Fulminant disseminated Varicella Zoster virus infection without skin involvement

Grant, Ronald; Weitzman, Sheila; Sherman, Christopher; Sirkin, Wilma; Petric, Martin; Tellier, Raymond

doi:10.1016/s1386-6532(01)00217-7

Cited by 48 publications

(32 citation statements)

References 15 publications

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“…This complication occurs in approximately 1 in 250 VZV-seropositive allograft recipients, and a review of the literature indicates that this highly fatal complication continues to be a significant clinical problem. 1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]25 An additional indirect benefit is the risk reduction for susceptible VZV-seronegative individuals.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Furthermore, hepatic or gastrointestinal VZV disease may occur with few or no skin lesions, which often delays the diagnosis and leads to a high mortality. 1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] Severe ocular complications and VZV myelitis may also occur. 1,24,25 Finally, patients with VZV reactivation disease, especially when disseminated, may expose susceptible individuals to VZV.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Boeckh

Kim

Flowers

et al. 2006

Blood

233

185

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Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P ‫؍‬ .006). In the postintervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZVspecific T-helper cell responses, HSV infections, CMV disease, chronic graftversus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Boeckh

Kim

Flowers

et al. 2006

Blood

233

185

View full text Add to dashboard Cite

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“…Immunocompromised hosts may experience disseminated cutaneous and/or visceral zoster, occasionally with a fatal outcome (67,121). A forme fruste termed zoster sine herpete (without rash) has been described.…”

Section: Clinical Features Of Varicella and Zostermentioning

confidence: 99%

Preventing Varicella-Zoster Disease

2005

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Varicella-zoster virus (VZV), the cause of chickenpox and shingles, is a pathogen in retreat following the introduction of mass vaccination in the United States in 1995. The live attenuated Oka vaccine, which is safe and immunogenic, gives good protection against both varicella and zoster in the short to medium term. It has undoubtedly been highly effective to date in reducing all forms of varicella, especially severe disease. However, the huge pool of latent wild-type virus in the population represents a continuing threat. Both the biology and the epidemiology of VZV disease suggest that new vaccination strategies will be required over time

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“…[1][2][3][4] Although acyclovir given at different doses for different time periods has been shown to be effective against VZV reactivation disease after HCT, [5][6][7] no consensus exists on the dose, the duration of treatment, or on which group of HCT recipients may benefit most from acyclovir prophylaxis. The most recent Centers for Disease Control and Prevention/ American Society for Blood and Marrow Transplantation/Infectious Diseases Society of America (CDC/ASBMT/IDSA) guidelines do not recommend universal prolonged acyclovir prophylaxis for prevention of VZV disease.…”

Section: Introductionmentioning

confidence: 99%

One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation

Erard

Guthrie

Varley

et al. 2007

Blood

180

139

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No consensus exists on whether acyclovir prophylaxis should be given for varicella-zoster virus (VZV) prophylaxis after hematopoietic cell transplantation because of the concern of "rebound" VZV disease after discontinuation of prophylaxis. To determine whether rebound VZV disease is an important clinical problem and whether prolonging prophylaxis beyond 1 year is beneficial, we examined 3 sequential cohorts receiving acyclovir from day of transplantation until engraftment for prevention of herpes simplex virus reactivation (n ‫؍‬ 932); acyclovir or valacyclovir 1 year (n ‫؍‬ 1117); or acyclovir/valacyclovir for at least 1 year or longer if patients remained on immunosuppressive drugs (n ‫؍‬ 586). In multivariable statistical models, prophylaxis given for 1 year significantly reduced VZV disease (P < .001) without evidence of rebound VZV disease. Continuation of prophylaxis beyond 1 year in allogeneic recipients who remained on immunosuppressive drugs led to a further reduction in VZV disease (P ‫؍‬ .01) but VZV disease developed in 6.1% during the second year while receiving this strategy. In conclusion, acyclovir/valacyclovir prophylaxis given for 1 year led to a persistent benefit after drug discontinuation and no evidence of a rebound effect. To effectively prevent VZV disease in long-term hematopoietic cell transplantation survivors, additional approaches such as vaccination will probably be required. (Blood. 2007; 110:3071-3077)

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Fulminant disseminated Varicella Zoster virus infection without skin involvement

Cited by 48 publications

References 15 publications

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Preventing Varicella-Zoster Disease

One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation

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