Chickenpox infection after renal transplantation

Kaul, Anupma; Sharma, Raj Kumar; Bhadhuria, Dharmendra; Gupta, Amit; Prasad, Narayan

doi:10.1093/ckj/sfs036

Cited by 17 publications

(26 citation statements)

References 16 publications

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“…Varicella infection is a potentially serious event in an immunocompromised patient, with possible complications including pneumonia, hepatitis, and encephalitis . For this reason, documentation of immunity by vaccination is strongly encouraged in transplant candidates, as far as is practical and possible.…”

Section: Discussionmentioning

confidence: 99%

Varicella infection following vaccination in a pediatric kidney transplant recipient

Bobrowski

Muller

2020

Pediatric Transplantation

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The live attenuated varicella-zoster virus (VZV) vaccine prevents varicella infection in immunocompetent children. Such live viral vaccines have been historically avoided in children after solid organ transplantation and bone marrow transplant, due to concerns for disseminated vaccine-induced disease and/or poor immunogenicity in immunocompromised recipients. As reviews emerge reporting safety and adequate immune response in immunosuppressed patients, however, some are considering a revision of this guideline to allow at least a subset of transplanted children to receive live viral vaccines after transplantation. Although the situation is admittedly rare, here we report a case of disseminated VZV infection in a 4-year-old kidney transplant recipient after he was inadvertently administered the live attenuated MMRV vaccine. | C A S E REP ORTA 4-year-old boy presented to the emergency department (ED) with a chief complaint of rash 16 months after receiving a living-related kidney transplant. He had a history of end-stage kidney disease (ESKD) secondary to kidney dysplasia and had received both peritoneal dialysis and hemodialysis prior to transplant. His post-transplant course had been complicated by recurrent Clostridioides difficile colitis, which had responded well to treatment. He had no history of rejection. The patient had developed a papular pruritic rash on his back and anterior chest 12 days prior to presentation, which spread to his nose and left cheek over the course of a week. The lesions at first seemed consistent with molluscum contagiosum, which the patient had been diagnosed with in the past. He presented to the ED due to increased fussiness thought to be due to pruritus. He had not been febrile at that time. His only known sick contact was a younger sibling with an upper respiratory tract infection with no associated rash. On examination, the patient was noted to have a crusted vesicular rash Abstract Live viral vaccines have historically been avoided in children after solid organ transplantation. Multiple reports of safety and immunogenicity, largely in the pediatric liver transplant population, have led to a reconsideration of this recommendation.Here, we report the case of a 4-year-old boy who inadvertently received the live attenuated MMR-varicella vaccine (MMRV) at a routine well-child visit 16 months after receiving a living donor kidney transplant. This was not known until after he was admitted with rash and documented disseminated varicella infection 5 weeks later. He was treated with intravenous acyclovir followed by oral therapy and recovered fully. This case and its discussion illustrate what is still unknown about the risk-to-benefit ratio of live viral vaccination in any individual transplant recipient. Criteria to determine which patients should receive these vaccines should be evaluated before their use after transplant becomes routine, and all recipients and their families should be counseled to have a low threshold to seek medical care for any febrile illness or rash after live vira...

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Section: Discussionmentioning

confidence: 99%

Varicella infection following vaccination in a pediatric kidney transplant recipient

Bobrowski

Muller

2020

Pediatric Transplantation

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“…In humans, disseminated Lyme disease has rarely been reported to cause orchitis . In solid organ transplant recipients, orchitis is a rare clinical presentation and has been reported in renal transplant patients secondary to chickenpox and tuberculosis, in a pediatric liver transplant patient due to Listeria monocytogenes and in a cardiac transplant recipient due to Nocardia asteroides . Differential diagnosis for transplant patients presenting with febrile illness, leukopenia, and thrombocytopenia is wide and includes mainly viral infections such as Cytomegalovirus , Parvovirus B19, Human herpes virus 6 and Human herpes virus 8 .…”

Section: Discussionmentioning

confidence: 99%

Anaplasma phagocytophilum presenting with orchitis in a renal transplant recipient

Khatri

Lloji

Doobay

et al. 2019

Transplant Infectious Dis

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Human granulocytic anaplasmosis (HGA), caused by Anaplasma phagocytophilum, is an emerging tick-borne disease. It is spread by the black-legged deer tick Ixodes scapularis that serves as the vector for six human pathogens. HGA is still rarely reported in solid organ transplant recipients. In solid organ transplant recipients, or-How to cite this article: Khatri A, Lloji A, Doobay R, et al. Anaplasma phagocytophilum presenting with orchitis in a renal transplant recipient. Transpl Infect Dis. 2019;21:e13129.

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“…Prior to the introduction of acyclovir the overall mortality rates was 34% [ 22 ]. One ten year retrospective analysis of renal allograft patients showed that varicella associated with an increased mortality of 13.4% [ 23 ]. To our knowledge and review of literature, there were no reports on mortality rates among patients with ESRD on dialysis and ESRD not on renal replacement therapy for direct comparison.…”

Section: Discussionmentioning

confidence: 99%

Incidence and mortality rates of varicella among end stage renal disease (ESRD) patients in Singapore General Hospital, a 12-year review

et al. 2018

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BackgroundEnd stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults.MethodsA retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively.ResultsSixty-six patients with ESRD developed varicella during the study period (2005–2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: − 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance.ConclusionsVaricella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients.

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Chickenpox infection after renal transplantation

Cited by 17 publications

References 16 publications

Varicella infection following vaccination in a pediatric kidney transplant recipient

Varicella infection following vaccination in a pediatric kidney transplant recipient

Anaplasma phagocytophilum presenting with orchitis in a renal transplant recipient

Incidence and mortality rates of varicella among end stage renal disease (ESRD) patients in Singapore General Hospital, a 12-year review

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