Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Mustapić, Željka; Bašić‐Jukić, Nikolina; Kes, Petar; Lovčić, Vesna; Bubić-Filipi, L; Mokos, Ivica; Kaštelan, Željko; Zekan, Šime

doi:10.1159/000328730

Cited by 33 publications

(37 citation statements)

References 40 publications

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“…There is evidence to suggest that seropositivity against VZV infection does not have any significant impact on fatal outcomes. The median time interval between kidney transplantation and such an infection is usually 2–3 years (this duration can be as high as 19 years in some patients) 6. Among the renal transplant recipients who develop VZV infection, most have a limited infection in one dermatome distribution.…”

Section: Discussionmentioning

confidence: 99%

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

Nabi¹,

Kahlon

Goggins

et al. 2014

BMJ Case Reports

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A 73-year-old woman with a history of deceased donor kidney transplantation and a recent cytomegalovirus (CMV) infection, presented to the emergency department with an altered mental status. She was found to have varicella zoster virus VZV encephalitis based on cerebrospinal fluid analysis and was treated successfully with intravenous valaciclovir with an improvement in her mental status. A review of the literature shows very few case reports on patients with kidney transplantation developing VZV encephalitis. A few case reports and studies report an association between CMV and VZV infection. In these patients, CMV infection can cause a marked decline in immunity and this predisposes them to other infections. Such associations have also been reported between other types of virus infections from the Herpesviridae family. The risk of disseminated VZV infection increases in the presence of CMV infection.

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Section: Discussionmentioning

confidence: 99%

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

Nabi¹,

Kahlon

Goggins

et al. 2014

BMJ Case Reports

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“…Posttransplant yüksek dozda kullanılan mikofenolat mofetilin VZV enfeksiyonu riskini artırdığı bildirilmiştir. Bu nedenle yüksek doz asiklovir tedavisi ile birlikte immünsüpresif ilaçların dozunun düşürülmesi VZV enfeksiyonu tedavisinin köşe taşını oluşturmaktadır (10). Hastamız ise asiklovir tedavisine dramatik olarak cevap vermiş, kullandığı immünsüpresif dozların azaltılmasına da gerek kalmamıştı.…”

Section: Kaynaklarunclassified

“…Varisella zoster posttransplant ölümcül komplikasyonlara neden olabildiği için, nakil öncesinde seronegatif hastalara, etkinliği sınırlı olsa da aşılama yapılması önerilebilir (9,10). VZV'ye maruziyet sonrasında ise pasif immünprofilaksi ve/ veya antiviral tedavi verilebilir (8).…”

Section: Kaynaklarunclassified

Varicella Zoster Infection Under Valganciclovir Prophylaxis After Renal Transplantation

Bardak¹,

Turgutalp²,

Koyuncu³

et al. 2016

Turk Neph Dial Transpl

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özBöbrek nakilli hastalara uygulanan yoğun immünsüpresif tedavi bir çok enfeksiyon hastalığı riskinde artışa neden olmaktadır. Bu enfeksiyonlar arasında yer alan varisella virüs enfeksiyonu (VZV) primer veya reaktivasyona ikincil olarak yaygın deri tutulumu veya spesifik doku ya da organ tutulumu ile seyredebilmektedir. Yaygın VZV enfeksiyonuna bağlı mortalite %30'a varabilmektedir. Sitomegalovirüs (CMV) profilaksisi amacıyla kullanılabilen ve geniş spektrumlu antiherpetik bir ajan olan valasiklovir ve valgansiklovir CMV'ye ek olarak herpes simpleks virüs (HSV), VZV gibi diğer herpesvirüs enfeksiyonlarına karşı da koruyucu olduğu düşünülmektedir. Burada, çocukluk çağında VZV enfeksiyonu geçirmemiş olan ve böbrek naklinden 5½ ay sonra, valgansiklovir profilaksisi altında gelişen ve yaygın deri, karaciğer ve sol göz tutulumu gösteren VZV enfeksiyonlu hasta ve yönetimi sunulmuştur.anahTaR SözCüklER: Renal transplantasyon, Valgansiklovir, Valasiklovir, Varisella aBSTRaCT Intensive immunosuppressive therapy in renal transplant patients increases the risk for infectious diseases. Varicella zoster virus (VZV) infection is one of these infectious diseases and can occur either primarily or with reactivation of latent disease with disseminated skin lesions or visceral involvement. Mortality rate due to disseminated VZV infection is as high as 30%. Valacyclovir and valganciclovir, which are wide spectrum antiherpetic agents used for cytomegalovirus (CMV) prophylaxis, act against not only CMV but also herpes simplex virus (HSV) and VZV. We describe a patient who did not have a VZV infection history in childhood and suffered from disseminated VZV infection with skin, liver and left eye involvement 5½ months after renal transplantation under valgancyclovir prophilaxis for CMV, and discuss the management of primary VZV infection. GirişBöbrek nakilli hastalarda, gerek klasik gerekse fırsatçı mikroorganizmalarla gelişen enfeksiyon riski artmıştır. Bu özel hasta grubunda enfeksiyonlar, kardiyovasküler nedenlerden sonra 2. sıklıkta izlenen ölüm nedenidir. Böbrek nakli sonrasında özellikle 1-6. aylar arasında yoğun immünsüpresyonun katkısıyla sitomegalovirüs (CMV), herpes simpleks virüs (HSV), varisella zoster virüs (VZV), epstein-barr virüs (EBV), hepatit B ve C gibi viral enfeksiyonlar primer olarak veya latent enfeksiyonun reaktivasyonu ile gelişebilmektedir (1).Böbrek nakli olan hastalarda primer veya reaktivasyona ikincil gelişen VZV enfeksiyonu yaygın deri tutulumu veya spesifik doku ya da organ tutulumu ile seyredebilmektedir. Bu hasta grubunda yaygın VZV enfeksiyonuna bağlı mortalite oranı %30'a ulaşabilmektedir (2). CMV enfeksiyon riskini azaltmak amacıyla uygulanabilen bazı profilaktik yaklaşımların VZV'ye karşı da koruyucu olabileceği bilinmektedir (3).

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“…Clinical manifestations of VZV infection are chickenpox or varicella (primary infection) and shingles (reactivation) 3 . In immunocompromised persons such as transplant recipients, patients with malignant diseases and HIV-infected patients, herpesviruses can cause severe, sometimes fatal disease 7,8 . In this population group, common clinical symptoms include retinitis, pneumonitis, hepatitis, esophagitis, meningitis and encephalitis 1,9 .…”

Section: Introductionmentioning

confidence: 99%

Herpes Group Viruses: a Seroprevalence Study in Hemodialysis Patients

Vilibić-Čavlek

Kolarić

Bogdanić

et al. 2017

acc

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SUMMARY -Herpes group viruses (herpes simplex virus, HSV; varicella-zoster virus, VZV; cytomegalovirus, CMV; and Epstein-Barr virus, EBV) remain an important cause of morbidity in immunocompromised persons. Th e aim of the study was to analyze the prevalence of HSV-1, HSV-2, VZV, CMV and EBV in patients undergoing hemodialysis. During a three-year period (2013)(2014)(2015), 152 consecutive serum samples from hemodialysis patients and 150 healthy subjects (control group) were tested for the presence of IgM/IgG antibodies to herpes group viruses. Serologic tests were performed using a commercial enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunofl uorescent assay (ELFA). Hemodialysis patients showed signifi cantly higher CMV IgG seropositivity compared to controls (88.2% vs. 78.7%, p=0.011). In addition, seroprevalence rates of HSV-1 and VZV were higher in hemodialysis patients; however, these diff erences did not reach statistical signifi cance (85.5% vs. 80.0%, p=0.054 and 99.3% vs. 96.0%, p=0.051, respectively). Th e prevalence of HSV-2 and EBV was similar in both groups (12.5% vs. 12.7%, p=0.137 and 98.0% vs. 95.3%, p=0.113, respectively). Th ere was no diff erence in IgG seropositivity according to gender and place of residence. Logistic regression showed that older age was a signifi cant predictor for CMV and EBV IgG seropositivity (increase in age by one year: CMV OR=1.055; 95%CI=1.030-1.080 and EBV OR=1.075, 95%CI=1.023-1.130).

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Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Cited by 33 publications

References 40 publications

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

VZV encephalitis following successful treatment of CMV infection in a patient with kidney transplant

Varicella Zoster Infection Under Valganciclovir Prophylaxis After Renal Transplantation

Herpes Group Viruses: a Seroprevalence Study in Hemodialysis Patients

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