Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Clin Kidney J. 2012 Jun;5(3):203-6. doi: 10.1093/ckj/sfs036. Epub 2012 Apr 25.
Chicken pox, although a common infection among children, is rare in immunocompromised patients, particularly renal transplant recipients, and carries a very high incidence of morbidity and mortality There is little data on chickenpox in adult renal transplant recipients, although reports have suggested that it may follow a virulent course requiring frequent hospitalization, and in severe cases can cause death.
To evaluate the incidence, severity and complications of a varicella/chickenpox infection in renal transplant recipients over 10 years follow-up.
An incidence of 1.48% of our patients were diagnosed with varicella infection during this 10-year period from June 2000 to June 2010 in our live-related renal transplant program, with a median patient age of 39 years (range 21-54 years). Graft dysfunction was observed among five patients following the infection, two of whom became dialysis-dependent. The other three had mild graft dysfunction from which they subsequently recovered, suggesting that infection was responsible for graft dysfunction. None of them developed rejection following exposure or with modification of immunosuppression. All of our patients required admission with 47.8% presenting with various presentations, with orchitis, pancreatitis, encephalitis and gastritis each affecting 8.6% of the patients. All patients were managed with intravenous acyclovir for 2 weeks followed by oral acyclovir for 3 months. The infection was associated with an increased mortality of 13.4% due to superadded infections and central nervous system involvement in one patient with fatal bilateral pneumonia.
This infection, which is a benign disease with a largely stable course among the general population, can have severe outcomes for immunocompromised patients, accounting for almost 90% with significant morbidity and mortality in the 8.6% of infected patients, thus highlighting the importance of pre-transplant vaccination in this subgroup of the population.
水痘虽然是儿童常见的感染，但在免疫功能低下的患者中很少见，尤其是肾移植受者，且发病率和死亡率极高。成人肾移植受者的水痘数据很少，但有报道称其可能病情较重，需要频繁住院，在严重的情况下可能导致死亡。
评估 10 年以上肾移植受者水痘/带状疱疹感染的发病率、严重程度和并发症。
在我们的活体相关肾移植项目中，从 2000 年 6 月至 2010 年 6 月的 10 年期间，我们的患者中有 1.48%被诊断患有水痘感染，中位患者年龄为 39 岁（21-54 岁）。感染后有 5 名患者出现移植物功能障碍，其中 2 名患者需要透析。另外 3 名患者的移植物功能轻度障碍随后恢复，提示感染是导致移植物功能障碍的原因。他们都没有在暴露于病毒或改变免疫抑制后发生排斥反应。我们所有的患者都需要住院治疗，其中 47.8%的患者有不同的表现，睾丸炎、胰腺炎、脑炎和胃炎分别影响了 8.6%的患者。所有患者均接受静脉用阿昔洛韦治疗 2 周，随后口服阿昔洛韦 3 个月。该感染与 13.4%的死亡率增加相关，1 例患者因继发感染和中枢神经系统受累而死亡，该患者发生致命性双侧肺炎。
这种感染在一般人群中是一种良性疾病，病程基本稳定，但在免疫功能低下的患者中可能导致严重后果，在感染患者中几乎 90%的患者有严重的发病率和死亡率，在感染的 8.6%患者中有显著的发病率和死亡率，因此突出了该人群中在移植前接种疫苗的重要性。
