Journal List > Korean J Pediatr Infect Dis > v.20(3) > 1096040

Kwak, Kim, Lee, and Choi: Clinical Manifestations of Hospitalized Children Due to Varicella-Zoster Virus Infection

Abstract

Purpose

This study was performed to describe the clinical manifestations of hospitalized children due to varicella-zoster virus (VZV) infection.

Methods

This study included 40 children who were hospitalized for varicella or herpes zoster at Seoul National University Children's Hospital, 2009-2012. Diagnosis of VZV infection was confirmed by VZV PCR or culture from vesicular fluid. Medical records were reviewed to collect clinical features and outcome, antiviral treatment, history of varicella vaccination, and underlying diseases.

Results

Sixteen patients with varicella and 24 patients with herpes zoster were included. Their median age was 10.5 years (16 days-19 years). Thirty-five (87.5%) patients had underlying diseases. Among 24 patients with herpes zoster, 11 patients had previous history of varicella and 1 had herpes zoster. Twenty patients (50%) had a history of varicella vaccination, and 19 immunocompromised patients had VZV infection despite of vaccination. Most (95%) patients were treated by intravenous or oral acyclovir, and no treatment failure of intravenous acyclovir was found. The median duration of fever was 4.4 days (1-10 days), and that of antiviral treatment was 12 days (7-23 days) in immunocompromised patients. Immunocompromised patients received longer duration of antiviral treatment than imunocompetent patients (P=0.014). Eleven (27.5%) immunocompromised patients had postherpetic neuralgia, 2 (5%) had proven co-infection by Streptococcus pyogenes and Klebsiella oxytoca, and 1 (2.5%) complicated with pneumonia.

Conclusion

Immunocompromised children require longer duration of treatment and are at risk of severe complication associated with VZV infection. Early initiation of antiviral therapy and close monitoring are necessary for those in immunocpompromised conditions.

Figures and Tables

Table 1
Clinical Course of Immunocompromised and Immunocompetent Patients
kjpid-20-161-i001

Abbreviations: VZV, varicella-zoster virus; IV, intravenous; ACV, acyclovir; VACV, valacyclovir; FCV, famciclovir.

References

1. Davison AJ, Scott JE. The complete DNA sequence of varicella-zoster virus. J Gen Virol. 1986; 67(Pt 9):1759–1816.
crossref
2. Schmidt-Chanasit J, Sauerbrei A. Evolution and worldwide distribution of varicella-zoster virus clades. Infect Genet Evol. 2011; 11:1–10.
crossref
3. Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, et al. Varicella disease after introduction of varicella vaccine in the United States, 1995-2000. JAMA. 2002; 287:606–611.
crossref
4. Takahashi M, Otsuka T, Okuno Y, Asano Y, Yazaki T. Live vaccine used to prevent the spread of varicella in children in hospital. Lancet. 1974; 2:1288–1290.
crossref
5. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. 2005; 352:450–458.
crossref
6. Oh SH. Update in varicella vaccination. Korean J Pediatr. 2006; 49:229–234.
crossref
7. Choi EH. Varicella vaccination: worldwide status and provisional updated recommendation in Korea. Korean J Pediatr Infect Dis. 2008; 15:11–18.
crossref
8. Park SJ, Song HJ, Kim CW, Lee KS. A clinical study of 72 cases of herpes zoster in children and adolescents. Korean J Dermatol. 2006; 44:664–668.
9. Seo PS, Yoon NH, Park SD. A clinical study of chicken pox in adolescents and adults. Korean J Dermatol. 2005; 43:933–938.
10. Lee GH, Lee SH, Lee SY, Lee JS, Whang KU. A clinical study of chickenpox in adult inpatients. Korean J Dermatol. 2010; 48:272–277.
11. Park CK, Kim HO, Park CW, Lee CH. The effect of active immunization on the clinical courses of varicella. Korean J Dermatol. 2008; 46:1011–1019.
12. Loparev VN, Rubtcova E, Seward JF, Levin MJ, Schmid DS. DNA sequence variability in isolates recovered from patients with postvaccination rash or herpes zoster caused by Oka varicella vaccine. J Infect Dis. 2007; 195:502–510.
crossref
13. Loparev VN, Gonzalez A, Deleon-Carnes M, Tipples G, Fickenscher H, Torfason EG, et al. Global identification of three major genotypes of varicella-zoster virus: longitudinal clustering and strategies for genotyping. J Virol. 2004; 78:8349–8358.
crossref
14. Carapetis JR, Russell DM, Curtis N. The burden and cost of hospitalised varicella and zoster in Australian children. Vaccine. 2004; 23:755–761.
crossref
15. Marshall HS, McIntyre P, Richmond P, Buttery JP, Royle JA, Gold MS, et al. Changes in patterns of hospitalized children with varicella and of associated varicella genotypes following introduction of varicella vaccine in Australia. Pediatr Infect Dis J. 2013; 32:530–537.
crossref
16. van Lier A, van der Maas NA, Rodenburg GD, Sanders EA, de Melker HE. Hospitalization due to varicella in the Netherlands. BMC Infect Dis. 2011; 11:85.
crossref
17. Kim SH, Lee HJ, Park SE, Oh SH, Lee SY, Choi EH. Seroprevalence rate after one dose of varicella vaccine in infants. J Infect. 2010; 61:66–72.
crossref
18. Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster? Lancet Infect Dis. 2004; 4:26–33.
crossref
19. Nagasawa K, Yamauchi Y, Tada Y, Kusaba T, Niho Y, Yoshikawa H. High incidence of herpes zoster in patients with systemic lupus erythematosus: an immunological analysis. Ann Rheum Dis. 1990; 49:630–633.
crossref
20. Morens DM, Bregman DJ, West CM, Greene MH, Mazur MH, Dolin R, et al. An outbreak of varicella-zoster virus infection among cancer patients. Ann Intern Med. 1980; 93:414–419.
crossref
21. Adler AL, Casper C, Boeckh M, Heath J, Zerr DM. An outbreak of varicella with likely breakthrough disease in a population of pediatric cancer patients. Infect Control Hosp Epidemiol. 2008; 29:866–870.
crossref
22. Folatre I, Zolezzi P, Schmidt D, Marin F, Tager M. Infections caused by varicella zoster virus in children with cancer aged less than 15 years old. Rev Med Chil. 2003; 131:759–764.
23. Arvin AM. Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis. 2002; 13:12–21.
crossref
24. Prober CG, Kirk LE, Keeney RE. Acyclovir therapy of chickenpox in immunosuppressed children--a collaborative study. J Pediatr. 1982; 101:622–625.
crossref
25. Nyerges G, Meszner Z, Gyarmati E, Kerpel-Fronius S. Acyclovir prevents dissemination of varicella in immunocompromised children. J Infect Dis. 1988; 157:309–313.
crossref
26. Novelli VM, Marshall WC, Yeo J, McKendrick GD. Acyclovir administered perorally in immunocompromised children with varicella-zoster infections. J Infect Dis. 1984; 149:478.
crossref
27. Meszner Z, Nyerges G, Bell AR. Oral acyclovir to prevent dissemination of varicella in immunocompromised children. J Infect. 1993; 26:9–15.
crossref
28. Jain Y, Lodha R, Tomar S, Arya LS, Kabra SK. Oral acyclovir in varicella zoster virus infections in children with acute lymphoblastic leukemia. Indian Pediatr. 2000; 37:1239–1241.
29. Carcao MD, Lau RC, Gupta A, Huerter H, Koren G, King SM. Sequential use of intravenous and oral acyclovir in the therapy of varicella in immunocompromised children. Pediatr Infect Dis J. 1998; 17:626–631.
crossref
30. Bomgaars L, Thompson P, Berg S, Serabe B, Aleksic A, Blaney S. Valacyclovir and acyclovir pharmacokinetics in immunocompromised children. Pediatr Blood Cancer. 2008; 51:504–508.
crossref
31. Eksborg S, Pal N, Kalin M, Palm C, Soderhall S. Pharmacokinetics of acyclovir in immunocompromized children with leukopenia and mucositis after chemotherapy: can intravenous acyclovir be substituted by oral valacyclovir? Med Pediatr Oncol. 2002; 38:240–246.
crossref
TOOLS
Similar articles