VARICELLA-ZOSTER VIRUS INFECTIONS IN IMMUNOCOMPROMISED PATIENTS
Dewi Syam,Yulia Iriani,Dian Puspita Sari
Department of Child Health Medical Faculty Sriwijaya University Dr Mohammad Hoesin General Hospital Palembang Indonesia Department of Child Health Medical Faculty, Sriwijaya University Dr Mohammad Hoesin General Hospital, Palembang Indonesia
Background : Varicella-zoster virus (VZV) infection is usually considered benign. However, severe complications with a potentially fatal or long term disabling outcome can occur especially in those whose immune system has been suppressed by diseases or by multi-agent chemotherapy treatment including corticosteroids. Management of VZV in immunocompromised patients has its own challenges and should be approached individually.
Case Presentation Summary : This case series included seven pediatric patients with VZV infection, either herpes zoster or varicella zoster with immunosuppression associated with malignancy or chemotherapy/immunosuppressant seen in Moh. Hoesin Hospital between January 1st, 2017 and April 30th, 2018. Median age was 10.5 years (range 7 to 15 years). Five patients received immunosuppressive treatments for underlying malignancies (four with ALL and one with Ewing’s sarcoma), one patient with steroid dependent nephrotic syndrome and one patient with beta thalassemia major. Severe cases included two patients with encephalitis (one VZV and HZV), and one with severe bleeding manifestations (hemorrhagic varicella and gross hematuria). All three patients with severe disease had febrile neutropenia, two had thrombocytopenia. Patients were hospitalized and intravenous acyclovir was started immediately except two patients (one beta thalassemia major and one ALL) who were given oral acyclovir. In most patient treatment started 1-3 days after onset, except in two who started after 7 and 14 days because of administration of oral medicine by primary health care providers before being consulted. All patients survived, two leukemic patients with encephalitis had neurological sequele.
Learning Points/Discussion : Our data show that patients with malignant diseases or immunosuppressive therapy are at risk for severe infections. Most severe cases with worse outcome and complications occurred in those with febrile neutropenia and thrombocytopenia. Awareness should be raised to prevent treatment delay.