Dear Editor,
It is recognized that the majority of the infections with COVID‐19 presented with mild and moderate symptoms, however, the minority (15%) of the infections can progress to severe pneumonia and acute respiratory distress syndrome (ARDS), or can progress to multiple organ failure. 1 Morbilliform rashes, chicken‐pox like lesions, covid toe and a various lesions were the main skin manifestations reported during COVID 19 epidemics. 2 There are recent reports on cases of herpes zoster infections among a symptomatic COVID‐19 infection. 3 , 4 Therefore, identifying or to raise the suspicion of the asymptomatic carriers is of paramount in the management of COVID‐19 outbreak.
The plausible explanation for the herpes zoster infections among a symptomatic COVID‐19 infections is the lymphopenia (which can favor herpes virus recurrences) which is a result of infecting lymphocytes and activation‐induced cell death and impairment to antiviral responses. 5 Therefore, the point of herpes zoster infections among a symptomatic COVID‐19 infection should be put in mind when a broad immunosuppression is used in patients with severe viral illness and the pros and cons of anti‐inflammatory effects vs the delay of virus clearance. 6
CONFLICT OF INTEREST
The author declares no conflict of interest.
Adam I. Is herpes zoster being an indicator for COVID 19 infection? Dermatologic Therapy. 2020;33:e13846. 10.1111/dth.13846
REFERENCES
- 1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497‐506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Wollina U, Karadağ AS, Rowland‐Payne C, Chiriac A, Lotti T. Cutaneous signs in COVID‐19 patients: a review. Dermatol Ther. 2020; http://www.ncbi.nlm.nih.gov/pubmed/32390279. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. de Freitas Ferreira ACA, Romão TT, SIlva Macedo Y, Pupe C, Nascimento OJ. COVID‐19 and herpes zoster co‐infection presenting with trigeminal neuropathy. Eur J Neurol. Eur J Neurol. 2020; https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.14361. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Herpes Zoster Might Be an Indicator for Latent COVID 19 Infection—PubMed [Internet]. https://pubmed.ncbi.nlm.nih.gov/32447801/?from_term=Covid+19+herpes+zoter&from_sort=date&from_size=100&from_pos=2. [cited May 26, 2020]. [DOI] [PMC free article] [PubMed]
- 5. Zheng HY, Zhang M, Yang CX, et al. Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID‐19 patients. Cell Mol Immunol Springer Nature. 2020;17:541‐543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Ritchie AI, Singanayagam A. Immunosuppression for hyperinflammation in COVID‐19: a double‐edged sword? Lancet. 2020;395(10230):1111. 10.1016/S0140-6736(20)30691-7. [DOI] [PMC free article] [PubMed] [Google Scholar]