Zoster in Children

Abstract

ZOSTER is said to occur less frequently in children than in older individuals. It has been suggested, however, that the disease occurs far more frequently in children than is generally realized, but because of the relatively benign course of childhood zoster, cases do not come to the attention of the physician.1Zoster is believed to be caused by activation of varicella zoster (VZ) virus which had been acquired during a previous attack of chickenpox. One might expect, therefore, to find a lower rate of zoster in children than in adults, since children who have not had chickenpox would not run the risk of getting zoster.Studies in adults indicate that the risk of contracting zoster increases with advancing age.2-4 Since most individuals get chickenpox in childhood, it would appear, therefore, that the risk of getting zoster increases as the interval of time since onset of chickenpox increases.Many reports of zoster in adults appear in the literature. The epidemiology,24 antibody response,56 and clinical course 3·4 have been described in older individuals.The following report describes 15 chil¬ dren with zoster. Clinical observations suggest that the disease may be milder in children than in adults. Epidemiologi¬ ca! and serological data provide some in¬ sight into the ecology of VZ virus and into host factors affecting resistance to this infection. Materials and MethodsFifteen children with zoster who were seen at New York University Medical Center between 1964 and 1966 were included in the study. A complete history was obtained and physical ex¬ amination performed at the initial visit. At this time, a blood sample was obtained. Five patients were hospitalized during the course of their zoster; seven additional patients were seen dur¬ ing convalescence. Additional blood samples were obtained from these 12 patients.Antibody determinations were performed by the method described previously.7 VZ antigen was prepared in human embryonic lung fibroblasts. All tests were performed by complement fixation adapted to microtiter.6 A significant anti¬ body response was defined as (1) a fourfold or greater rise in serum antibody titer between acute and convalescent specimens, or (2) a single serum specimen with an antibody titer of 64 or greater which is significantly higher that would be expected in the normal population.15 Clinical FeaturesAll patients had typical zosteriform eruptions (color Figure). Vesicular le¬ sions were grouped; they were found in the distribution of one to three sensory nerve segments. Only one of the patients had cranial nerve involvement. In this case, the third division of the fifth cranial nerve was affected. Eight patients had thoracic involvement, three patients had lumbar involvement, and one patient each had thoracolumbar, cervicothoracic, or sacral segments involved.The vesicular lesions appeared in crops.In one patient in whom the presenting symptoms were pain, headache, and nausea, the cause of these symptoms was not realized when the child was first seen, since only a single group of vesicle...

Varicella‐Zoster Virus Infection in Children with Underlying Human Immunodeficiency Virus Infection

“…zoster. For the analysis of the incidence of zoster, 1 child was not included because her varicella occurred at 5 months of age, which is known to increase the incidence of zoster [7,8]. The child with a low CD4 / cell count and poor growth (who was Discussion judged to have AIDS) when she developed varicella was included in the analysis of zoster but not in the analysis of the We could find no obvious evidence that acute varicella worsened the course of HIV infection in children with regard spectrum of varicella in HIV infection.…”

Herpes Zoster in Childhood: Case Report and Review of the Literature

“…In 1990 the Food and Drug Administration (FDA) approved high-dose oral acyclovir for the treatment of acute zoster (10). Although many antiviral drugs are available today, acyclovir is the first-line agent (1 [1][2][3][4][5][6][7][8][9][10][11][12][13]. Its benefits are a relatively high therapeutic index, small fluid volume requirements (with intravenous use), and relative ease of administration (14).…”

Revisiting Childhood Herpes Zoster

“…It usually affects elderly patients (1–3). More rarely, shingles may occur in immunocompromised (4–12) and immunocompetent children (9,11–25). The disease affects about 0.07% of children who are organ recipients or have malignancies at less than 9 years of age (1,26–29).…”