Date Published: February 8, 2017
Publisher: Public Library of Science
Author(s): Ying Lian, Yun Zhu, Fang Tang, Bing Yang, Ruisheng Duan, Ilhem Messaoudi.
Herpes zoster infection and stroke are highly prevalent in the general population; however, reports have presented inconsistent findings regarding the relationship between herpes zoster infection and stroke. In this meta-analysis, we aimed to clarify this association.
The PubMed and Embase databases were searched for studies published from their inception to January 2016. Two investigators independently extracted the data. The pooled relative risk (RR) was calculated using a random effects model.
A total of 8 studies met the inclusion criteria. During the first 1 month after herpes zoster infection, the pooled RRs for ischemic stroke and hemorrhagic stroke were 1.55 (95% CI, 1.46–1.65) and 1.70 (95% CI, 0.73–3.96), respectively, and within 3 months after infection, the corresponding RRs were 1.17 (95% CI, 1.12–1.23) and 2.05 (95% CI, 1.17–3.60), respectively. At 1 year and more than 1 year after herpes zoster infection, a significant relationship was not observed between herpes zoster infection and the incidence of ischemic and hemorrhagic stroke. Publication bias was not observed.
The accumulated evidence generated from this systematic review indicates that an increased risk for ischemic stroke occurred in the short term after herpes zoster infection, whereas a significant relationship was not observed in the long term after infection. With respect to hemorrhagic stroke, the association was not significant. With respect to hemorrhagic stroke, the association between was not significant except within 3 months after a herpes zoster infection.
Herpes zoster (HZ) infectious outbreaks, also called shingles, are caused by the reactivation of the varicella-zoster virus (VZV). Primary infection with VZV in childhood manifests as chickenpox, and then VZV enters a dormant period in the dorsal root ganglia. After VZV reactivates, it travels along sensory nerve endings and causes neuronal damage to the corresponding dermatome of the skin, where it is characterized by a vesicular rash [1,2]. Spontaneous reactivation of VZV may occur in the elderly and individuals with compromised cell-mediated immunity; therefore, the risk of an HZ outbreak substantially increases with age and immunosuppression. Accumulating evidence has shown that more than 95% of adults worldwide are infected with VZV, and approximately 30% will develop HZ in their lifetime, with this proportion increasing to 50% in those aged at least 85 years [3,4].
The study design was developed and the analyses were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines (S2 Text).
Our systemic review quantitatively summarized the current literature and analyzed 8 studies to determine the short-term and long-term stroke risk after HZ infection. Overall, the incidence of ischemic stroke is significantly higher in short-term after herpes zoster, whereas a significant relationship was not observed in the long term after HZ infection. With respect to hemorrhagic stroke, herpes zoster correlated positively with the stroke. With respect to hemorrhagic stroke, the association between was not significant except within 3 months after a herpes zoster infection.