The effect of immunologic marker levels on the development of postherpetic neuralgia in diabetes mellitus patients with acute herpes zoster: Immunologic markers in acute herpes zoster

Numan Demiralp; Sema Tuncer Uzun; Gülçin Büyükbezi̇rci̇; Sevgi Keleş; Şule Arıcan; Resul Yılmaz; Ruhiye Reisli; İsmail Reisli

doi:10.28982/josam.8588

Authors

Numan Demiralp Department of Anesthesiology and Reanimation, Kulu State Hospital, Konya, Turkey https://orcid.org/0000-0002-0734-4872
Sema Tuncer Uzun Department of Algology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-6205-1706
Gülçin Büyükbezi̇rci̇ Department of Anesthesiology and Reanimation, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-9438-3414
Sevgi Keleş Department of Pediatric Allergy and Immunology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0001-7344-8947
Şule Arıcan Department of Anesthesiology and Reanimation, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-8634-1150
Resul Yılmaz Department of Anesthesiology and Reanimation, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-5527-2893
Ruhiye Reisli Department of Algology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-1616-5497
İsmail Reisli Department of Pediatric Allergy and Immunology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0001-8247-6405

DOI:

https://doi.org/10.28982/josam.8588

Keywords:

diabetes mellitus, herpes zoster, immune system, natural killer cells, postherpetic neuralgia

Abstract

Background/Aim: Neuropathic pain is a complex condition with an incompletely understood pathogenesis, and immunologic mechanisms are increasingly recognized as important contributors. This study aimed to evaluate the association between immunologic marker levels and the development of postherpetic neuralgia in patients with acute herpes zoster, with a particular focus on the impact of diabetes mellitus.

Methods: In this prospective observational study, 20 patients with acute herpes zoster and a Douleur Neuropathique 4 score of 4 or higher were enrolled. Patients were categorized into two groups: those with diabetes mellitus (Group I, n = 10) and those without diabetes mellitus (Group II, n = 10). Routine laboratory parameters, including hemogram, C-reactive protein, erythrocyte sedimentation rate, fasting blood glucose, and hemoglobin A1c, were recorded. Immunologic markers, including CD3+, CD4+, CD8+, FOXP3+ regulatory T cells, natural killer cell subsets (regulatory, defective, cytotoxic, CD56 bright, and CD56 dim), and NK CD57, were analyzed at baseline and at month 3.

Results: NK defective subset levels were lower in Group I than in Group II at baseline and at month 3 (P = 0.028 and P = 0.037, respectively). During follow-up, significant reductions in CD3+, CD4+, and CD8+ levels were observed in Group I (P = 0.013, P = 0.017, and P = 0.041, respectively), whereas significant decreases in NK defective and NK regulatory subsets were identified in Group II (P = 0.037 and P = 0.047, respectively). At the 3-month assessment, all patients met the study definition of postherpetic neuralgia.

Conclusion: Diabetes mellitus was associated with alterations in natural killer cell subpopulations, suggesting impaired innate immune function in patients with acute herpes zoster. However, within the limitations of this small cohort, diabetes mellitus did not appear to independently increase the risk of postherpetic neuralgia. Larger, well-designed studies are needed to clarify the predictive role of immunologic markers in chronic neuropathic pain outcomes.

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