Adjuvant treatment of severe varicella pneumonia with intravenous varicella zoster virus-specific immunoglobulins

Mangioni, Davide; Grasselli, Giacomo; Abbruzzese, Chiara; Muscatello, Antonio; Gori, Andrea; Bandera, Alessandra

doi:10.1016/j.ijid.2019.05.022

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…The rates of varicella after VZVSOG in the current study were lower than those in these recent reports, even though the administered immunoglobulin dose was lower than previously recommended. 13 …”

Section: Discussionmentioning

confidence: 99%

Preventing varicella zoster infection in immunocompromised adults with varicella zoster–specific immunoglobulins

Gelman

Zektser

Nesher

2023

ASHE

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Background: Varicella zoster virus (VZV) exposure seriously threatens immunocompromised hosts. Postexposure prophylaxis (PEP) using immune globulins is considered the standard of care; however, the available literature is mainly based on its use in pediatric patients. Here, we describe a widespread VZV exposure among immunocompromised adults treated with VZV-specific immunoglobulins (VZVSIG), and we discuss management and outcomes. Methods: We conducted a retrospective study to describe the exposure of immunocompromised patients to a single healthcare worker with primary VZV in 2019. Patients were grouped by their overall risk for infection, and those at risk received a single intramuscular dose of 625 IU of VZVSIG and were followed for 1 year. Results: In total, 83 patients received PEP at <96 hours of exposure: 14 were hospitalized, 68 were outpatients, and 1 was an immunocompromised staff member. The median age was 69 years (range, 21–92), and 49.4% were male. In addition, 30% of the patients were deemed high risk, 42% were intermediate risk, and 28% were considered low risk, although they were given PEP. Varicella infection was not diagnosed in any patient in the first weeks of follow-up. However, during the year of follow-up, 4 patients developed symptoms suspicious of VZV, all >3 months after exposure, thus were probably unrelated to the event. Adverse events related to VZVSIG (pyrexia) were reported in 2 patients (2.4%). Conclusions: Our findings demonstrate the utility of VZVSIG as PEP in one of the largest cohorts of immunocompromised adults to date. No early varicella infection was found following exposure, supporting the current recommendations of the VZVSIG administration.

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Section: Discussionmentioning

confidence: 99%

Preventing varicella zoster infection in immunocompromised adults with varicella zoster–specific immunoglobulins

Gelman

Zektser

Nesher

2023

ASHE

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“…Treatment for patients presenting with Varicella pneumonia would be to begin IV acyclovir with intensive supportive care [ 15 , 16 ]. The use of steroids as part of the treatment regimen remains controversial, yet a multitude of case reports have included steroids as part of care management [ 17 , 18 ]. Treatments using Varicella IG (VZIG) have been recorded as treatment or prophylaxis, but in most cases, the use of immunoglobulins is time-sensitive with efficacy decreasing as the disease progresses [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of steroids as part of the treatment regimen remains controversial, yet a multitude of case reports have included steroids as part of care management [ 17 , 18 ]. Treatments using Varicella IG (VZIG) have been recorded as treatment or prophylaxis, but in most cases, the use of immunoglobulins is time-sensitive with efficacy decreasing as the disease progresses [ 17 ]. Some case reports have indicated the use of VZIG in immunocompromised patients or patients who have disseminated Varicella infections, but no studies have quantified the efficacy of VZIG in the treatment of severe Varicella infections [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Healed Varicella Pneumonia: A Case of Diffuse Pulmonary Microcalcifications

Mylarapu¹,

Yarabarla²,

Padilla³

et al. 2021

Cureus

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Varicella pneumonia is a potentially fatal complication of the Varicella-zoster virus (VZV), which causes the well-known chickenpox disease of childhood. Identifying this type of pneumonia by characteristic features is important for radiologists and radiology residents. Typical manifestations of active Varicella pneumonia include diffuse pulmonary nodules, which may mimic other diseases. Healed Varicella pneumonia can present as diffuse, calcified pulmonary micronodules. We describe a case of healed Varicella pneumonia in a patient with a history of remote VZV infection.

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“…Pneumonia is usually self-limiting, and recovery is temporally correlated with the clearing of skin lesions [3]. Blood gas analyses and pulmonary function tests indicate a significant diffusion defect that may persist in some cases for months after clinical recovery.…”

Section: Discussionmentioning

confidence: 99%

Varicella pneumonia in an immunocompromised adult: Not always fatal !

Kadiri¹,

Douhi²,

Chhiti³

2020

Our Dermatol Online

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Chickenpox is a very common and usually mild rash disease in healthy children. In adults especially immunocompromised, its course may be punctuated by serious complications such as varicella pneumonia. Herein we report a case of a 48-yearold male patient followed for stage IV Hodgkin lymphoma treated by the BEACOPPR protocol and referred for severe pneumonia varicella. Radiologic exploration showed multiple bilateral micronodular and reticulonodular opacities, diffuse throughout the lungs. Laboratory exams revealed g severe hypoxemia and pancytopenia. The patient received antiviral treatment acyclovir (10 mg/kg/8 hours) intravenously, combined with oxygen therapy via nasal cannula on 5 L/ min and prednisone 60mg per day for 5days with favorable evolution.

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Adjuvant treatment of severe varicella pneumonia with intravenous varicella zoster virus-specific immunoglobulins

Cited by 8 publications

References 16 publications

Preventing varicella zoster infection in immunocompromised adults with varicella zoster–specific immunoglobulins

Preventing varicella zoster infection in immunocompromised adults with varicella zoster–specific immunoglobulins

Healed Varicella Pneumonia: A Case of Diffuse Pulmonary Microcalcifications

Varicella pneumonia in an immunocompromised adult: Not always fatal !

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