RESUMO
Varicella is the manifestation of primary infection with the varicella-zoster virus, mainly affecting preschool and school-aged children. The children suffer from a generalised, vesicular rash and fever. Despite the infection's typically non-threatening course, a variety of severe complications have been described.The authors present the case of a female infant suffering from varicella and developing preseptal cellulitis with a frontal abscess while being treated with intravenous antibiotics. Otorhinolaryngology consultation was sought since the clinical image was highly suggestive for sinusitis complications, namely orbital cellulitis and frontal bone osteomyelitis (Pott's puffy tumour). However, the child was below the age of frontal sinus development and there was no other apparent sign of sinonasal involvement. Ultrasonography revealed a mid-frontal collection without signs of abscess formation preseptally or postseptally, leading to the diagnosis of cutaneous superinfection of varicella lesions. The frontal abscess was drained, and the child fully recovered under antibiotic treatment.
Assuntos
Abscesso , Antibacterianos , Varicela , Feminino , Humanos , Lactente , Abscesso/diagnóstico , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Doença Aguda , Antibacterianos/uso terapêutico , Varicela/complicações , Varicela/diagnóstico , Diagnóstico Diferencial , RinossinusiteRESUMO
The objective of this study is to provide practical recommendations on the management of pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The recommendations specifically address the cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, invasive fungal disease). A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify publications on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapies. The results were presented and discussed in a nominal group meeting, comprising a committee of 12 pediatric rheumatologists from the Infection Prevention and Treatment Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process; this was extended to members of the Spanish Society of Pediatric Rheumatology and Spanish Society of Pediatric Infectious Disease of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (totally disagree) to 10 (totally agree). Agreement was defined as a vote ≥ 7 by at least 70% of participants. The literature review included more than 400 articles. Overall, 63 recommendations (19 on surgery, fever, and opportunistic infections) were generated and voted by 59 pediatric rheumatologists and other pediatric specialists. Agreement was reached for all 63 recommendations. The recommendations on special situations cover management in cases of surgery, fever, and opportunistic infections (varicella, herpes-zoster, tuberculosis, and invasive fungal disease). Conclusions: Hereby, we provided consensus and updated of recommendations about the management of special situations such as surgery, fever, and opportunistic in children with immune-mediated rheumatic diseases receiving immunosuppressive therapies. Several of the recommendations depend largely on clinical judgement and specific balance between risk and benefit for each individual and situation. To assess this risk, the clinician should have knowledge of the drugs, the patient's previous situation as well as the current infectious disease, in addition to experience. What is Known: ⢠Infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. ⢠Information on how to manage the treatment in situations of fever, opportunistic infections, and surgery in children is limited, and guidelines for action are often extrapolated from adults. What is New: ⢠In the absence of strong evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could support the clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists.
Assuntos
Varicela , Doenças Transmissíveis , Herpes Zoster , Micoses , Infecções Oportunistas , Doenças Reumáticas , Tuberculose , Criança , Humanos , Varicela/diagnóstico , Varicela/prevenção & controle , Doenças Transmissíveis/complicações , Herpes Zoster/complicações , Terapia de Imunossupressão/efeitos adversos , Micoses/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas/complicações , Doenças Reumáticas/complicações , Doenças Reumáticas/tratamento farmacológico , Tuberculose/complicações , Vacinação/efeitos adversosRESUMO
BACKGROUND: Varicella vaccine, a live-attenuated Oka-strain of varicella zoster virus (VZV), is a recommended childhood vaccine by many countries. As with wild varicella strain, after primary infection, the live-attenuated virus can establish latency in sensory ganglia and reactivate causing vaccine-strain illnesses: herpes zoster (HZ), visceral or peripheral and central nervous system dissemination. We report a case of early reactivation of live-attenuated virus-HZ and meningoencephalitis-in an immunocompromised child. METHODS: This is a retrospective descriptive report of a case, in a tertiary pediatric hospital, CHU Sainte-Justine (Montréal, Canada). RESULTS: An 18 month-year old girl diagnosed with a primitive neuro-ectodermal tumor (PNET) received the day prior to diagnosis, a first varicella vaccine (MMRV). She received chemotherapy 20 days post MMRV vaccine and autologous bone marrow transplantation 3 months post vaccination. She was considered not eligible, to acyclovir prophylaxis prior transplantation (positive for VZV IgG and negative for herpes simplex virus IgG by ELISA). At day 1 post transplantation, she developed dermatomal HZ and meningoencephalitis. Oka-strain varicella was isolated, she was treated with acyclovir and foscarnet. Neurologic status improved in 5 days. Control of VZV viral load in cerebrospinal fluid showed a slow decrease to from 5.24 log 10 copies/mL to 2.14 log 10 copies/mL in 6 weeks. No relapse was observed. She recovered without neurological sequelae. CONCLUSIONS: Our experience highlights the importance of conducting a thorough medical history regarding vaccination and serological status of newly immunocompromised patients. Intensive chemotherapy succeeding live vaccine administration <4 weeks could have influenced early and severe viral reactivation. Early initiation of prophylactic antiviral treatment is questioned in such circumstances.
Assuntos
Varicela , Herpes Zoster , Meningoencefalite , Feminino , Humanos , Criança , Lactente , Transplante de Medula Óssea/efeitos adversos , Varicela/diagnóstico , Varicela/etiologia , Estudos Retrospectivos , Vacina contra Varicela/efeitos adversos , Herpesvirus Humano 3 , Aciclovir/uso terapêutico , Vacinas AtenuadasRESUMO
Varicella gangrenosa is a rare but life-threatening dermatological complication of infection with varicella-zoster virus. A healthy 37-year-old male who had been diagnosed with varicella 20 days back was admitted to our hospital with complaints of fever and painful necrotic skin lesions. Physical examination revealed multiple round to oval ulcers covered with eschar predominantly over arms, lower limbs, back of trunk and flanks. Streptococcus pyogenes and Staphylococcus aureus grew in wound culture. Biopsy revealed ulceration and necrosis of epidermis, and edema, hemorrhage and granulation tissue formation involving the dermis and subcutaneous tissue. The patient was treated with acyclovir - parenteral followed by oral, antibiotics and supportive measures. The lesions healed and he was discharged after 20 days. We report this case to draw attention to the fact that varicella gangrenosum, even though a rare complication, may occur in the lesions of chicken pox and that the survival of patient depends on early diagnosis and aggressive treatment.
Assuntos
Varicela , Masculino , Humanos , Varicela/complicações , Varicela/diagnóstico , Varicela/patologia , Herpesvirus Humano 3 , Aciclovir/uso terapêutico , Necrose/complicaçõesRESUMO
Varicella-Zoster virus (VZV) infection is well-known for its dermatological appearances, such as chickenpox and shingles. In addition to its dermal disease, we report a case of visceral dissemination of VZV in immunocompromised patients. A 38-year-old male Caucasian with a history of bone marrow transplantation due to diffuse large B-cell-lymphoma presented himself with severe abdominal pain. Immediate endoscopy revealed numerous gastric and duodenal ulcerations, while histological and molecular evaluation on tissue biopsies and blood samples confirmed VZV infection. Positive serological findings and history of chickenpox during childhood supported visceral VZV dissemination due to reactivation of VZV. The patient received Aciclovir treatment and fully recovered. This case illustrates that visceral dissemination of VZV may lead to acute abdominal pain due to severe mucosal ulcerations even in the absence of dermatological manifestations. Early endoscopic evaluation may therefore be crucial and the only means to immediately guide differential diagnosis, especially in immunocompromised patients. Characteristic histomorphological findings from mucosal ulcerations should lead to the immediate initiation of antiviral therapy and specific molecular evaluation in order to avoid detrimental spread of visceral VZV infection.
Assuntos
Varicela , Herpes Zoster , Dor Abdominal/diagnóstico , Adulto , Varicela/complicações , Varicela/diagnóstico , Varicela/tratamento farmacológico , Diagnóstico Diferencial , Endoscopia , Herpes Zoster/diagnóstico , Herpesvirus Humano 3 , Humanos , Hospedeiro Imunocomprometido , MasculinoRESUMO
BACKGROUND: Hematopoietic stem cell allograft is a treatment for patients with severe constitutional or acquired hematopoietic system diseases. This act is always linked to complications requiring multidisciplinary care. Our study describes the post-allograft cutaneous complications. METHODS: A prospective study was conducted at the Hematology department of "20 Août Hospital" in Casablanca during a period going from January 2018 to December 2020; including all patients who presented acute or chronic cutaneous complications post-allograft. RESULTS: Twenty-five patients were included. All patients received induction chemotherapy (Busulfan/Fludarabine or Busulfan/Melphalan). A skin infection was found in 8 patients : four cases of Malassezia folliculitis, one case of perineal zona, one case of genital herpes, one case of varicella and one case of Candida sepsis. The acute graft versus host reaction was found in 3 patients, revealed by an erythematous rash all over the body. The chronic graft versus host reaction was found in five patients on a lichenoid form. Nine patients had a hyperpigmentation of the folds followed by detachment in the same areas, concluding to a Busulfan toxidermy. DISCUSSION: Hematopoietic stem cell allograft has many complications. The literature mainly specifies hematological and digestive complications, while skin complications are little described. Our series is special by reporting different types and mechanisms of skin complications that can occur; with a predominance of skin graft-on-host reactions and infections. It also reports an unusual Busulfan toxidermy.
Assuntos
Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Dermatopatias/etiologia , Doença Aguda , Adolescente , Adulto , Aloenxertos , Bussulfano/uso terapêutico , Candidíase/diagnóstico , Varicela/diagnóstico , Criança , Doença Crônica , Dermatomicoses/diagnóstico , Dermatomicoses/microbiologia , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Herpes Genital/diagnóstico , Humanos , Quimioterapia de Indução/métodos , Malassezia , Masculino , Melfalan/uso terapêutico , Pessoa de Meia-Idade , Marrocos , Estudos Prospectivos , Dermatopatias/patologia , Dermatopatias Infecciosas/diagnóstico , Vidarabina/análogos & derivados , Vidarabina/uso terapêutico , Adulto JovemAssuntos
Varicela/patologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Exantema/patologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Biópsia por Agulha , COVID-19 , Teste para COVID-19 , Varicela/diagnóstico , Técnicas de Laboratório Clínico , Diagnóstico Diferencial , Exantema/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Medição de Risco , Estudos de AmostragemAssuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Varicela/diagnóstico , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Aciclovir/uso terapêutico , Corticosteroides/uso terapêutico , Adulto , Varicela/tratamento farmacológico , Varicela/etiologia , Vacina contra Varicela , Doença de Crohn/complicações , Humanos , MasculinoRESUMO
Necrotizing periodontal disease are acute periodontal conditions which can present with simple gingivitis to more complex life threatening condition where it can perforate the skin of cheek. They are found in patients with severe illness, stress and reduced immunity. The prevalence of this whole group of disease is usually very low and is stated frequently as the first manifestation in HIV infection. Herpes zoster, a common dermatological condition is a secondary infection due to re-activation of Varicella zoster virus in a person previously acquiring a chicken pox in his/her lifetime. There are limited scientific literatures citing the occurrence of necrotizing stomatitis in varicella zoster infection. Thus, here we present a detail about a case and management of 46 years old female who had a hospital stay of over 5 days for treatment of Herpes zoster infection of mandibular nerve presented with necrotizing stomatitis lesion within oral cavity.
Assuntos
Varicela , Infecções por HIV , Herpes Zoster , Estomatite , Varicela/complicações , Varicela/diagnóstico , Feminino , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Sympathetic ophthalmia (SO) is a rare bilateral diffuse granulomatous panuveitis that occurs in few days to several years after penetrating injury. This intraocular inflammation can occur in any age group without a sex predilection. Pathology and immunohistochemistry-supported evidence is important to know the disease in a better way. We present a case of a 24-year-old female with clinical diagnosis of SO with an atypical past history of chicken pox in that eye and residual corneal opacity.
Assuntos
Varicela/diagnóstico , Achados Incidentais , Oftalmia Simpática/diagnóstico , Oftalmia Simpática/virologia , Varicela/complicações , Opacidade da Córnea/virologia , Olho/patologia , Olho/virologia , Feminino , Humanos , Imuno-Histoquímica , Adulto JovemRESUMO
OBJECTIVE: To describe varicella cases in Tshuapa Province of the Democratic Republic of the Congo identified during monkeypox surveillance. METHODS: Demographic, clinical and epidemiological data were collected from each suspected monkeypox case 2009-2014. Samples were tested by PCR for both Orthopoxviruses and varicella-zoster virus (VZV); a subset of VZV-positive samples was genotyped. We defined a varicella case as a rash illness with laboratory-confirmed VZV. RESULTS: There were 366 varicella cases were identified; 66% were ≤19 years old. Most patients had non-typical varicella rash with lesions reported as the same size and stage of evolution (86%), deep and profound (91%), on palms of hands and/or soles of feet (86%) and not itchy (49%). Many had non-typical signs and symptoms, such as lymphadenopathy (70%) and sensitivity to light (23%). A higher proportion of persons aged ≥20 years than persons aged ≤19 years had ≥50 lesions (79% vs. 65%, P = 0.007) and were bedridden (15% vs. 9%, P = 0.056). All VZV isolates genotyped from 79 varicella cases were clade 5. During the surveillance period, one possible VZV-related death occurred in a 7-year-old child. CONCLUSIONS: A large proportion of patients presented with non-typical varicella rash and clinical signs and symptoms, highlighting challenges identifying varicella in an area with endemic monkeypox. Continued surveillance and laboratory diagnosis will help in rapid identification and control of both monkeypox and varicella and improve our understanding of varicella epidemiology in Africa.
OBJECTIF: Décrire les cas de varicelle identifiés dans la province de Tshuapa en République Démocratique du Congo (RDC) au cours de la surveillance de la variole du singe (monkeypox). MÉTHODES: Des données démographiques, cliniques et épidémiologiques ont été recueillies pour chaque cas présumé de monkeypox entre 2009 et 2014. Les échantillons ont été testés par PCR pour les orthopoxvirus et le virus varicelle-zona (VZV); un sous-ensemble d'échantillons positifs au VZV a été génotypé. Nous avons défini un cas de varicelle comme une éruption cutanée avec confirmation du VZV en laboratoire. RÉSULTATS: 366 cas de varicelle ont été identifiés; 66% avaient 19 ans ou moins. La plupart des patients présentaient une éruption non typique de varicelle avec des lésions rapportées de la même taille et le même stade d'évolution (86%), profonds (91%), sur la paume des mains et/ou la plante des pieds (86%), sans démangeaisons (49%). Nombre d'entre eux présentaient des signes et des symptômes inhabituels, tels qu'une adénopathie lymphatique (70%) et une sensibilité à la lumière (23%). Une proportion plus élevée de personnes âgées de 20 ans et plus que de personnes âgées de 19 ans et moins avaient 50 lésions ou plus (79% contre 65%, p = 0,007) et étaient alitées (15% contre 9%; p = 0,056). Tous les isolats de VZV génotypés chez 79 cas de varicelle appartenaient au clade 5. Au cours de la période de surveillance, un décès possible lié au VZV est survenu chez un enfant de 7 ans. CONCLUSIONS: Une forte proportion de patients ont présenté une éruption de varicelle ainsi que des signes et symptômes cliniques non typiques, soulignant les difficultés rencontrées pour identifier la varicelle dans une zone endémique pour le monkeypox. Une surveillance continue et des diagnostics de laboratoire aideront à identifier et à contrôler rapidement le monkeypox et la varicelle et à améliorer notre compréhension sur l'épidémiologie de la varicelle en Afrique.
Assuntos
Varicela/diagnóstico , Varicela/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , República Democrática do Congo/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Mpox/diagnóstico , Mpox/epidemiologia , Reação em Cadeia da Polimerase , Adulto JovemAssuntos
Varicela/diagnóstico , Dermatite/etiologia , Febre/etiologia , Leucemia Linfocítica Crônica de Células B/complicações , Aciclovir/uso terapêutico , Adenina/análogos & derivados , Adulto , Antivirais/uso terapêutico , Varicela/complicações , Varicela/tratamento farmacológico , Varicela/patologia , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Masculino , Piperidinas , Pirazóis/uso terapêutico , Pirimidinas/uso terapêuticoAssuntos
Varicela/líquido cefalorraquidiano , Varicela/complicações , Infecções por HIV/complicações , Vasculite do Sistema Nervoso Central/diagnóstico por imagem , Vasculite do Sistema Nervoso Central/virologia , Adulto , Varicela/diagnóstico , Hospitais , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.
Introduction. In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. Objective. To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. Materials and methods. Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. Results. A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval -#91;CI-#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. Conclusion. The burden of disease was significant, with a considerable impact in patients without an underlying disease.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Varicela/epidemiologia , Efeitos Psicossociais da Doença , Argentina/epidemiologia , Varicela/diagnóstico , Varicela/tratamento farmacológico , Estudos Retrospectivos , Assistência Ambulatorial , HospitalizaçãoAssuntos
Varicela/diagnóstico , Herpesvirus Humano 3/fisiologia , Proteínas de Homeodomínio/genética , Mutação/genética , Púrpura Trombocitopênica Idiopática/diagnóstico , Imunodeficiência Combinada Severa/diagnóstico , Linfócitos T/patologia , Adulto , Anticorpos Antivirais/sangue , Autoanticorpos/sangue , Citocinas/imunologia , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Transplante de Células-TroncoAssuntos
Varicela/diagnóstico , Neoplasias Orbitárias/diagnóstico , Rabdomiossarcoma Embrionário/diagnóstico , Varicela/complicações , Pré-Escolar , Conjuntivite Viral/diagnóstico , Conjuntivite Viral/virologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/complicações , Rabdomiossarcoma Embrionário/complicaçõesAssuntos
Varicela/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Infecções por HIV/epidemiologia , Herpes Simples/epidemiologia , Influenza Humana/epidemiologia , Infecções por Papillomavirus/epidemiologia , Paraplegia/epidemiologia , Infecções Respiratórias/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Relatórios Anuais como Assunto , Austrália/epidemiologia , Varicela/diagnóstico , Varicela/virologia , Criança , Pré-Escolar , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Notificação de Doenças/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Herpes Simples/diagnóstico , Herpes Simples/virologia , Humanos , Incidência , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Influenza Humana/virologia , Masculino , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Paraplegia/diagnóstico , Paraplegia/virologia , Vigilância em Saúde Pública , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/diagnóstico , Rubéola (Sarampo Alemão)/virologiaAssuntos
Varicela/complicações , Herpes Zoster/complicações , Infecção pelo Vírus da Varicela-Zoster/classificação , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Varicela/diagnóstico , Herpes Zoster/diagnóstico , Herpesvirus Humano 3/isolamento & purificação , Humanos , Imunocompetência , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Infecção pelo Vírus da Varicela-Zoster/diagnósticoRESUMO
A 35-year-old woman who had previously undergone a lung transplantation presented with severe abdominal pain and vomiting. The gastroscopy showed diffuse ulcerative gastric lesions. Tests for varicella zoster virus and Epstein-Barr virus via polymerase chain reactions (PCR) on endoscopically obtained gastric biopsies were found to be positive and confirmed varicella gastritis. Intravenous antiviral therapy with acyclovir was administered resulting in a normalization of all clinical symptoms, especially of abdominal pain and inflammation parameters.
Assuntos
Varicela/diagnóstico , Gastrite/diagnóstico , Granulomatose com Poliangiite/cirurgia , Transplante de Pulmão , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Varicela/complicações , Varicela/tratamento farmacológico , Feminino , Gastrite/tratamento farmacológico , Gastrite/virologia , Herpesvirus Humano 3 , Humanos , Hospedeiro ImunocomprometidoRESUMO
There is paucity of data on the incidence, severity and management of chicken pox in patients receiving active chemotherapy for cancer. From October 2010 to October 2011, patients were included in this study if they developed a chicken pox infection during their chemotherapy. The details of patients' cancer diagnosis and treatment along with clinical and epidemiological data of the chicken pox infections were assessed from a prospectively maintained database. Twenty-four patients had a chicken pox infection while receiving chemotherapy and/or radiotherapy. The median age of the patients was 21 years, and two-thirds of the patients had solid tumor malignancies. Overall, eight (33%) patients had complications, six (25%) patients had febrile neutropenia, four (17%) had diarrhea/mucositis, and four (17%) had pneumonia. The median time for recovery of the infection and complications in the patients was 9.5 days (5-29 days), whereas for neutropenic patients, it was 6.5 days (3-14 days). The median time for recovery from chicken pox infections in neutropenic patients was 10 days (5-21 days), compared with 8.5 days (0-29 days) in non-neutropenic patients (P=0.84). The median time for recovery from infections was 8.5 days in patients with comorbidities (N=4), which was the same for patients with no comorbidities. The clinical presentation and complication rates of chicken pox in cancer patients, who were on active chemotherapy, are similar to the normal population. The recovery from a varicella infection and complications may be delayed in patients with neutropenia. The varicella infection causes a therapy delay in 70% of patients. Aggressive antiviral therapy, supportive care and isolation of the index cases remain the backbone of treatment.