Systemic varicella-zoster virus infection in two critically ill patients in an intensive care unit

Abstract

Varicella-zoster virus (VZV) usually causes localized zoster in adults. However, in immunocompromised patients, it can cause systemic infection accompanied by complications such as pneumonia, encephalitis, and hepatitis. Although most of critically ill patients in intensive care unit (ICU) are immunologically compromised, they are usually not considered to be at risk for systemic VZV infection.We report two cases of systemic VZV infection occurring in critically ill patients in an ICU. One patient was a 69-year-old man with Streptococcus pneumoniae-induced purpurafulminans, and the other was a 75-year-old woman with severe acute pancreatitis. During the clinical course in the ICU, characteristic vesicles with umbilical fossa appeared diffusely and bilaterally on their face, trunk, and extremities. VZV-specific IgG levels were confirmed to be elevated compared to that of the pre-onset, and a diagnosis of recurrent VZV infection was made in both patients. The patients were treated at the same ICU but did not coincide with each other; therefore a cross-infection was unlikely. They were treated with intravenous acyclovir, but the latter patient eventually died of respiratory failure.VZV infection can cause a number of serious complications, and can lead to death in some patients. Early detection and proper treatment are needed to prevent the infection from spreading out and save the patients. It might be necessary to consider antiviral prophylaxis against VZV infection for a part of critically ill patients in ICU, although the effectiveness of this approach is yet to be established.

Acute Pancreatitis Due to Disseminated Varicella Zoster Infection in an Individual with Newly Diagnosed Human Immunodeficiency Virus

“…Till now, only a few cases of herpes zoster-associated acute pancreatitis have been reported; among them, most involve immunocompromised individuals, such as those in intensive care, AIDS patients, or receiving long-term immunosuppression, such as recipients of stem cell, renal or liver transplants [5][6][7][8][9]. There were only a handful of studies which reported acute pancreatitis associated with VZV in children with chickenpox and one study reported an elderly patient with herpes zoster suffering from systemic complications, including pancreatitis and encephalitis [10][11][12]13].…”

Management of Viral Central Nervous System Infections: A Primer for Clinicians

“…Toxicities associated with acyclovir, which are often dose dependent, remain significant and may be exacerbated in immunocompromised patients with underlying renal dysfunction. The duration of therapy should be 14 days; however, 21 days should be strongly considered in patients with underlying immunocompromise 36,92,93. Use of oral agents such as valacyclovir has not been studied and cannot be recommended at this time.…”

Disseminated zoster in an adult patient with extensive burns: a case report

“…By contrast, in disseminated zoster, a rare manifestation of reactivated latent VZV, the systemic distribution of vesicular eruptions and systemic dissemination of the pathogen to many other organs occurs. Disseminated zoster is rarely seen in immunocompetent patients, but has been reported in immunocompromised patients such as those who have undergone hematopoietic stem cell transplantation and solid organ transplantation, or who have lymphoma or acquired immune deficiency syndrome (AIDS) [6].…”

“…We administered 500 mg of acyclovir as high-dose acyclovir therapy. Intravenous immunoglobulin has also been reported to be a treatment option [6, 10]. VZV vaccination cannot be used as a preventative in immunocompromised patients, because the VZV vaccine is a live-virus vaccine.…”

“…VZV infects not only neurons but also many other cell types. In severe systemic cases of VZV infection, infected cells can be found in almost every organ, including the spleen, liver, lungs, thymus, digestive tract, kidneys, pancreas, aorta, heart, and brain [1, 3, 6, 37–42]. The VZV organisms in disseminated zoster are thought to be spread through the blood stream [43].…”