Skip to main content
Erschienen in: Infection 4/2022

Open Access 22.12.2021 | COVID-19 | Correspondence

Dexamethasone enhances risk of herpes zoster in severe COVID-19 infection

verfasst von: Nathan B. Price, Charles Grose

Erschienen in: Infection | Ausgabe 4/2022

download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN
We read the review article about herpes zoster and COVID-19 infection with great interest [1]. As an example from the review, the author noted that the Brazilian Ministry of Health had documented an increase in cases of herpes zoster from 9.69 to 14.13 cases per million people in the Rio de Janeiro region pre-and post-COVID-19 epidemic. We propose that we can answer the question whether this association is a coincidence or a causal relationship, at least in several of the severe treated cases. There is a 70-year history in the medical literature about the induction of herpes zoster in a wide variety of patients who were prescribed corticosteroid therapy. We have recently reviewed this association [2]. This association has been documented in both immunocompetent and immunodeficient children and both immunocompetent and immunodeficient adults [3].
Dexamethasone has become commonplace in the treatment protocols for management of more severe cases of COVID-19 infection [4]. A standard dexamethasone dosage is 6 mg per day for 10 days. The consensus in the virology literature is that a daily prednisone dosage of 20 mg enhances the likelihood of herpes zoster in any adult [2]. The dexamethasone/prednisone equivalence between a daily dexamethasone dosage of 6 mg is approximately 37 mg of prednisone, almost twice the known risk dosage of 20 mg. Even smaller dosages of prednisone (7. 5 mg daily, equivalent to ~ 1 mg dexamethasone) have been associated with increased herpes zoster in immunocompromised adults [2, 3]. Furthermore, prednisone has a half-life around 24 h whereas dexamethasone has a longer half-life. Thus, dexamethasone given on a daily basis may accumulate to higher levels over the usual COVID-19 treatment period of 10 days.
When we performed a search on the PubMed website, looking for articles on dexamethasone treatment of COVID-19, we retrieved 788 titles. A brief survey of these articles included an estimation that during 2020, as many as 50% of patients with severe COVID-19 disease received corticosteroids. For example, in a large controlled open-label trial carried out in the United Kingdom by the Recover Collaborative Group, the investigators concluded that the use of dexamethasone resulted in a lower 28-day mortality among COVID-19 patients who were receiving either invasive mechanical ventilation or oxygen alone at randomization [5]. Finally, the guidelines of the Infectious Disease Society of America also recommend dexamethasone therapy for critically ill and severe but not critically ill cases of COVID-19 infection.
As cited in the review [1], most patients developed herpes zoster between 1 to 4 weeks after the diagnosis of COVID-19 infection, the average being 17 days. One case occurred 2 days before diagnosis and another case occurred on the same day of diagnosis. Obviously, herpes zoster cases that occurred before or at the time of diagnosis of COVID-19 infection cannot be caused by dexamethasone, but the evidence in the medical literature strongly suggests that cases of herpes zoster that occur between 1 and 8 weeks after corticosteroid therapy can be secondary to the lymphopenia caused by corticosteroids [2, 3]. To define a comprehensive hypothesis, we propose that COVID-19 infection by itself can on some occasions cause sufficient lymphopenia to lead to herpes zoster before onset of clinical COVID-19 infection. But more commonly we propose that the additive effect of dexamethasone-induced lymphopenia on COVID-19-induced lymphopenia leads to the increased rate of herpes zoster after diagnosis and treatment of COVID-19 infection. Finally, we note that the majority of herpes zoster cases occurred in COVID-19 patients who were older than 50 years and therefore already at higher risk to develop herpes zoster.

Acknowledgements

Both NBP and CG are members of the Infectious Diseases Society of America.

Declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This article is a review of published articles. Ethics approval is not relevant.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

Unsere Produktempfehlungen

Neuer Inhalt

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

e.Med Innere Medizin

Kombi-Abonnement

Mit e.Med Innere Medizin erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Innere Medizin, den Premium-Inhalten der internistischen Fachzeitschriften, inklusive einer gedruckten internistischen Zeitschrift Ihrer Wahl.

Weitere Produktempfehlungen anzeigen
Literatur
2.
Zurück zum Zitat Price NB, Grose C. Corticosteroids contribute to serious adverse events following live attenuated varicella vaccination and live attenuated zoster vaccination. Vaccines (Basel). 2021;9:23.CrossRef Price NB, Grose C. Corticosteroids contribute to serious adverse events following live attenuated varicella vaccination and live attenuated zoster vaccination. Vaccines (Basel). 2021;9:23.CrossRef
3.
Zurück zum Zitat Marra F, Lo E, Kalashnikov V, Richardson K. Risk of herpes zoster in individuals on biologics, disease-modifying antirheumatic drugs, and/or corticosteroids for autoimmune diseases: a systematic review and meta-analysis. Open Forum Infect Dis. 2016;3: ofw05.CrossRef Marra F, Lo E, Kalashnikov V, Richardson K. Risk of herpes zoster in individuals on biologics, disease-modifying antirheumatic drugs, and/or corticosteroids for autoimmune diseases: a systematic review and meta-analysis. Open Forum Infect Dis. 2016;3: ofw05.CrossRef
4.
Zurück zum Zitat Hasan SS, Capstick T, Ahmed R, Kow CS, Mazhar F, Merchant HA, Zaidi STR. Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis. Expert Rev Respir Med. 2020;14:1149–63.CrossRef Hasan SS, Capstick T, Ahmed R, Kow CS, Mazhar F, Merchant HA, Zaidi STR. Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis. Expert Rev Respir Med. 2020;14:1149–63.CrossRef
5.
Zurück zum Zitat Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384:693–704.CrossRef Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384:693–704.CrossRef
Metadaten
Titel
Dexamethasone enhances risk of herpes zoster in severe COVID-19 infection
verfasst von
Nathan B. Price
Charles Grose
Publikationsdatum
22.12.2021
Verlag
Springer Berlin Heidelberg
Schlagwort
COVID-19
Erschienen in
Infection / Ausgabe 4/2022
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-021-01747-x

Weitere Artikel der Ausgabe 4/2022

Infection 4/2022 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.