From the Pediatric Hemato-Oncology Department.
Pediatric Infectious Diseases Unit.
Pediatr Infect Dis J. 2018 Jul;37(7):649-653. doi: 10.1097/INF.0000000000001920.
Immunocompromised patients exposed to varicella may experience significant morbidity and a 7% mortality rate. Management and outcome of an outbreak of varicella infection among hospitalized pediatric hemato-oncology patients using the guidelines of the American Academy of Pediatrics Committee on Infectious Diseases are presented.
This retrospective study describes an outbreak of varicella infection between February 2011 and June 2011. Data were retrieved from the patients' files. Positive polymerase chain reaction results for varicella zoster virus from vesicular skin lesions were used for the diagnosis of varicella infection.
Twelve pediatric hemato-oncology patients experienced 13 episodes of varicella infection, 11 underwent 1 episode each and 1 patient had 2 episodes. All exposed patients without immunity received varicella zoster immune globulins or intravenous immunoglobulin and were isolated as recommended by the guidelines. Infected patients received intravenous acyclovir. One patient with acute lymphoblastic leukemia at induction chemotherapy died. All the other patients survived.
Our experience in the management of hospitalized immunocompromised patients exposed to varicella was that a positive IgG serology did not confer protection after exposure to varicella infection and thus can not serve as a marker for immunity. Unlike the isolation period sufficient for immunocompetent patients, crusted lesions can be contagious and thus require extended isolation for immunocompromised patients. Patients receiving rituximab are at greater risk of having persistent or recurrent disease. Studies with a larger sample size should be performed to better assess the management of immunocompromized patients exposed to varicella.
免疫功能低下的水痘患者可能会出现严重的发病率和 7%的死亡率。本文介绍了美国儿科学会传染病委员会指南在管理和治疗住院儿科血液肿瘤患者水痘感染爆发方面的应用。
本回顾性研究描述了 2011 年 2 月至 2011 年 6 月期间发生的水痘感染爆发。从患者档案中提取数据。采用疱疹性皮肤损伤的水痘带状疱疹病毒聚合酶链反应阳性结果来诊断水痘感染。
12 名儿科血液肿瘤患者经历了 13 次水痘感染，11 名患者各发生 1 次，1 名患者发生 2 次。所有未免疫的暴露患者均按指南要求接种水痘带状疱疹免疫球蛋白或静脉注射免疫球蛋白，并进行隔离。感染患者接受静脉注射阿昔洛韦。1 例处于诱导化疗期的急性淋巴细胞白血病患者死亡。所有其他患者均存活。
我们在管理暴露于水痘的住院免疫功能低下患者方面的经验是，暴露于水痘感染后 IgG 血清学阳性并不能提供保护，因此不能作为免疫的标志物。与免疫功能正常患者所需的隔离期不同，结痂皮损仍具有传染性，因此免疫功能低下患者需要延长隔离期。接受利妥昔单抗治疗的患者更有可能出现持续或复发疾病。应进行更大样本量的研究，以更好地评估免疫功能低下患者暴露于水痘的管理。
