Is VZV reactivation a common cause of unexplained unilateral pain? Resultsof a prospective study of 57 patients

Objective: Pain is a common reason for patients to present to a doctor. Man y patients with tester have seen their doctor with pain during the days bef ore the rash and tester sine herpete is well described. If early varicella tester virus (VZV) reactivation could be identified confidently it could pr ovide an opportunity for early antiviral intervention, This prospective stu dy was performed to assess how often patients presenting to their general p ractitioner with unilateral pain of no obvious clinical cause proved to hav e evidence of VZV reactivation, Methods: Fifty-seven patients were recruited and followed for 28 days; labo ratory testing included VZV polymerase chain reaction (PCR) from peripheral blood mononuclear cells. VZV IgG, IgA and IgM. The control group consisted of 81 blood donors. Results: Only two study patients developed the rash of tester. There was no significant difference in PCR or serological responses between the study g roup and control group. Clinical characteristics did not enable identificat ion of patients presenting to their doctor with unilateral pain who had pro dromal zoster. Conclusion: There was no evidence on clinical or laboratory tests used in t his study to support the view that reactivation of VZV is a common cause of unexplained unilateral pain. (C) 1999 The British Infection Society.