaju L and Shah N. (2009). Herpes zoster induced acute urinary retention in the immunocompetent female. BMJ Case Rep.
106. Paudyal BP, Karki A, Zimmerman M, Kayastha G, et al. (2006). Hemidiaphragmatic paralysis: a rare complication of cervical herpes zoster. Kathmandu Univ Med J. 4(2), 246-248.
107. Tola-Arribas MA, Zarco-Tejada JM and Marco-Llorente J. (1997). Horners syndrome secondary to ophthalmic herpes zoster. Rev Neurol. 25(148), 1922-1924.
108. Patil SK, Srinivas BH, Reddy S and Gupta M. (2013). Prodromal Herpes Zoster mimicking Odontalgia- A diagnostic challenge. 23(1), 73- 77.
109. Hung MH, Kuo JR, Huang KF and Wang WC. (2010). Sacral herpes zoster presenting as sciatica. CMAJ. 82(11), E534.
110. Shah PA, Khan HB, Yaseen Y, Malik AH, et al. (2011). Herpes zoster oticus masquerading as lateral pontomedullary syndrome. Neurology Asia. 16(3), 259-261.
111. Stary A. (1989). New knowledge regarding herpes zoster. Z Hautkr. 64(4), 255-6, 259-62, 265.
112. Hirata K and Higa K. (2000). Pain treatment of herpes zoster Nihon Rinsho. 58(4), 951-956.
113. Sagir , zaslan S, Meri Y, Arslan I, et al. (2013). Neuropathic pain due to herpes zoster infection with atypical localization. Agri. 25(4), 179-182
114. Volpi A. (2007). Severe complications of herpes zoster. 14 Suppl. (2). 35-39.
115. Morrow MJ. (2000). Bells Palsy and Herpes Zoster Oticus. Curr Treat Options Neurol. 2(5), 407-416.