The significance of the determination of lymphocytes with clinical manifestation of ophthalmic zoster sine herpete

Abstract

Objective:To examine the significance of VZV-IgG (IgG) enzyme immunoassay (EIA) and the determination of peripheral blood lymphocyte counts in the diagnosis of ophthalmic zoster sine herpete (ophthalmic ZSH).Method:Clinical case-control study with a sample of 65 patients with ophthalmic ZSH (16 males and 49 females; mean age 56 ± 18 years) in whom pressure elicited pain in tender points of Valleix (tender points of sites at which the trigeminal nerve appears subcutaneously). A total of 41 healthy controls (17 males and 24 females, mean age 48 ± 21 years) were also recruited. In each group, IgG and lymphocyte count were determined upon receiving the consent of patients. Multiple logistic regression analysis was used to evaluate the factors associated with diagnosis of ophthalmic ZSH. Odds ratios and 95% confidence intervals (CI) were determined for each variable.Results:Lymphocyte count in the patients with ophthalmic ZSH was significantly low, though there were no significant differences in age, gender, and IgG between the two groups. Multiple logistic regression analysis revealed that lymphocytes pose a significant prognostic factor, and in case of 1,800 lymphocytes/μl or more, the odds ratio to less than1,800 lymphocytes/μl was 0.29 (95% CI: 0.12–0.72).Conclusion:Patients with orbital pain should be suspected as having ophthalmic ZSH as this allows for the determination of lymphocyte counts after tender points were confirmed. The swift diagnosis of ophthalmic ZSH and the administration of antiviral drugs from an early stage improve the subjective symptoms of the patient and is regarded as necessary to reduce the risk of severe complications.

Can COVID-19 Increase the Risk of Herpes Zoster? A Narrative Review

“…T cells than the control group [22]. A similar observation was also made in another study that included 65 patients with ophthalmic zoster sine herpete (and 41 controls), in which patients with ophthalmic zoster sine herpete had significantly lower lymphocyte counts [23].…”

Zoster sine herpete of the trigeminal nerve revisited as a COVID-19-associated disease: Atypical manifestation of herpes zoster masquerading odontogenic symptoms

“…In patients with ophthalmic ZSH before the pandemic, lymphocyte counts were lower than those of normal individuals, whereas there were no significant differences in age and serum VZV-IgG levels between the two groups [12] ; Only 6.2% (4 out of 65 patients with ZSH) had VZV-IgG levels greater than 50, with a mean VZV-IgG value of 18 for all patients, which is similar to that of normal individuals in the control group. Serum VZV-IgG values can be considered unreliable to diagnose patients with persistent pain in the unilateral dermatomal distribution, though lymphocyte counts can be considered more helpful for the swift diagnosis of mandibular ZSH as well as ophthalmic ZSH.…”

Herpes zoster in children during the COVID-19 pandemic in France: A retrospective multicenter observational study

“…The main explanatory hypothesis was that lymphopenia, common among COVID-19 patients [20] , [21] , could induce reactivation of VZV [22] , [23] . This hypothesis was further supported by the occurrence of HZ soon after COVID-19 vaccination, probably due to temporary lymphopenia [24] , [25] .…”