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Pulmonary function following varicella-zoster pneumonia in children with leukemia
D C Stokes1, S Feldman, S K Sanyal
1Cardiopulmonary Division, St. Jude Children's Research Hospital, Memphis, Tennessee 38101.
Insights
Varicella-zoster virus (VZV) pneumonia in children with leukemia rarely causes lasting lung function issues. Most patients showed minimal or no long-term respiratory problems after VZV infection.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Hematology-Oncology
Background:
- Varicella-zoster virus (VZV) can cause severe pneumonia, particularly in immunocompromised individuals.
- While adult VZV pneumonia may leave residual lung changes, pediatric outcomes are less understood.
- Children with acute lymphocytic leukemia (ALL) are at risk for VZV infections.
Purpose of the Study:
- To investigate long-term lung function in children with leukemia following VZV pneumonia.
- To determine the prevalence and nature of residual pulmonary effects after VZV pneumonia in this pediatric population.
Main Methods:
- Retrospective study of 11 pediatric patients with a history of VZV pneumonia and ALL.
- Pulmonary function tests (PFTs) including lung volumes, diffusing capacity, and gas exchange were performed.
- Radiographic imaging was used to assess for residual lung changes.
Main Results:
- Most VZV pneumonia cases were mild, with only one severe case requiring ventilatory support.
- Three patients (27%) exhibited significant restrictive lung defects; one showed transient abnormalities.
- No obstructive defects were observed, and gas exchange remained normal in all patients.
Conclusions:
- VZV pneumonia appears to have minimal long-term impact on lung function in children with leukemia.
- Restrictive changes were infrequent and potentially associated with co-infections like Pneumocystis pneumonia.
- Further research is warranted to fully elucidate the long-term respiratory sequelae in this vulnerable group.
Abstract:
Varicella-zoster virus (VZV) is a cause of serious pneumonias in immunosuppressed patients. Although there are reports of residual lung changes in adults following VZV pneumonia, no previous studies of lung function in children following this infection have been done. We studied 11 patients (median age 11 years) who had had VZV pneumonia 1 to 16 years previously. All patients had a primary diagnosis of acute lymphocytic leukemia. Pneumonia was mild in most of the patients: Three had only radiographic evidence of pneumonia and required no supplemental oxygen, and seven required an FiO2 less than or equal to 0.4 for intervals for up to 11 days. One patient had severe pneumonia and required major ventilatory support. Three patients (27%) had significant restrictive defects on follow-up, with total lung capacity 62-69% predicted; and a fourth was abnormal at 1 month follow-up but normal at 16 months. No obstructive defects were noted, although RV/TLC ratios were elevated in three patients and volume of isoflow increased in three. Single breath diffusing capacity was reduced in two patients, but gas exchange was normal in all. No residual radiographic changes were present except in the patient who had severe pneumonia and increased lung markings at 2 months follow-up. All three patients with restrictive changes had other infections before or following VZV, including Pneumocystis carinii pneumonia in two and recurrent, nonspecific pneumonias in the third. We conclude that VZV pneumonia had minimal residual effects on lung function in children with leukemia.