Herpes zoster infection after bone marrow transplantation in children

Kawasaki, Hirohide; Takayama, Jun; Ohira, Masaichi

doi:10.1016/s0022-3476(96)70280-9

Cited by 58 publications

(50 citation statements)

References 6 publications

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“…16 It is also unusual to find severe complication from VZV infection in children after BMT. 2,6 Our present study also confirmed the low complication rate (3%) from post-transplant VZV infection even in immunocompromised children following HSCT. 5 Several retrospective reviews have indicated that older age at BMT, underlying haematologic malignancies, VZV seropositive subjects, allogeneic transplantation, conditioning regimens containing TBI or BU, acute or chronic GVHD, post-transplant use of ATG and delayed immune reconstitution were risk factors for VZV infection following BMT.…”

Section: Discussionsupporting

confidence: 85%

“…2,5 However, our children developed HZ later, at a median time of 124 days after transplant in contrast to days 96 and 101 as reported by two Japanese groups. 2,3 Median T helper to suppressor cell ratio in our subjects were 0.61 and 0.86 at 3 months and 1 year post transplant. This rapid immune reconstitution in our patients may explain the later onset of HZ.…”

Section: Discussioncontrasting

confidence: 65%

“…5 Several retrospective reviews have indicated that older age at BMT, underlying haematologic malignancies, VZV seropositive subjects, allogeneic transplantation, conditioning regimens containing TBI or BU, acute or chronic GVHD, post-transplant use of ATG and delayed immune reconstitution were risk factors for VZV infection following BMT. 2,3,7,11,12,[17][18][19] Patients who are non-immune to VZV are likely to develop CP after contact with this virus irrespective of whether they had HSCT or not. On the other hand, those who underwent HSCT are prone to develop VZV reactivation as a result of this profoundly immunosuppressive procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of VZV infec- tion in children following HSCT varied from 23% to 67%. [2][3][4][5][6] Herpes zoster is one of the common late infections in post-transplant patients. The median onset of HZ following HSCT occurred at the fifth month.…”

mentioning

confidence: 99%

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Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Leung

Chik

et al. 2000

Bone Marrow Transplant

104

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Summary:We report a retrospective analysis of VZV infection after haematopoietic stem cell transplantation (HSCT) in children. Thirty-three (30%) of the total 109 children who were transplanted during a 7 year period developed post-transplant VZV infection. Twenty-four of these 33 (73%) children had VZV infection within 1 year following HSCT. The cumulative incidences of post-transplant VZV infection at 1 and 5 years were 26% and 45%, respectively. The positive and negative predictive values of pretransplant VZV serology in recipients on the development of HZ following HSCT were 39% and 88%, respectively. Pretransplant VZV seropositivity in recipients was the only risk factor for post-transplant herpes zoster (HZ) infection on multivariate analysis. All patients responded to acyclovir. The median duration of VZV infection was 5 days. Three (11%) and one (3%) children with HZ developed visceral dissemination and post-herpetic neuralgia, respectively. No mortality was directly attributed to VZV infection. VZV infection remains a major cause of morbidity in children after HSCT. Further studies are warranted to evaluate the potential use of VZV vaccine in these children. Bone Marrow Transplantation (2000) 25, 167-172. Keywords: haematopoietic stem cell transplantation; herpes zoster; paediatric; varicella-zoster virus Varicella-zoster virus (VZV) is a herpes virus that causes chickenpox (CP) as a primary infection and herpes zoster (HZ) when the latent virus is reactivated. It is a significant cause of morbidity and mortality in immunocompromised patients. Ten percent of children with leukaemia on maintenance chemotherapy died of VZV infection in the preacyclovir era. 1 Haematopoietic stem cell transplantation (HSCT) is now the treatment of choice for some malignant and nonmalignant conditions in children. However, these patients are at high risk of having severe VZV infection because of significant and prolonged immunosuppression in the post-transplant period. The incidence of VZV infec- tion in children following HSCT varied from 23% to 67%. [2][3][4][5][6] Herpes zoster is one of the common late infections in post-transplant patients. The median onset of HZ following HSCT occurred at the fifth month. 7 However, risk factors for post-transplant VZV infection in children are less well defined because there are few reports on this subject. In this study, we review the incidence, risk factors, treatment and clinical outcome of VZV infection in children who underwent HSCT at our centre. Patients and methods Study population and design

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Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Leung

Chik

et al. 2000

Bone Marrow Transplant

104

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“…6,14,15 Underlying hematologic malignancy, use of radiation in the preparative regimen, allogeneic transplant, development of severe acute GVHD, age 10 years or greater, and VZV seropositivity prior to BMT have been identified as possible risk factors. Similar to the findings in these reports, all of our children had a diagnosis of leukemia and all but one of the children received TBI prior to allogeneic transplant.…”

Section: Discussionmentioning

confidence: 99%

Herpes zoster ophthalmicus following bone marrow transplantation in children

Walton

Reed

1999

Bone Marrow Transplant

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Summary:Varicella zoster virus (VZV) infection is a frequent complication following bone marrow transplantation (BMT). Involvement of the ophthalmic division of the trigeminal nerve, herpes zoster ophthalmicus (HZO), can result in significant and potentially vision-threatening ocular complications. We report the frequency and characteristics of HZO following BMT, including the timing of infection, treatment, ocular complications, and visual outcome. Between 1983 and 1997, 572 patients underwent BMT and seven children developed HZO at a median of 150 days following transplantation. All but one of the children had undergone allogeneic BMT. All of the children were treated with acyclovir after onset of the rash but none had received prophylactic therapy. All seven children developed ocular complications within the first 4 weeks following the onset of the dermatomal rash but none reported any symptoms during this period. Complications included keratitis in six, anterior uveitis in three and scleritis in one. Keratitis was an early complication developing within the first 4 weeks, while anterior uveitis and scleritis occurred later in the course of the disease. The high frequency of ocular complications and lack of symptoms in children with HZO following BMT suggests that early ophthalmologic evaluation is warranted in this group of patients. Prompt diagnosis and treatment of ocular complications is essential in the prevention of acute and long-term ocular sequelae in these children. Keywords: herpes zoster ophthalmicus; bone marrow transplantation; varicella zoster; keratitis; uveitis; scleritis Varicella zoster virus (VZV) infection is a relatively frequent complication following autologous and allogeneic BMT. [1][2][3][4][5][6] The clinical course of zoster in these immunosuppressed patients tends to be more severe and prolonged due to the profound impairment in cellular immunity following transplantation. VZV infection may develop as a primary infection or more commonly, reactivation of latent infection typically producing dermatomal zoster. 6 In most series, the risk for infection appears to be highest during the 6-9 months following transplantation and up to 30% of patients who develop VZV following BMT will develop complications. [3][4][5][6] Involvement of the ophthalmic division of the trigeminal nerve -herpes zoster ophthalmicus -can result in serious and potentially vision-threatening ocular complications. 7 In adults, up to 72% of patients will develop ocular complications. 8 However, because HZO is uncommon in the pediatric population there is little information on the nature of the disease in children. 9 The purpose of this study was to describe the frequency and characteristics of HZO in children following BMT. Patients and methodsTo identify all children developing HZO following BMT, a computerized search of the BMT database at St Jude Children's Research Hospital in Memphis, TN was performed. All patients with a diagnosis of varicella zoster involving the ophthalmic division of the trigeminal nerve f...

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Varicella‐Zoster Virus Infections

Arvin

2003

Thomas' Hematopoietic Cell Transplantation

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Herpes zoster infection after bone marrow transplantation in children

Cited by 58 publications

References 6 publications

Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation

Herpes zoster ophthalmicus following bone marrow transplantation in children

Varicella‐Zoster Virus Infections

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