Disseminated Varicella-Zoster Virus Infection in Organ Transplant Recipients: A 10-year Retrospective Study
Ryosuke Yamamuro1, Alba Romero2, Ahsha Khandelwal-Young3
1Ajmera Transplant Centre, Toronto, Ontario, Canada.
Background:
Data on disseminated herpes zoster (HZ) infections in solid organ transplant (SOT) recipients are limited. We aimed to investigate the clinical characteristics and outcomes of HZ infection in SOT patients presenting with microbiologically confirmed disease.
Methods:
All SOT recipients who tested positive for varicella-zoster virus (VZV) from any sample type between January 2013 and December 2022 were included. Disseminated HZ was defined as skin lesions involving > 2 contiguous dermatomes or evidence of end organ disease. An analysis of risk factors associated with disseminated infection was performed.
Results:
A total of 146 adult SOT patients with confirmed VZV infections were included in the study. Of these, 4 were primary varicella and 142 were HZ. Median time to HZ presentation was 1.8 years (range 0.02-27). Disseminated HZ was diagnosed in 55/142(38.7%). Post-herpetic neuralgia (PHN) occurred in 33(22.6%) patients and vaccine breakthrough in 5(3.5%). Hospitalization was in 101(71.6%) patients, and 5(3.5%) died within 30 days, none attributable to HZ. VZV DNAemia was detected in 12/13 (92.3%) patients with disseminated disease versus 11/29 (37.9%) with localized disease (p = 0.002). Recurrent HZ rate was 10/142 (7.0%) over a median follow-up of 4.1 years with 90% of recurrences occurring in thoracic transplant. On multivariable logistic regression, no clinical factors were associated with disseminated disease.
Conclusions:
In a large cohort of SOT patients with VZV, disseminated disease and PHN were frequent. VZV DNAemia was noted in both disseminated and localized infections suggesting that subclinical detection of virus in blood is frequent. The implications of this require further study.
