Clinico-Epidemiological Profile of Immunocompetent Patients Diagnosed with Herpes Zoster: A Single-Center Retrospective Cohort Study from Sinop
Öz
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.
Anahtar Kelimeler
Herpes zoster immunocompetent postherpetic neuralgia ophthalmic herpes zoster neutrophil-to-lymphocyte ratio
Kaynakça
- 1. Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014; 348: g2911.
- 2. Gross G, Schöfer H, Wassilew S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP, Wutzler P, Doerr HW. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol 2003; 26: 277-289.
- 3. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 2014; 4: e004833.
- 4. Dayan RR, Peleg R. Herpes zoster - typical and atypical presentations. Postgrad Med 2017;129:567-571.
- 5. Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc 2017;92:1806-1821.
- 6. Thomas SL, Hall AJ. What does epidemiology tell us about the risk factors for herpes zoster? Lancet Infect Dis 2004;4:26-33.
- 7. Schmidt SAJ, Langan SM, Pedersen HS, Schønheyder HC, Thomas SL, Smeeth L, Mansfield KE, Sørensen HT, Forbes HJ, Vestergaard M. Mood disorders and risk of herpes zoster in 2 population-based case-control studies in Denmark and the United Kingdom. Am J Epidemiol 2018;187:1019-1028.
- 8. Özkol HU, Güneş Bilgili S, Karadağ AS, Altun F, Çalka Ö. The evaluation clinical and demographic characteristics of 115 patients diagnosed with herpes zoster in Eastern Turkey. Turk J Dermatol 2013;7:201-205.
- 9. Küçükçakır O, Aliağaoğlu C, Turan H, Yanık ME, Gürlevik Z, Acer E, Albayrak H, Gönen İ. Retrospective evaluation of patients with herpes zoster followed up in our department between 1999-2010. Turkderm 2012;46:186-190.
- 10. Acer E, Kaya Erdoğan H, Bulur I, Acar EM. Evaluation of demographic and clinical characteristics of 166 patients with herpes zoster in the Kırşehir region. Turkderm-Turk Arch Dermatol Venereology 2018;52:95-99.
- 11. Türkiye İstatistik Kurumu (TÜİK). Available from: https://data. tuik.gov.tr/Bulten/Index?p=Adrese-Dayali-Nufus-Kayit-Sistemi- Sonuclari-2022-49685. Access date: February 18 2023.
- 12. Goh CL, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol 1997;36:667-672.
- 13. Chidiac C, Bruxelle J, Daures JP, Hoang-Xuan T, Morel P, Leplège A, El Hasnaoui A, de Labareyre C. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis 2001;33:62-69.
- 14. Cohen EJ, Kessler J. Persistent dilemmas in zoster eye disease. Br J Ophthalmol 2016;100:56-61.
- 15. Jain A, van Hoek AJ, Walker JL, Forbes HJ, Langan SM, Root A, Smeeth L, Thomas SL. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol 2018;178:1324-1330.
- 16. Yang YW, Chen YH, Lin HW. Risk of herpes zoster among patients with psychiatric diseases: a population-based study. J Eur Acad Dermatol Venereol 2011;25:447-453.
- 17. Rammal H, Bouayed J, Falla J, Boujedaini N, Soulimani R. The impact of high anxiety level on cellular and humoral immunity in mice. Neuroimmunomodulation 2010;17:1-8.
- 18. Irwin M, Costlow C, Williams H, Artin KH, Chan CY, Stinson DL, Levin MJ, Hayward AR, Oxman MN. Cellular immunity to varicella-zoster virus in patients with major depression. J Infect Dis 1998;178:104-108.
- 19. Vijay A, Dalela G. Herpes zoster duplex bilateralis in immunocompetent patients: report of two cases. J Clin Diagn Res 2015;9:WR01-3.
- 20. Zhang F, Zhou J. Zoster duplex: a clinical report and etiologic analysis. Int J Clin Exp Med 2015;8:11020-11025.
- 21. Hwang JH, Kim KH, Han SB, Kim HH, Kim JH, Lee SY, Choi UY, Kang JH. A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children. Clin Exp Vaccine Res 2019;8:116-123.
- 22. Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, Bialek SR, Marin M. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis 2013;208:1859-1868.
- 23. Wolfson LJ, Daniels VJ, Pillsbury M, Kurugöl Z, Yardimci C, Kyle J, Dinleyici EC. Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model. PLoS One 2019;14:e0220921.
- 24. Liesegang TJ. Herpes zoster ophthalmicus: natural history, risk factors, clinical presentation, and morbidity. Ophthalmology 2008;115:3-12.
- 25. Butsch F, Greger D, Butsch C, von Stebut E. Prognostic value of Hutchinson’s sign for ocular involvement in herpes zoster ophthalmicus. J Dtsch Dermatol Ges 2017;15:563-564.
- 26. Yawn BP, Wollan PC, St Sauver JL, Butterfield LC. Herpes zoster eye complications: rates and trends. Mayo Clin Proc 2013;88:562-570.
- 27. Davies EC, Pavan-Langston D, Chodosh J. Herpes zoster ophthalmicus: declining age at presentation. Br J Ophthalmol 2016;100:312-314.
- 28. Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol 2018;84:251-262.
- 29. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982;61:310-316.
- 30. Womack LW, Liesegang TJ. Complications of herpes zoster ophthalmicus. Arch Ophthalmol 1983;101:42-45.
- 31. Thomas SL, Wheeler JG, Hall AJ. Case-control study of the effect of mechanical trauma on the risk of herpes zoster. BMJ 2004;328:439.
- 32. Zhang JX, Joesoef RM, Bialek S, Wang C, Harpaz R. Association of physical trauma with risk of herpes zoster among Medicare beneficiaries in the United States. J Infect Dis 2013;207:1007-1011.
- 33. Berlinberg EJ, Kim E, Deiner MS, Patterson C, Porco TC, Acharya NR. Seasonality of herpes zoster and herpes zoster ophthalmicus. J Clin Virol 2020;126:104306.
- 34. Toyama N, Shiraki K; Society of the Miyazaki Prefecture Dermatologists. Epidemiology of herpes zoster and its relationship to varicella in Japan: a 10-year survey of 48,388 herpes zoster cases in Miyazaki prefecture. J Med Virol 2009;81:2053-2058.
- 35. Gamus D, Romano A, Sucher E, Ashkenazi IE. Herpetic eye attacks: variability of circannual rhythms. Br J Ophthalmol 1995;79:50-53.
- 36. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, Langan SM. A systematic review and metaanalysis of risk factors for postherpetic neuralgia. Pain 2016;157:30-54.
- 37. Soh Y, Lee JH, Jung J, Dong SH, Byun JY, Park MS, Kim SH, Yeo SG. A high neutrophil-to-lymphocyte ratio is associated with recovery from Ramsay Hunt Syndrome. ORL J Otorhinolaryngol Relat Spec 2019;81:130-137.
- 38. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 2017;10:12.
- 39. Kim YJ, Park GH, Kim MJ, Sim HB, Lee WJ, Lee SJ, Kim SW, Jeon YH, Jang YH, Kim DW. Usefulness of inflammatory markers for the prediction of postherpetic neuralgia in patients with acute herpes zoster. Ann Dermatol 2018;30:158-163
Herpes Zoster Tanısı Alan İmmünkompetan Hastaların Epidemiyolojik ve Klinik Özellikleri: Sinop İlinden Tek Merkezli Retrospektif Kohort Çalışma
Öz
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.
Anahtar Kelimeler
Herpes zoster immünkompetan postherpetik nevralji oftalmik herpes zoster nötrofil lenfosit oranı
Kaynakça
- 1. Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Langan SM. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014; 348: g2911.
- 2. Gross G, Schöfer H, Wassilew S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP, Wutzler P, Doerr HW. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol 2003; 26: 277-289.
- 3. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 2014; 4: e004833.
- 4. Dayan RR, Peleg R. Herpes zoster - typical and atypical presentations. Postgrad Med 2017;129:567-571.
- 5. Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc 2017;92:1806-1821.
- 6. Thomas SL, Hall AJ. What does epidemiology tell us about the risk factors for herpes zoster? Lancet Infect Dis 2004;4:26-33.
- 7. Schmidt SAJ, Langan SM, Pedersen HS, Schønheyder HC, Thomas SL, Smeeth L, Mansfield KE, Sørensen HT, Forbes HJ, Vestergaard M. Mood disorders and risk of herpes zoster in 2 population-based case-control studies in Denmark and the United Kingdom. Am J Epidemiol 2018;187:1019-1028.
- 8. Özkol HU, Güneş Bilgili S, Karadağ AS, Altun F, Çalka Ö. The evaluation clinical and demographic characteristics of 115 patients diagnosed with herpes zoster in Eastern Turkey. Turk J Dermatol 2013;7:201-205.
- 9. Küçükçakır O, Aliağaoğlu C, Turan H, Yanık ME, Gürlevik Z, Acer E, Albayrak H, Gönen İ. Retrospective evaluation of patients with herpes zoster followed up in our department between 1999-2010. Turkderm 2012;46:186-190.
- 10. Acer E, Kaya Erdoğan H, Bulur I, Acar EM. Evaluation of demographic and clinical characteristics of 166 patients with herpes zoster in the Kırşehir region. Turkderm-Turk Arch Dermatol Venereology 2018;52:95-99.
- 11. Türkiye İstatistik Kurumu (TÜİK). Available from: https://data. tuik.gov.tr/Bulten/Index?p=Adrese-Dayali-Nufus-Kayit-Sistemi- Sonuclari-2022-49685. Access date: February 18 2023.
- 12. Goh CL, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol 1997;36:667-672.
- 13. Chidiac C, Bruxelle J, Daures JP, Hoang-Xuan T, Morel P, Leplège A, El Hasnaoui A, de Labareyre C. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis 2001;33:62-69.
- 14. Cohen EJ, Kessler J. Persistent dilemmas in zoster eye disease. Br J Ophthalmol 2016;100:56-61.
- 15. Jain A, van Hoek AJ, Walker JL, Forbes HJ, Langan SM, Root A, Smeeth L, Thomas SL. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol 2018;178:1324-1330.
- 16. Yang YW, Chen YH, Lin HW. Risk of herpes zoster among patients with psychiatric diseases: a population-based study. J Eur Acad Dermatol Venereol 2011;25:447-453.
- 17. Rammal H, Bouayed J, Falla J, Boujedaini N, Soulimani R. The impact of high anxiety level on cellular and humoral immunity in mice. Neuroimmunomodulation 2010;17:1-8.
- 18. Irwin M, Costlow C, Williams H, Artin KH, Chan CY, Stinson DL, Levin MJ, Hayward AR, Oxman MN. Cellular immunity to varicella-zoster virus in patients with major depression. J Infect Dis 1998;178:104-108.
- 19. Vijay A, Dalela G. Herpes zoster duplex bilateralis in immunocompetent patients: report of two cases. J Clin Diagn Res 2015;9:WR01-3.
- 20. Zhang F, Zhou J. Zoster duplex: a clinical report and etiologic analysis. Int J Clin Exp Med 2015;8:11020-11025.
- 21. Hwang JH, Kim KH, Han SB, Kim HH, Kim JH, Lee SY, Choi UY, Kang JH. A clinico-epidemiological multicenter study of herpes zoster in immunocompetent and immunocompromised hospitalized children. Clin Exp Vaccine Res 2019;8:116-123.
- 22. Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, Bialek SR, Marin M. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis 2013;208:1859-1868.
- 23. Wolfson LJ, Daniels VJ, Pillsbury M, Kurugöl Z, Yardimci C, Kyle J, Dinleyici EC. Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model. PLoS One 2019;14:e0220921.
- 24. Liesegang TJ. Herpes zoster ophthalmicus: natural history, risk factors, clinical presentation, and morbidity. Ophthalmology 2008;115:3-12.
- 25. Butsch F, Greger D, Butsch C, von Stebut E. Prognostic value of Hutchinson’s sign for ocular involvement in herpes zoster ophthalmicus. J Dtsch Dermatol Ges 2017;15:563-564.
- 26. Yawn BP, Wollan PC, St Sauver JL, Butterfield LC. Herpes zoster eye complications: rates and trends. Mayo Clin Proc 2013;88:562-570.
- 27. Davies EC, Pavan-Langston D, Chodosh J. Herpes zoster ophthalmicus: declining age at presentation. Br J Ophthalmol 2016;100:312-314.
- 28. Koshy E, Mengting L, Kumar H, Jianbo W. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol 2018;84:251-262.
- 29. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982;61:310-316.
- 30. Womack LW, Liesegang TJ. Complications of herpes zoster ophthalmicus. Arch Ophthalmol 1983;101:42-45.
- 31. Thomas SL, Wheeler JG, Hall AJ. Case-control study of the effect of mechanical trauma on the risk of herpes zoster. BMJ 2004;328:439.
- 32. Zhang JX, Joesoef RM, Bialek S, Wang C, Harpaz R. Association of physical trauma with risk of herpes zoster among Medicare beneficiaries in the United States. J Infect Dis 2013;207:1007-1011.
- 33. Berlinberg EJ, Kim E, Deiner MS, Patterson C, Porco TC, Acharya NR. Seasonality of herpes zoster and herpes zoster ophthalmicus. J Clin Virol 2020;126:104306.
- 34. Toyama N, Shiraki K; Society of the Miyazaki Prefecture Dermatologists. Epidemiology of herpes zoster and its relationship to varicella in Japan: a 10-year survey of 48,388 herpes zoster cases in Miyazaki prefecture. J Med Virol 2009;81:2053-2058.
- 35. Gamus D, Romano A, Sucher E, Ashkenazi IE. Herpetic eye attacks: variability of circannual rhythms. Br J Ophthalmol 1995;79:50-53.
- 36. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, Langan SM. A systematic review and metaanalysis of risk factors for postherpetic neuralgia. Pain 2016;157:30-54.
- 37. Soh Y, Lee JH, Jung J, Dong SH, Byun JY, Park MS, Kim SH, Yeo SG. A high neutrophil-to-lymphocyte ratio is associated with recovery from Ramsay Hunt Syndrome. ORL J Otorhinolaryngol Relat Spec 2019;81:130-137.
- 38. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 2017;10:12.
- 39. Kim YJ, Park GH, Kim MJ, Sim HB, Lee WJ, Lee SJ, Kim SW, Jeon YH, Jang YH, Kim DW. Usefulness of inflammatory markers for the prediction of postherpetic neuralgia in patients with acute herpes zoster. Ann Dermatol 2018;30:158-163
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Ağustos 2023 |
| Kabul Tarihi | 6 Ağustos 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 7 Sayı: 2 |
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