Clinical characteristics and outcomes of varicella zoster virus infection in children with hematologic malignancies in the acyclovir era

Abstract

BackgroundAlthough intravenous acyclovir therapy is recommended for varicella zoster virus (VZV) infection in immunocompromised children, the clinical characteristics and outcomes of VZV infection in the acyclovir era have rarely been reported.MethodsThe medical records of children diagnosed with varicella or herpes zoster virus, who had underlying hematologic malignancies, were retrospectively reviewed, and the clinical characteristics and outcomes of VZV infection were evaluated.ResultsSeventy-six episodes of VZV infection (herpes zoster in 57 and varicella in 19) were identified in 73 children. The median age of children with VZV infection was 11 years (range, 1-17), and 35 (46.1%) episodes occurred in boys. Acute lymphoblastic leukemia was the most common underlying malignancy (57.9%), and 90.8% of the episodes occurred during complete remission of the underlying malignancy. Acyclovir was administered for a median of 10 days (range, 4-97). Severe VZV infection occurred in 16 (21.1%) episodes. Although the finding was not statistically significant, a previous history of hematopoietic cell transplantation (HCT) appeared to be associated with the development of more severe episodes of herpes zoster (P=0.075).ConclusionClinical characteristics of VZV infection in immunocompromised children were not significantly different from those without it, and clinical outcomes improved after the introduction of acyclovir therapy. However, risk factors for severe VZV infection require further investigation in a larger population and a prospective setting.

Vaccination With Live Attenuated Vaccines in Four Children With Chronic Myeloid Leukemia While on Imatinib Treatment

“…In addition, it has been established that patients with CML who are exposed to someone who has varicella or shingles disease or measles should alert their healthcare team, which will consider if they are quickly eligible to receive chemoprophylaxis with acyclovir or hyperimmune globulin. Of note, immunosuppressed cancer patients may present with atypical severe complications that have not been documented in immunocompetent patients, such as giant-cell pneumonia, measles inclusion-body encephalitis, and abdominal pain due to visceral dissemination and fulminant hepatitis in the case of varicella infection (37,38). In outbreaks of varicella, measles, or influenza on oncological ward or stem cell transplant units or in renal transplantation, a 5-10% case fatality rate has been reported (39)(40)(41)(42)(43)(44)(45).…”

Different Clinical Presentations and Outcomes of Disseminated Varicella in Children With Primary and Acquired Immunodeficiencies

“…The standard treatment for DV in immunocompromised patients includes prompt intravenous acyclovir treatment, initiated as soon as possible ( 31 ). Early treatment may improve prognosis ( 32 ). The addition of interferon-alpha, early in infection, may also improve outcome by helping to control of the initial viremia.…”

Evaluation of Varicella-Zoster Virus Immunoglobulin G in Children With Malignancies on Chemotherapy

“…In general, VZV is transmitted through close personal contact or airborne droplets (11). Children are susceptible to VZV infection, and it is estimated that approximately 90% of VZV infections are diagnosed in children aged < 15 years worldwide (13,14).…”

“…The total varicella-induced mortality rate in most countries is estimated at 0.05% to 1% (12). However, the mortality rate from VZV infection is 3% in pediatric patients with malignancy on chemotherapy without vaccines (11).…”