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

• Main Authors: Liese Johannes, Girschick Hermann J, Gattenlöhner Stefan, Weissbrich Benedikt, Beer Meinrad, Schick Judith, Wiegering Verena, Schlegel Paul G, Eyrich Matthias
• Format: Article
• Language: English
• Published: BMC 2011-05-01
• Series: BMC Pediatrics
• Subjects: varicella-zoster virus; immunosuppression; pediatrics; cidofovir
• Online Access: http://www.biomedcentral.com/1471-2431/11/31

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p>