Chen P Y, Chu H Y, Shian W J, Shu S G, Chi C S
Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Dec;54(6):417-23.
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.
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.
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.
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.
免疫功能低下的儿童容易受到感染的威胁，其中传染性极强的水痘感染最为常见。在过去六个月里，恶性肿瘤患儿中出现了五例水痘感染病例，这些患儿当时均在接受化疗。
回顾了台中荣民总医院17例在化疗期间患水痘 - 带状疱疹感染的恶性肿瘤患儿的病例。
他们的肿瘤诊断为12例急性淋巴细胞白血病（ALL）、2例淋巴瘤、3例实体瘤。平均年龄为6.8±4.0岁（范围3至15岁）。从水痘皮疹出现到入院的平均时间为3.3±1.8天。4例患儿出现腹痛，其中3例很快死亡；3例出现背痛，其中1例后来死亡。这11例患儿中有7例肝功能受损（谷草转氨酶>45 U/L），其中4例后来死亡。有7例患儿发生肺炎，其中5例后来死亡。在12例ALL患儿中，3例绝对淋巴细胞计数（ALC）<500/mm³，但只有1例后来死亡；9例ALC>500/mm³，其中4例发生肺炎，均后来死亡。4例患儿发生弥散性血管内凝血，其中3例后来死亡。7例患儿在首次皮疹出现后三天内使用了阿昔洛韦，这些患儿均未死亡。10例患儿在首次皮疹出现三天或更长时间后使用了阿昔洛韦，其中5例后来死亡。5例患儿在首次皮疹出现后三天内使用了静脉注射免疫球蛋白（IVIG），这些患儿均未死亡；7例在首次皮疹出现三天或更长时间后使用IVIG的患儿中，3例后来死亡。
腹痛和弥散性血管内凝血（DIC）是内脏播散的迹象。严重肝功能损害、肺炎和DIC是主要死因。早期给予阿昔洛韦和静脉注射免疫球蛋白（IVIG）可能有效预防水痘 - 带状疱疹病毒（VZV）的播散。当水痘 - 带状疱疹免疫球蛋白（VZIG）无法获得时，IVIG在治疗VZV感染方面仍然有价值。
