Herpes Zoster--带状疱疹Guildline.pdf

clinical practice T h e n e w e ngl a nd j o u r na l o f m e dic i n e n engl j med 369;3 nejm.org july 18, 2013 255 Caren G. Solomon, M.D., M.P.H., Editor An audio version of this article is available at NEJM.org This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Herpes Zoster Jeffrey I. Cohen, M.D. From the Medical Virology Section, Lab- oratory of Infectious Diseases, National Institutes of Health, Bethesda, MD. Ad- dress reprint requests to Dr. Cohen at the Laboratory of Infectious Diseases, Nation- al Institutes of Health, Bldg. 50, Rm. 6134, 50 South Dr., MSC1807, Bethesda, MD 20892-1807, or at jcohen@niaid.nih.gov. N Engl J Med 2013;369:255-63. DOI: 10.1056/NEJMcp1302674 Copyright ? 2013 Massachusetts Medical Society. A 65-year-old man presents with a rash of 2 days’ duration over the right forehead with vesicles and pustules, a few lesions on the right side and tip of the nose, and slight blurring of vision in the right eye. The rash was preceded by tingling in the area and is now associated with aching pain. How should this patient be evaluated and treated? The Clinic a l Problem Primary infection with varicella–zoster virus (VZV) results in chickenpox, charac- terized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome. There are more than 1 million cases of herpes zoster in the United States each year, with an annual rate of 3 to 4 cases per 1000 persons. Studies suggest that the incidence of herpes zoster is increasing.1 Unvac- cinated persons who live to 85 years of age have a 50% risk of