Clinico-Epidemiological Profile of Immunocompetent Patients Diagnosed with Herpes Zoster: A Single-Center Retrospective Cohort Study from Sinop

Year 2023, , 120 - 127, 31.08.2023

Zeynep Keskinkaya , Ayna Sariyeva Ismayilov , Özge Aydın Güçlü

https://doi.org/10.29058/mjwbs.1267521

Abstract

Aim: Herpes zoster (HZ) mainly occurs in immunocompetent individuals, even though immunosuppression
is a well-known risk factor. The aim of this study was to evaluate the demographic and clinical features
of immunocompetent HZ patients and HZ-related complications with a special focus on possible
contributing factors.
Material and Methods: This single-center, retrospective cohort study included 98 patients with no
known immunosuppressive condition out of 103 patients diagnosed with HZ between September 2019
and August 2020. The patients were evaluated in terms of age, sex, medical history, clinical features,
triggering factors, seasonality, complications, and neutrophil-to-lymphocyte ratio (NLR) as a marker of
systemic inflammation.
Results: Ninetyeight immunocompetent patients (male:female ratio=1.1:1) were diagnosed with HZ,
with a median age of 59 years (age range: 5-88). Thoracic dermatome was the leading dermatome
(n=45). Trigeminal nerve was involved in 11 patients, eight of them presenting with ophthalmic HZ. HZ
attacks were mainly detected in summer, while ophthalmic HZ cases were exclusively diagnosed during
fall and winter. Two patients developed ophthalmic HZ following trauma. Eleven patients experienced
postherpetic neuralgia (PHN) during follow-up with a male predominance (p=0.009). A higher mean NLR
value was detected in PHN patients, although it was not statistically significant (p=0.136).
Conclusion: The findings of our study are compatible with the current literature regarding the main
presentation pattern of HZ as unilateral thoracic dermatome involvement and the complications such as
PHN and ophthalmic HZ occurring in a subgroup of patients. The high HZ incidence rate in our series is
likely due to the high median age of the population in our region. The summer peak of HZ cases further
supports the seasonal variability due to the ultraviolet effect, whereas mechanical trauma is another
possible triggering factor. The predictive value of NLR for PHN should be evaluated in further studies.

Keywords

Herpes zoster, immunocompetent, postherpetic neuralgia, ophthalmic herpes zoster, neutrophil-to-lymphocyte ratio

Herpes Zoster Tanısı Alan İmmünkompetan Hastaların Epidemiyolojik ve Klinik Özellikleri: Sinop İlinden Tek Merkezli Retrospektif Kohort Çalışma

Abstract

Amaç: İmmünsupresyon herpes zoster (HZ) için iyi bilinen bir risk faktörü olsa da, bu tablo genellikle
immünkompetan olgularda görülür. Bu çalışmada immünkompetan HZ olgularında demografik ve klinik
özelliklerin, HZ gelişimine neden olan faktörlerin ve HZ ile ilişkili komplikasyonların değerlendirilmesi
amaçlanmıştır.
Gereç ve Yöntemler: Bu tek merkezli retrospektif kohort çalışmaya, Eylül 2019 ve Ağustos 2020 tarihleri arasında HZ tanısı alan 103
hasta arasından bilinen immünsupresif durumu olmayan 98 hasta dahil edilmiştir. Hastalar yaş, cinsiyet, tıbbi özgeçmiş, klinik bulgular,
tetikleyici faktörler, tanı aldıkları mevsim, komplikasyonlar ve sistemik inflamasyon göstergesi olarak nötrofil lenfosit oranı (NLO) açısından
değerlendirilmiştir.
Bulgular: Ortanca yaşı 59 olan (yaş aralığı: 5-88) 98 immünkompetan hasta (erkek:kadın oranı=1,1:1) HZ tanısı almıştı. En sık tutulan
dermatom torakal dermatomdu (n=45). Trigeminal sinir tutulumu olan 11 hastanın sekizinde oftalmik HZ mevcuttu. HZ atakları sıklıkla yaz
döneminde görülürken tüm oftalmik HZ olguları sonbahar ve kış mevsimlerinde tanı almıştı. İki olguda travma sonrası oftalmik HZ görülmüştü.
Takipte erkek cinsiyet baskın olmak üzere 11 hastada postherpetik nevralji (PHN) gelişmişti (p=0,009). İstatistiksel olarak anlamlı olmamakla
birlikte (p=0,136), PHN gelişen hastalarda ortalama NLO değeri daha yüksekti.
Sonuç: Çalışmamızdaki bulgular, HZ'nin ana prezentasyon paterni olan tek taraflı torakal dermatom tutulumu ve bir grup hastada ortaya
çıkan PHN ve oftalmik HZ gibi komplikasyonlar açısından mevcut literatür ile uyumludur. Serimizdeki yüksek HZ insidans oranı, muhtemelen
bölgemizdeki popülasyonun ortanca yaşının yüksek olmasından kaynaklanmaktadır. HZ olgularının yaz döneminde artış göstermesi
ultraviyole ışınlarına bağlı mevsimsel etkiyi desteklerken, mekanik travma başka bir olası tetikleyici faktördür. NLO'nun PHN açısından
prediktif değeri ileri çalışmalarla değerlendirilmelidir.

Keywords

Herpes zoster, immünkompetan, postherpetik nevralji, oftalmik herpes zoster, nötrofil lenfosit oranı

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