Varicella in Children With Cancer: Impact of Antiviral Therapy and Prophylaxis

To estimate the impact of antiviral therapy and prophylaxis on the natural course of the infection, 288 cases of varicella in children with cancer were reviewed. Among 127 patients with untreated infections, the overall mortality rate was 7%. Varicella-zoster virus pneumonitis developed in 28% of the untreated patients and was associated with a 25% mortality rate. Pneumonitis was much more likely to develop in patients with acute leukemia than in those with other malignancies (32% v 19%). Similarly, deaths due to pneumonitis were restricted to patients with acute leukemia. Lymphopenia (absolute lymphocyte count <500/µL) was significantly associated with varicella-zoster virus pneumonitis and a higher fatality rate among patients with this complication. Both acyclovir and adenine arabinoside, administered to 18 and 28 patients, respectively, stopped the progression of skin lesions; however, pneumonitis developed in none of the acyclovir recipients after two days of treatment, compared with 29% of the adenine arabinoside recipients (P = .03). Passive immunization in 45 children who subsequently had varicella was associated with an 11% incidence of varicella-zoster virus pneumonitis. Despite passive immunization of approximately 150 children, the attack rate of varicella at our institution remains unchanged. Results of this study demonstrate the efficacy of antiviral therapy and passive immunization in patients with childhood cancer and varicella, but prevention of the infection will require a universal vaccine.

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Varicella-Zoster Virus

10.1093/med/9780190604813.003.0014 ◽

2018 ◽

Author(s):

Olivier Picone ◽

Christelle Vauloup-Fellous ◽

Laurent Mandelbrot

Keyword(s):

Varicella Zoster Virus ◽

Early Recognition ◽

Varicella Vaccine ◽

Skin Lesions ◽

Varicella Infection ◽

Varicella Zoster ◽

Mother And Child ◽

Life Threatening ◽

Peripartum Period ◽

The Impact

Chickenpox in a pregnant woman is uncommon, but it is a major concern for patients and their families, as well as for clinicians caring for pregnant women. Varicella infection during pregnancy is usually benign, but there can be serious consequences for both mother and child. Notably, fetal varicella syndrome (FVS) can happen when infection occurs before 21 weeks of gestation. It can present with serious neurological anomalies and unusual cicatricial skin lesions. Later in pregnancy, primary neonatal varicella may occur when the mother is infected in the peripartum period, and it can be life-threatening. The complications of varicella during pregnancy are reviewed, with an emphasis on early recognition, accurate timing of infection, and risk to the developing fetus and newborn infant. The impact of varicella vaccine on the epidemiology of these infections is reviewed, as well as indications for varicella-zoster virus (VZV)–specific immune globulin and antiviral therapy with acyclovir.

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Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

Case Reports in Dermatology ◽

10.1159/000512710 ◽

2021 ◽

pp. 148-153

Author(s):

Tetsuko Sato ◽

Takenobu Yamamoto ◽

Yumi Aoyama

Keyword(s):

Herpes Zoster ◽

Early Diagnosis ◽

Varicella Zoster Virus ◽

Immunosuppressive Therapy ◽

Unusual Case ◽

Cranial Nerves ◽

Skin Lesions ◽

Immunocompromised Patients ◽

Aggressive Treatment ◽

Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

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Cytomegalovirus, varicella-zoster virus, and Coxsackie B virus-specific IgM antibody responses in children with cancer

Serodiagnosis and Immunotherapy in Infectious Disease ◽

10.1016/0888-0786(90)90035-m ◽

1990 ◽

Vol 4 (2) ◽

pp. 115-120 ◽

Cited By ~ 7

Author(s):

D.J Morris ◽

A.J. Fox ◽

P.C.A. Grint ◽

E.J. Bell ◽

J. Lomax ◽

...

Keyword(s):

Varicella Zoster Virus ◽

Antibody Responses ◽

Children With Cancer ◽

Varicella Zoster ◽

Igm Antibody ◽

B Virus ◽

Coxsackie B Virus ◽

Coxsackie B

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Case 3

Oxford Case Histories in Infectious Diseases and Microbiology ◽

10.1093/med/9780198846482.003.0003 ◽

2020 ◽

pp. 14-18

Author(s):

Andrew Woodhouse

Keyword(s):

Varicella Zoster Virus ◽

Immune Globulin ◽

Passive Immunization ◽

Evidence Base ◽

Drug Levels ◽

Varicella Zoster ◽

Intravenous Treatment ◽

Varicella Pneumonia

Chickenpox is caused by varicella-zoster virus and is predominantly a self-limiting disease of childhood. Chickenpox in adults is more likely to be associated with complications such as varicella pneumonia. Treatment with antivirals is helpful in adults if given early after the onset of rash in uncomplicated disease. In complicated disease such as pneumonia, intravenous treatment is essential to optimize drug levels although an evidence base for this is lacking. Exposure to varicella during pregnancy is a particular concern for non-immune women and passive immunization with varicella immune globulin is indicated.

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Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000898 ◽

2007 ◽

Vol 122 (2) ◽

pp. 170-176 ◽

Cited By ~ 23

Author(s):

S-I Chitose ◽

H Umeno ◽

S Hamakawa ◽

T Nakashima ◽

H Shoji

Keyword(s):

Varicella Zoster Virus ◽

Enzyme Immunoassay ◽

Antiviral Therapy ◽

Immunoglobulin M ◽

Virus Antibody ◽

Antibody Testing ◽

Laryngeal Elevation ◽

Pharyngeal Wall ◽

Varicella Zoster ◽

Laryngeal Paralysis

AbstractThe relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary.

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Multi-organ involvement secondary to varicella zoster virus, herpes simplex virus and cytomegalovirus in an immunocompromised patient

BMJ Case Reports ◽

10.1136/bcr-2018-228150 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228150 ◽

Cited By ~ 1

Author(s):

Ripal Jariwala ◽

Kristen Zeitler ◽

Nicole D Riddle ◽

Chakrapol Sriaroon

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Varicella Zoster Virus ◽

Immunocompromised Patient ◽

Case Reports ◽

Skin Lesions ◽

Viral Reactivation ◽

Organ Involvement ◽

Varicella Zoster ◽

Simplex Virus

The use of immunosuppressing agents can act as a catalyst for viral reactivation, promoting systemic infection with organ involvement. Current literature remains sparse on this topic but does provide individual case reports involving single viruses. We present the case of an immunocompromised patient with skin lesions, pancreatitis, colitis and hepatitis. Work-up revealed varicella zoster virus, which likely put the patient at risk for multi-organ involvement, as well as clinical suspicion of other implicated viruses, specifically herpes simplex virus and cytomegalovirus. A high clinical index of suspicion along with biopsy guidance for viral involvement in immunocompromised patients is crucial for early diagnosis and treatment of these conditions.

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