The yield of monitoring for HSV and VZV viremia in pediatric hematopoietic stem cell transplant patients

Abstract

Reactivation of HSV and VZV is common following HSCT. Consensus guidelines do not support the use of routine screening for viremia following HSCT in adults, but no such clear guidelines exist in pediatrics. In our center, routine practice was to screen patients weekly for HSV and VZV viremia until engraftment in autologous transplant patients and up to day +100 in allogeneic transplant patients. We conducted a retrospective study of over 500 patients to establish whether this screening identified any patients with HSV or VZV viremia who would not have been identified by clinical signs or symptoms. Over a 4.5-yr period, routine screening identified three cases of HSV viremia and one case of VZV viremia. Two patients had persistent, unexplained fever and two patients had skin or mucosal lesions suggestive of HSV/VZV. We conclude that routine screening for HSV and VZV viremia in pediatric HSCT patients has a very low yield and that viremia can be reliably identified by targeted testing in patients with vesicular skin lesions, oral or genital ulceration, unexplained fever, neurological symptoms, or unexplained abnormal liver transaminases.

Co-infections of human herpesviruses (CMV, HHV-6, HHV-7 and EBV) in non-transplant acute leukemia patients undergoing chemotherapy

“…In contrast, another study carried out by Persson and al did not detect any HHV-6 or HHV-7 DNA in any of the febrile episodes in neutropenic patients treated with cytotoxic chemotherapy [21]. In the current study, HSV and VZV DNA was not detected in plasma samples indicating that DNAemia are not common in this group of patients suggesting that DNAemia might be rarely observed in recurrent infections in immunocompromised hosts [22,23]. Patients who are present from geographic regions with a high seroprevalence of either virus in both developing and developed countries are at a higher risk of viral reactivation and symptomatic and asymptomatic screening should be tailored to the present increased risk [8].…”

Herpesviruses excretion in saliva of pediatric transplant recipients

“…Treatment with prophylactic antivirals could also explain the lack of VZV detection . No VZV vaccine is available or data on VZV seroprevalence available in Cuba; however, the authors inferred that the seroprevalence in Cuba must be high, because most Cuban adults have had chickenpox.…”

Human cord blood-derived viral pathogens as the potential threats to the hematopoietic stem cell transplantation safety: A mini review

“…The estimated prevalence of post-SCT VZV infection either primary infection or reactivation in children is as high as 22% to 32% after allogeneic and 9% to 46% after autologous transplantation. Based on previous studies, Older age, pre-transplant irradiation, HLA-mismatched transplantation, chronic GVHD, and recipient pre-transplant VZV seropositivity have been described as predisposing risk factors for VZV disease[44,45]. Accordingly, Umezawa et al[46] retrospectively analyzed the clinical symptoms of VZV disease and risk factors for disease progression in allogeneic HSCT patients.…”

“…On the other hand, Patrick et al[45] conducted a retrospective study to assess the efficacy of routine screening for identification of HSV or VZV viremia following HSCT. They aimed to discuss whether this screening identifies any patients with viremia who had not been identified via clinical manifestations.…”