Comparison of Varicella-zoster Infections in Pediatric Cancer Patients Versus Other Immunocompromised Patients

Abstract

Objective: This study aims to compare the clinical features of varicella and herpes zoster infections in cancer patients with chronic immuno compromised patients. Material and Methods: Medical records of 144 immunocompromised patients between the ages of 0 and 18 were examined. The patients were divided into two groups. Group A consisted of cancer patients, while Group B consisted of patients with non-cancer immunodeficiency. Data were collected showing the complications associated with varicella-zos ter virus, length of hospital stay, vaccination status, acyclovir, intrave nous immunoglobulin, antibiotic therapy, and disease outcomes. Results: Of 144 children patients, 55 (38.2%) were in Group A and 89 (61.8%) were in Group B. Acute lymphoblastic leukemia (54.5%) in Group A and neurological disorders (33.8%) in Group B were the underlying primary disease. Seventeen of those with herpes zoster disease were in Group A, and 83 of those with varicella disease were in Group B. Chick enpox/herpes zoster was observed more in the spring (70.4%) in Group B and in the summer season in Group A (53.1%). The median duration of the rash was nine (3-36) days in chickenpox and 10 (8-12) days in herpes zoster. There was no significant difference between the two groups in terms of CRP positivity and antibiotic treatment (p> 0.05). 38.1% of the patients in Group A and 5.6% of the patients in Group B were neutrope nic (p< 0.05). There were complications in 54 patients in Group A and 25 patients in group B. Among the complications, secondary bacterial infection/sepsis was seen more in Group A than in Group B. There was a statistically significant difference between the groups in the distribution of acyclovir use and the duration of acyclovir (p< 0.05). The length of hos pital stay between groups was longer in group A (p< 0.05). Conclusion: Varicella zoster infections are one of the important causes of mortality and morbidity in pediatric oncology patients. The frequency of herpes zoster is higher in cancer patients compared to other immuno deficient patients and close monitoring is required. At least one compli cation can often be seen in immunocompromised patients who become ill with varicella zoster virus, and it is possible to prevent complications or to decrease their severity by starting acyclovir/antiviral therapy with out delay. Cancer patients require a longer period of acyclovir treatment than other immunocompromised VZV patients. Initiation of acyclovir/ antiviral therapy by hospitalization of cancer patients with varicella zos ter virus infection and other immunodeficient patients without delay will decrease the complications and mortality rates of varicella zoster virus. Multidisciplinary follow-up of pediatric infection specialists, pediatric he matology-oncology specialists and other specialists who follow immu nocompromised patients will reduce the morbidity and mortality of VZV infections in these patient groups.