Abstract:To investigate the nature of viremia during the acute phase of varicella, we studied the viral load in nine otherwise healthy children with varicella. Plasma and peripheral blood mononuclear cells (PBMC) were obtained, then PBMC were divided into CD4+T, CD8+T, and B lymphocytes and monocyWmacrophage fractions. The viral DNA in each component was quantified using a real-time quantitative polymerase chain reaction assay. Varicella-zoster virus (VZV) DNA was detected in plasma, PBMC and all subpopulations. The amount of viral DNA was similar in each PBMC subpopulation, suggesting that each lymphocyte fraction and monocytes carry similar amounts of VZV DNA during viremia.Key words: Varicella-zoster virus, Lymphocyte subpopulations, Quantitative PCR assay Varicella (chickenpox) is characterized by febrile illness with pruritic vesicles, and is the result of primary infection with varicella-zoster virus (VZV). The pathogenesis is as follows: virus entry at the respiratory mucosa and primary viremia are believed to occur; then secondary viremia of greater magnitude occurs; finally, the rash results. Understanding the nature of the viremia is thought to be important in order to clarify the pathophysiology of varicella infections and complications of the disease (I, 7). Peripheral blood mononuclear cell (PBMC)-associated viremia has been demonstrated just before and after the onset of disease (2,5,6,13,15,16). Determining the phenotypes of the PBMC subpopulations is complicated by the low frequency of positive cells and the difficulty in achieving highly purified preparations of subpopulations.Recently, we established a quantitative real-time polymerase chain reaction (PCR) assay to quantify the VZV genome copies (8). Using this assay, we observed that there was a higher occurrence of viremic VZV in varicella than in zoster, and that acyclovir treatment marked-*Address correspondence to Dr. Yoshinori Ito, Department of PediatricslDevelopmental Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. Fax: 81-52-744-2974. E-mail: yyito @med.nagoya-u.ac.jp 267 ly suppressed viremia in varicella (9). In this study, we quantified the viral load in the peripheral blood leukocyte subpopulations to determine which subpopulations harbor VZV during the acute phase of varicella. We also quantified the viral load in plasma to investigate whether viral DNA in blood is restricted to PBMC fraction.Nine healthy children with clinically diagnosed varicella (0 to 3 years old, median: I year) were enrolled in this study. None of these patients had a previous history of varicella. At the time of entry, none of the patients had received oral acyclovir therapy.All the specimens were obtained after informed consent. Blood samples were taken when the patients had clinical indications in the acute phase. Sampling occurred 2 to 5 days after the onset (mean: 2.3 days). Whole blood was obtained from the patients, and plasma and PBMC were separated by density gradient with Ficoll-P...