Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis

BMC Pediatr. 2011 May 10:11:31. doi: 10.1186/1471-2431-11-31.

Abstract

Background: Infection with varicella-zoster virus (VZV) contemporaneously with malignant disease or immunosuppression represents a particular challenge and requires individualized decisions and treatment. Although the increasing use of varicella-vaccines in the general population and rapid initiation of VZV-immunoglobulins and acyclovir in case of exposure has been beneficial for some patients, immunocompromised individuals are still at risk for unfavourable courses.

Methods: In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZV-infections in our center and compare them to published data. Furthermore, we report three instructive cases.

Results: Hospitalization rate of referred children with VZV-infections was 45%, among these 17% with malignancies and 9% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroid-dependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h.

Conclusion: Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / therapeutic use
  • Antiviral Agents / therapeutic use
  • Chickenpox / diagnosis
  • Chickenpox / drug therapy
  • Chickenpox / immunology*
  • Child
  • Child, Preschool
  • Cidofovir
  • Cytosine / analogs & derivatives
  • Cytosine / therapeutic use
  • Female
  • Herpes Zoster / diagnosis
  • Herpes Zoster / drug therapy
  • Herpes Zoster / immunology*
  • Herpesvirus 3, Human / drug effects
  • Herpesvirus 3, Human / immunology*
  • Hospitalization* / statistics & numerical data
  • Humans
  • Immunocompromised Host / drug effects
  • Immunocompromised Host / immunology*
  • Incidence
  • Infant
  • Male
  • Organophosphonates / therapeutic use
  • Practice Guidelines as Topic

Substances

  • Antiviral Agents
  • Organophosphonates
  • Cytosine
  • Cidofovir
  • Acyclovir