TY - JOUR
T1 - Assessment of pediatric cases with chickenpox and zona hospitalised at our inpatient clinics
AU - Çalışkan, Bahar
AU - Somer, Ayper
AU - Sütçü, Murat
AU - Törün, Selda Hançerli
AU - Anak, Sema
AU - Salman, Nuran
AU - Ünüvar, Ayşegül
AU - Karaman, Serap
AU - Karakaş, Zeynep
AU - Devecioğlu, Ömer
N1 - Publisher Copyright:
© 2014 by Pediatric Infectious Diseases Society.
PY - 2014
Y1 - 2014
N2 - Objective: Chickenpox and zona are benign virus infections caused by varicella zoster virus (VZV). However, in immunocompromised individuals, including patients with malignancy, the infection may cause severe complications and mortality. The complications of VZV are one of the arguments in favor of universal vaccination programs in children. Material and Methods: In this study, patients between ages 15 days and 18 years (median: 5.7±3.8 years), hospitalized in our inpatient clinics from January 1986 to December 2013, were retrospectively evaluated. A review of medical records, including information on immune status, causes of hospitalization, treatment modalities, complications, and prognosis, was also carried out. Statistical analysis was performed using chi-square test and student t-test in the SPSS 13.0 program. A p value of <0.05 was defined as statistically significant. Results: Of all patients, 159 (83%) had varicella zoster infection and 33 (17%) had zona; 67 (42%) of 159 patients with varicella zoster infection and 32 (97%) of 33 patients with zona were immunocompromised. Complications occurred in 123 (64%) cases; 84 (68.3%) of these 123 patients were immunocompetent, and 39 (31.7%) patients were immunocompromised. The major complications were as follows: cerebellitis and/or encephalitis [n=37 (30%)], pneumonia [n=32 (26%)], secondary bacterial skin/soft tissue infections [n=20 (16.2%)], varicella gangrenosum or purpura fulminans (n=7 (5.7%)], disseminated intravascular coagulopathy [n=3 (2.4%)], aseptic meningitis [n=2 (1.6%)], septic shock [n=2 (1.6%)], myocarditis [n=2 (1.6%)], hemophagocytic syndrome [n=1 (0.8%)], transverse myelitis [n=1 (0.8%)], meningoencephalitis [n=1 (0.8%)], purulent meningitis [n=1 (0.8%)], facial palsy [n=1 (0.8%)], septic arthritis [n=1 (0.8%)], and immune thrombocytopenic purpura (ITP) [n=1 (0.8%)]. In one of the cases listed above (which had autoimmune lymphoproliferative disease), severe hemolytic anemia also developed. Concomitant pneumonia and skin infections [n=4 (3.2%)] and concomitant encephalitis and pneumonia [n=4 (3.2%)] were among the complications defined. In 2 other patients (1.6%), concomitant encephalitis and skin infections were also noted. In a single immunocompetent patient who was hospitalized recently, septic shock, adult respiratory distress syndrome (ARDS), purpura fulminans, osteomyelitis, and septic arthritis were observed. Parenteral acyclovir treatment was administered to immunocompromised patients (e.g., patients with malignancy or under steroid treatment for any kind of reason), as well as immunocompetent patients with central nervous system (CNS) complications. During the follow-up period, 3 patients (1.6%, n=192) died; 3 others who developed encephalitis survived with neurological sequela. Conclusion: Varicella zoster infection, which is known as a benign disease, may cause severe complications and mortality in immunocompetent pediatric patients, as well as immunocompromised ones. These data are consistent with the previous and are relevant in the decision-making process regarding the benefits of routine varicella vaccination.
AB - Objective: Chickenpox and zona are benign virus infections caused by varicella zoster virus (VZV). However, in immunocompromised individuals, including patients with malignancy, the infection may cause severe complications and mortality. The complications of VZV are one of the arguments in favor of universal vaccination programs in children. Material and Methods: In this study, patients between ages 15 days and 18 years (median: 5.7±3.8 years), hospitalized in our inpatient clinics from January 1986 to December 2013, were retrospectively evaluated. A review of medical records, including information on immune status, causes of hospitalization, treatment modalities, complications, and prognosis, was also carried out. Statistical analysis was performed using chi-square test and student t-test in the SPSS 13.0 program. A p value of <0.05 was defined as statistically significant. Results: Of all patients, 159 (83%) had varicella zoster infection and 33 (17%) had zona; 67 (42%) of 159 patients with varicella zoster infection and 32 (97%) of 33 patients with zona were immunocompromised. Complications occurred in 123 (64%) cases; 84 (68.3%) of these 123 patients were immunocompetent, and 39 (31.7%) patients were immunocompromised. The major complications were as follows: cerebellitis and/or encephalitis [n=37 (30%)], pneumonia [n=32 (26%)], secondary bacterial skin/soft tissue infections [n=20 (16.2%)], varicella gangrenosum or purpura fulminans (n=7 (5.7%)], disseminated intravascular coagulopathy [n=3 (2.4%)], aseptic meningitis [n=2 (1.6%)], septic shock [n=2 (1.6%)], myocarditis [n=2 (1.6%)], hemophagocytic syndrome [n=1 (0.8%)], transverse myelitis [n=1 (0.8%)], meningoencephalitis [n=1 (0.8%)], purulent meningitis [n=1 (0.8%)], facial palsy [n=1 (0.8%)], septic arthritis [n=1 (0.8%)], and immune thrombocytopenic purpura (ITP) [n=1 (0.8%)]. In one of the cases listed above (which had autoimmune lymphoproliferative disease), severe hemolytic anemia also developed. Concomitant pneumonia and skin infections [n=4 (3.2%)] and concomitant encephalitis and pneumonia [n=4 (3.2%)] were among the complications defined. In 2 other patients (1.6%), concomitant encephalitis and skin infections were also noted. In a single immunocompetent patient who was hospitalized recently, septic shock, adult respiratory distress syndrome (ARDS), purpura fulminans, osteomyelitis, and septic arthritis were observed. Parenteral acyclovir treatment was administered to immunocompromised patients (e.g., patients with malignancy or under steroid treatment for any kind of reason), as well as immunocompetent patients with central nervous system (CNS) complications. During the follow-up period, 3 patients (1.6%, n=192) died; 3 others who developed encephalitis survived with neurological sequela. Conclusion: Varicella zoster infection, which is known as a benign disease, may cause severe complications and mortality in immunocompetent pediatric patients, as well as immunocompromised ones. These data are consistent with the previous and are relevant in the decision-making process regarding the benefits of routine varicella vaccination.
KW - Hematologic malignancy
KW - Immunocompromised patient
KW - Varicella zoster virus
UR - http://www.scopus.com/inward/record.url?scp=84922522731&partnerID=8YFLogxK
U2 - 10.5152/ced.2014.1843
DO - 10.5152/ced.2014.1843
M3 - Article
AN - SCOPUS:84922522731
SN - 1307-1068
VL - 8
SP - 171
EP - 177
JO - Cocuk Enfeksiyon Dergisi
JF - Cocuk Enfeksiyon Dergisi
IS - 4
ER -