Shingles Raises Stroke Risk: Study
Patients with the virus should be monitored for high blood pressure, expert says
By Ed Edelson
HealthDay Reporter
THURSDAY, Oct. 8 (HealthDay News) -- Adults with the skin disease shingles appear to be at raised risk for stroke, especially when it affects the area around the eyes, researchers report.
Previous reports have linked shingles with stroke risk, but "the exact frequency and risk for these phenomena are still unknown," said study lead author Dr. Jiunn-Horng Kang, a principal investigator in the Neuroscience Research Center of Taipei Medical University Hospital, Taiwan. His team published their findings in the November issue of Stroke.
"Our study is the first to explore these issues with a nationwide population-based data," Kang said.
Shingles is a painful skin rash resulting from infection by the varicella zoster virus, which causes chickenpox. The virus remains in the body after recovery from chickenpox and can erupt again to cause shingles.
Kang and his colleagues studied data on 7,760 adult Taiwanese who were treated for shingles between 1997 and 2001. In the year after treatment, 133 of them, or1.7 percent, had strokes. The incidence in a control group of 23,280 adults who were not treated for shingles was 1.3 percent (306 people).
Analysis of the data found that the risk of stroke in that one-year period was 31 percent higher in the shingles group. The incidence was dramatically higher for those with a shingles infection in or around the eye -- nearly 4.3 times higher than in the control group.
Strokes can be ischemic, caused by a blood clot blocking a brain artery, or hemorrhagic, due to rupture of a blood vessel. The study found a 31 percent higher incidence of ischemic strokes, the most common kind, and a 2.79-times higher incidence of hemorrhagic stroke in the shingles group.
"The major mechanism of our findings is that stroke results from herpes zoster virus-induced vasculopathy [blood vessel damage]," Kang said. "The vessel to the brain damaged by the virus could be occluded [blocked] or ruptured."
"However, several other factors could also be involved," he added.
No known treatment exists to reduce the apparent risk of stroke that results from shingles infection, Kang said. "Our interest and ongoing research are focused on whether early anti-viral treatment for herpes zoster can reduce the risk of stroke," he said. "Also, from the clinical view, patients who have a shingles attack should be aware of the risk of stroke, and intensive monitoring and management of pre-existing risk factors for stroke, such as hypertension, hyperlipidemia [raised lipid levels] and diabetes, should be emphasized."
Shingles usually starts as a rash on one side of the face or body, which often causes pain, itching and tingling. Attacks can last for two to four weeks. The incidence of shingles increases with age, and the U.S. Centers for Disease Control and Prevention recommends most people over 60 be vaccinated against the virus, with the major exception being those with weakened immune systems.
While there have been scattered reports about a possible association of shingles with stroke, "to my knowledge this is the first study to link shingles very specifically with stroke," said Dr. Daniel Lackland, professor of epidemiology and medicine at the Medical University of South Carolina, and a spokesman for the American Stroke Association.
"It might be a little too early for a lot of clinical implications here," Lackland said. "But a physician who is treating someone with shingles should emphasize the importance of traditional risk factors for stroke, and let the patient know that your risk might be a little bit increased and you should pay more attention to high blood pressure, cholesterol and the like."
More information
Learn the basics about shingles from the U.S. National Library of Medicine.
SOURCES: Jiunn-Horng Kang, M.D., principal investigator, Neuroscience Research Center, Taipei Medical University Hospital, Taiwan; Daniel Lackland, M.D., professor, epidemiology and medicine, Medical University of South Carolina, Charleston; November 2009 Stroke
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Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.
Shingles is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.
The name shingles comes from the Latin word cingulum, which means "belt" or "girdle." The scientific name for the virus that causes shingles is varicella-zoster, combining the Latin word for "little pox" with the Greek word for "girdle." Another name for shingles is herpes zoster.
The virus that causes shingles is a herpes virus. Once you are infected with this kind of virus, it remains in your body for life. It stays inactive until a period when your immunity is down.
If you have had chickenpox, shingles is not contagious. Nothing will happen to you if you are exposed to someone who has shingles. If you have never had chickenpox, however, avoid contact with anyone who has shingles; the fluid from their open blisters is infectious. You will not get shingles, but you could get chickenpox if exposed.
If you have not had chickenpox and you come into contact with someone who has shingles, ask your healthcare provider whether you should get a chickenpox vaccination.
Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended.
The pain of shingles can be debilitating. If it is severe and persists for months or years, it is called postherpetic neuralgia. And unfortunately, persistent pain is a common symptom in people over 60.
Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.
Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome and necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.
The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression.
In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.
If you are basically healthy, shingles usually goes away without complications. You are not likely to ever get it again!
More importantly, the shingles vaccine may one day make shingles a rare disease
Causes and Risk Factors
Shingles is caused by a germ called varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores healed and the other symptoms went away, but the virus remained. It is with you for life.
The virus hides out in nerve cells, usually in the spine. But it can become active again. Somehow, the virus gets a signal that your immunity has become weakened. This triggers the reactivation.
When the virus becomes active again, it follows a nerve path called a dermatome. The nerve path begins at specific points in the spine, continues around one side of the body, and surfaces at the nerve endings in the skin. The pattern of the rash reflects the location of that nerve path.
The leading risk factor for shingles is a history of having had chickenpox. One out of every five people who have had chickenpox is likely to get shingles.
Another risk factor is aging. As we age, our natural immunity gradually loses its ability to protect against infection. The shingles virus can take advantage of this and become active again.
Conditions that weaken the immune system can also put people at risk for shingles. Shingles is especially dangerous for anyone who has had cancer, radiation treatments for cancer, HIV/AIDS, or a transplant operation.
Most cases of shingles occur in adults. Only about 5 percent of cases occur in children. With children, immune deficiency is the primary risk factor, but children who had chickenpox before they were one year old may also get shingles before they become adults.
There have been studies of adults who had chickenpox as children and were later exposed to children who had chickenpox. Interestingly, that exposure apparently boosted the adult's immunity, which actually helped them avoid getting shingles later in life.
Stress is another factor that may contribute to outbreaks. While stress alone does not cause the outbreaks, shingles often occurs in people who have recently had a stressful event in their lives.
Symptoms and Diagnosis
An outbreak of shingles usually begins with a burning, itching, or tingling sensation on the back, chest, or around the rib cage or waist. It is also common for the face or eye area to be affected.
Some people report feeling feverish and weak during the early stages. Usually within 48 to 72 hours, a red, blotchy rash develops on the affected area. The rash erupts into small blisters that look like chickenpox. The blisters seem to arrive in waves over a period of three to five days.
The blisters tend to be clustered in one specific area, rather than being scattered all over the body like chickenpox. The torso or face are the parts most likely to be affected, but on occasion, shingles breaks out in the lower body. The burning sensation in the rash area is often accompanied by shooting pains.
After the blisters erupt, the open sores take a week or two to crust over. The sores are usually gone within another two weeks. The pain may diminish somewhat, but it often continues for months -- and can go on for years.
Shingles can be quite painful. Many shingles patients say that it was the intense pain that ultimately sent them to their healthcare provider. They often report that the sensation of anything brushing across the inflamed nerve endings on the skin is almost unbearable.
A typical shingles case is easy to diagnose. A healthcare provider might suspect shingles if
- the rash is only on one side of the body
- the rash erupts along one of the many nerve paths, called dermatomes, that stem from the spine
A healthcare provider usually confirms a diagnosis of shingles if the person also
- reports a sharp, burning pain
- has had chickenpox
- has blisters that look like chickenpox
- is elderly.
Some people go to their healthcare provider because of burning, painful, itchy sensations on one area of skin, but they don't get a rash. If there is no rash, the symptoms can be difficult to diagnose because they can be mistaken for numerous other diseases.
In cases where there is no rash or the diagnosis is questionable, healthcare providers can do a blood test. If there is a rash, but it does not resemble the usual shingles outbreak, a healthcare provider can examine skin scrapings from the sores.
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Treatment with an antiviral can reduce the severity of the nerve damage and speed healing. If you suspect you have shingles, see your healthcare provider within 72 hours of the first sign of the rash.
A healthcare provider can confirm the diagnosis, prescribe the antiviral pills, and may also prescribe other drugs such as pain relievers. Patients with long-term pain may also be treated with numbing patches, tricyclic antidepressants, and gabapentin, an anti-seizure medication.
While these treatments can reduce the symptoms of shingles, they are not a cure. The antivirals do weaken the virus and its effects, but the outbreak still tends to run its course.
Good hygiene, including daily bathing, can help prevent bacterial infections. It is a good idea to keep fingernails clean and well trimmed to reduce scratching.
In May 2006, the U.S. Food and Drug Administration approved a vaccine to prevent shingles in people age 60 and older, even if they have had shingles. The vaccine is designed to boost the immune system and protect older adults from getting shingles later on.
The vaccine is basically a stronger version of the chickenpox vaccine, which became available in 1995. The chickenpox shot prevents chickenpox in 70 to 90 percent of those vaccinated, and 95 percent of the rest have only mild symptoms. Millions of children and adults have already received the chickenpox shot.
Interestingly, the chickenpox vaccine may reduce the shingles problem. Widespread use of the chickenpox vaccine means that fewer people will get chickenpox in the future. And if people do not get chickenpox, they cannot get shingles. Use of the shingles and chickenpox vaccines may one day make shingles a rare disease.
