回復期リハビリテーション病棟における汎発性帯状疱疹発症時の管理と予防の重要性について再認識させられた1例

Management and Prevention of Generalized Herpes Zoster in Elderly Patients in the Convalescent Rehabilitation Ward : A Case Report

はじめに

　帯状疱疹は三叉神経節，脊髄後根神経節といった知覚神経に潜伏感染した水痘帯状疱疹ウイルス（varicella zoster virus：VZV）が宿主の免疫力低下を契機に再活性化し，神経節支配領域に沿って帯状に皮疹が発現することで発症する．しかし，ごくまれに，この再活性化の際にVZVがウイルス血症を起こし，皮疹が全身に播種・汎発化することがある¹⁾．この状態が汎発性帯状疱疹と呼ばれ，気道粘膜におけるウイルスの増殖は空気感染のリスクを高める．そのため，迅速な診断と院内感染への対策が必要となる．

　今回，回復期リハビリテーション病棟入院中に汎発性帯状疱疹を発症した症例を経験した．本症例の臨床症状，経過，感染予防対策，そしてワクチン定期接種導入など，社会的背景から発症予防について考察し，報告する．なお，本報告に際し，患者家族へ十分に説明を行い，書面で同意を得ている．

A 95-year-old woman was admitted to our hospital for rehabilitation after a subarachnoid hemorrhage, but her physical function deteriorated due to repeated aspiration pneumonia. On the first day of the illness, a painless erythema appeared on the right elbow fossa, and expanded soon afterwards. She developed a fever of unknown origin, which led us to the diagnosis of generalized herpes zoster by using a rapid diagnostic kit. The patient was placed in a private room to prevent nosocomial infection, and we took contact infection prevention measures, such as, restricting the number of staff in the room. Antiviral drugs were administered to the patient, quickly relieving her fever. The erythema became encrusted in about 2 weeks, and private room management was terminated.

Recently, due the start of periodic vaccination, the incidence of varicella has decreased；however, the increasing incidence of herpes zoster infections among the elderly remains a concern, since the onset of herpes zoster infections is inhibited by the booster effect of contact with varicella patients. Many patients are at a high risk for herpes zoster in convalescent rehabilitation wards due to the long-term admission of elderly patients with underlying diseases. Because more patients with severe herpes zoster are expected in convalescent rehabilitation wards in the future, we herein reexamine the management of such patients from the perspective of early diagnosis, nosocomial infection prevention measures, and prevention of herpes zoster onset.