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Varicella-zoster virus infection in children with malignancy
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Insights
Chickenpox (varicella-zoster virus) is a serious threat to immunocompromised children undergoing chemotherapy. Early treatment with acyclovir and intravenous immunoglobulin (IVIG) significantly improves survival rates in these vulnerable patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Immunocompromised children, particularly those with malignancy undergoing chemotherapy, are at high risk for severe infections.
- Chickenpox (varicella-zoster virus infection) is a common and highly contagious infection posing a significant threat to this patient population.
- A recent cluster of five chickenpox cases in children with malignancy highlights the ongoing risk.
Purpose of the Study:
- To review cases of varicella-zoster virus infection in children with malignancies during chemotherapy.
- To identify risk factors, clinical manifestations, and outcomes associated with varicella-zoster virus infection in this cohort.
- To evaluate the effectiveness of early antiviral and immunoglobulin therapy.
Main Methods:
- Retrospective review of 17 pediatric patients with malignancies who contracted varicella-zoster virus infection during chemotherapy.
- Analysis of patient demographics, diagnoses (acute lymphoblastic leukemia, lymphoma, solid tumors), and clinical presentations.
- Evaluation of treatment timing (acyclovir, intravenous immunoglobulin) and patient outcomes, including mortality.
Main Results:
- Varicella-zoster virus infection occurred in children with acute lymphoblastic leukemia, lymphoma, and solid tumors, with a mean age of 6.8 years.
- Complications included abdominal pain, impaired liver function, pneumonitis, and disseminated intravascular coagulopathy (DIC), all associated with increased mortality.
- Patients receiving acyclovir or intravenous immunoglobulin (IVIG) within three days of symptom onset had significantly lower mortality rates compared to those treated later.
Conclusions:
- Abdominal pain and DIC are indicators of visceral dissemination of varicella-zoster virus.
- Severe liver dysfunction, pneumonitis, and DIC are primary causes of death in these patients.
- Prompt administration of acyclovir and IVIG is crucial for preventing VZV dissemination and improving survival, with IVIG showing value when VZIG is unavailable.
Background:
Immunocompromised children are potentially threatened by infections, among which, the highly contagious chickenpox infection is the most common. In the past six months, there has been a spate of five chickenpox infections in children with malignancy, all of whom were receiving chemotherapy at that time.
Methods:
The cases of 17 children with malignancies, who suffered from varicella-zoster infection during a period of chemotherapy at Taichung Veterans General Hospital were reviewed.
Results:
The diagnoses of their neoplasms were 12 acute lymphoblastic leukemia (ALL), 2 lymphoma, 3 solid tumors. The mean age was 6.8 +/- 4.0 year-old (range 3 to 15 year-old). The average duration from chickenpox skin eruption to admission was 3.3 +/- 1.8 days. Four patients suffered from abdominal pain and three of them died soon; three of them suffered from back pain and one died later. Seven of these 11 patients had impaired liver function (GOT > 45 U/L), of whom 4 died later. There were seven patients with pneumonitis, of whom five died later. Among 12 patients with ALL, 3 had absolute lymphocyte counts (ALC) < 500/mm3, but only 1 died later; 9 had ALC > 500/mm3, of whom 4 had pneumonitis, and all died later. Four patients developed disseminated intravascular coagulopathy, and three of them died later. Seven patients were prescribed acyclovir within three days after first skin eruption, none of these died. Ten patients were prescribed acyclovir three days or more after first skin eruption and five of them died later. Five patients were prescribed intravenous immunoglobulin (IVIG) within three days after first skin eruption, and none of them died; of the seven patients prescribed IVIG three days or more after first skin eruption, three died later.
Conclusions:
Abdominal pain and disseminated intravascular coagulopathy (DIC) were signs of visceral dissemination. Severe liver function impairment, pneumonitis and DIC were the principal causes of death. Early administration of acyclovir and intravenous immunoglobulin (IVIG) can probably effectively prevent the dissemination of varicella-zoster virus (VZV). While varicella-zoster immunoglobulin (VZIG) was unavailable, IVIG was still valuable in treating VZV infection.