Case-control study of the effect of mechanical trauma on the risk of herpes zoster
http://www.100md.com
《英国医生杂志》
1 Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, 2 Department of Public Health and Primary Care, Institute of Public Health, Cambridge CB2 2SR
Correspondence to: S L Thomas sara.thomas@lshtm.ac.uk
Introduction
In this study, mechanical trauma was associated with a significantly increased risk of zoster the next month. The results indicate that trauma increases the risk of zoster at the trauma site, but not elsewhere. This suggests that traumatic stimulation of the nerve may trigger viral reactivation in the dorsal root ganglion of that nerve. The findings could be affected by recall bias—cases may have remembered more clearly that minor trauma occurred immediately before their zoster. Many of the 11 cases included in these analyses, however, reported memorable traumatic events—for example, undergoing cardioversion or being assaulted—and controls are unlikely to have forgotten such events.
Our sample size enabled us to show significant association with recent trauma, but only 14 participants had recent trauma at the site of the cases' zoster, resulting in wide 95% confidence intervals. Most trauma experienced by cases was not followed by zoster at the trauma site, perhaps because zoster occurs most often within thoracic, lumbar, or trigeminal (ophthalmic) dermatomes, whereas physical injuries are more common elsewhere (such as the limbs). Traumatic stimulation of nerves in parts of the body predisposed to reactivation of varicella zoster virus may be relatively uncommon in older people, and so only a modest proportion of zoster cases are likely to result directly from trauma.
We thank all the patients who agreed to take part in the study; Albion Street Health Centre; Aylesbury Partnership; Belmont Hill Surgery; Brixton Hill Group Practice; Camberwell Green Surgery; Crown Dale Medical Centre; Grange Road Practice; Downham Way Surgery; Forest Hill Group Practice; Isidore Crown Health Centre; Jenner Health Centre; Lee Road Surgery; Mawbey Brough Health Centre; New Surgery, Clapham; Paxton Green Health Centre; Queens Road Partnership; Sternhall Lane Surgery; Sydenham Green Group Practice; Torridon Road Surgery; Judy Breuer for helpful discussions on the diagnosis of zoster and for analyses of the polymerase chain reactions.
Contributors: AJH conceived the study, and all authors contributed to the design. SLT ran the study, did the interviews, managed the data, and did the statistical analyses with input from AJH and JGW. All authors interpreted the findings and wrote the manuscript. SLT is guarantor.
Funding: SLT was funded initially by a research studentship from the Medical Research Council (UK) and then by the Research Foundation for Microbial Diseases, Osaka University.
Competing interests: None declared.
Ethical approval: Research ethics committees of Kings Healthcare, Guy's Hospital, St Thomas's Hospital, Lewisham Hospital Trust, and the London School of Hygiene and Tropical Medicine.
Table A on bmj.com gives details of 14 people who had recent trauma at the site of subsequent rash in the case
References
Arvin AM. Cell-mediated immunity to varicella-zoster virus. J Infect Dis 1992;166(suppl): S35-41.
Burke BL, Steele RW, Beard OW, Wood JS, Cain TD, Marmer DJ. Immune responses to varicella-zoster in the aged. Arch Intern Med 1982;142: 291-3.
Morens DM, Bregman DJ, West CM, Greene MH, Mazur MH, Dolin R, et al. An outbreak of varicella-zoster virus infection among cancer patients. Ann Intern Med 1980;93: 414-9.
Juel-Jensen BE. The natural history of shingles: events associated with reactivation of varicella-zoster virus. J R Coll Gen Pract 1970;20: 323-7.
Thomas SL, Wheeler JG, Hall AJ. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Lancet 2002;360: 678-82.(S L Thomas, clinical lect)
Correspondence to: S L Thomas sara.thomas@lshtm.ac.uk
Introduction
In this study, mechanical trauma was associated with a significantly increased risk of zoster the next month. The results indicate that trauma increases the risk of zoster at the trauma site, but not elsewhere. This suggests that traumatic stimulation of the nerve may trigger viral reactivation in the dorsal root ganglion of that nerve. The findings could be affected by recall bias—cases may have remembered more clearly that minor trauma occurred immediately before their zoster. Many of the 11 cases included in these analyses, however, reported memorable traumatic events—for example, undergoing cardioversion or being assaulted—and controls are unlikely to have forgotten such events.
Our sample size enabled us to show significant association with recent trauma, but only 14 participants had recent trauma at the site of the cases' zoster, resulting in wide 95% confidence intervals. Most trauma experienced by cases was not followed by zoster at the trauma site, perhaps because zoster occurs most often within thoracic, lumbar, or trigeminal (ophthalmic) dermatomes, whereas physical injuries are more common elsewhere (such as the limbs). Traumatic stimulation of nerves in parts of the body predisposed to reactivation of varicella zoster virus may be relatively uncommon in older people, and so only a modest proportion of zoster cases are likely to result directly from trauma.
We thank all the patients who agreed to take part in the study; Albion Street Health Centre; Aylesbury Partnership; Belmont Hill Surgery; Brixton Hill Group Practice; Camberwell Green Surgery; Crown Dale Medical Centre; Grange Road Practice; Downham Way Surgery; Forest Hill Group Practice; Isidore Crown Health Centre; Jenner Health Centre; Lee Road Surgery; Mawbey Brough Health Centre; New Surgery, Clapham; Paxton Green Health Centre; Queens Road Partnership; Sternhall Lane Surgery; Sydenham Green Group Practice; Torridon Road Surgery; Judy Breuer for helpful discussions on the diagnosis of zoster and for analyses of the polymerase chain reactions.
Contributors: AJH conceived the study, and all authors contributed to the design. SLT ran the study, did the interviews, managed the data, and did the statistical analyses with input from AJH and JGW. All authors interpreted the findings and wrote the manuscript. SLT is guarantor.
Funding: SLT was funded initially by a research studentship from the Medical Research Council (UK) and then by the Research Foundation for Microbial Diseases, Osaka University.
Competing interests: None declared.
Ethical approval: Research ethics committees of Kings Healthcare, Guy's Hospital, St Thomas's Hospital, Lewisham Hospital Trust, and the London School of Hygiene and Tropical Medicine.
Table A on bmj.com gives details of 14 people who had recent trauma at the site of subsequent rash in the case
References
Arvin AM. Cell-mediated immunity to varicella-zoster virus. J Infect Dis 1992;166(suppl): S35-41.
Burke BL, Steele RW, Beard OW, Wood JS, Cain TD, Marmer DJ. Immune responses to varicella-zoster in the aged. Arch Intern Med 1982;142: 291-3.
Morens DM, Bregman DJ, West CM, Greene MH, Mazur MH, Dolin R, et al. An outbreak of varicella-zoster virus infection among cancer patients. Ann Intern Med 1980;93: 414-9.
Juel-Jensen BE. The natural history of shingles: events associated with reactivation of varicella-zoster virus. J R Coll Gen Pract 1970;20: 323-7.
Thomas SL, Wheeler JG, Hall AJ. Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. Lancet 2002;360: 678-82.(S L Thomas, clinical lect)