Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience

Abstract

Herpes zoster (HZ), a varicella-zoster virus reactivation, frequently complicates hematopoietic stem cell transplantation (HSCT). Its incidence, complications, and associated risk factors in 310 children undergoing HSCT were reviewed. In all, 61 of 201(32%) patients who had undergone allogeneic and 10 of 109 (9%) patients who had undergone autologous HSCT developed HZ. Of 90 VZV seropositive allogeneic patients, 50 (53%) developed HZ. Seven (17%) of 41 VZV seropositive autologous patients developed HZ. Although a substantial number of patients develop HZ in the early post-HSCT period, risk for HZ persists and HZ can occur up to 5 years post-HSCT. Risk factors for HZ included age 410 years (Po0.0001), allogeneic HSCT (Po0.001), and total body irradiation (TBI) (Po0.059) in allogeneic recipients. Of 37, 22 (59%) patients experienced an elevated alanine aminotransferase (ALT), unassociated with GVHD, in the month preceding HZ. Of the 48/64 patients (75%) hospitalized for treatment (median stay, 6 days; range, 2-39), length of stay was unaffected by donor type but increased by cutaneous dissemination and visceral involvement (P ¼ 0.023 and 0.034, respectively) in allogeneic patients. Consideration of HZ infection particularly in patients 410 years of age with elevated ALT after TBIconditioned allogeneic HSCT may permit earlier diagnosis and therapeutic intervention.

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

“…However, VZV disease also may occur in allogeneic hematopoietic cell transplant recipients without GVHD as well as in autologous transplant recipients, and GVHD was not a risk factor for disease in all studies. 3,7,13,33,34 Acyclovir was effective in preventing the morbidity of herpes zoster, thereby also decreasing the need for the oftennecessary hospitalization and intravenous treatment, as well as late complications such as post-herpetic neuralgia and secondary infections. Although not seen in this study, acyclovir For personal use only.…”

“…Morbidity, including pain, scarring, post-herpetic neuralgia, and secondary infection occur in up to one third of patients with VZV infection, and hospitalization may be required with disseminated disease. 1,[7][8][9] VZV disease can occasionally also be fatal after allogeneic HCT, even if treated with acyclovir, with most fatalities occurring during the first year after transplantation. [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][2][3][4][5][6][7] Most cases occur between the third and twelfth month after transplantation. During this time, the care of these patients is predominantly managed by their referring physicians rather than at specialized cancer centers.…”

Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients

“…HZ is common after allogeneic or autologous BM or peripheral blood hematopoietic SCT. [4][5][6][7][8][9][10][11][12][13][14][15][16] The incidence of HZ at 1 year following autologous SCT (ASCT) varies from 8 to 30%. 3,11,[14][15][16] However, little is known about the incidence of HZ specifically in myeloma patients undergoing ASCT.…”

Disseminated Simian Varicella Virus Infection in an Irradiated Rhesus Macaque ( Macaca mulatta )

“…Also, SVV and VZV are related antigenically, share DNA homology, and become latent in ganglionic neurons (6,7). VZV reactivates in irradiated (2,14) and immunocompromised humans, and dissemination has previously been described to occur in a bone marrow transplant recipient 265 days after total-body irradiation (14) and in 12/27 children who received total-body irradiation after stem cell transplantation (8).…”