Subclinical varicella-zoster virus viremia, herpes zoster, and T lymphocyte immunity to varicella-zoster viral antigens after bone marrow transplantation.
Bone marrow transplant (BMT) recipients were evaluated for subclinical varicella-zoster virus (VZV) viremia and symptoms of herpes zoster after transplantation. Viremia was demonstrated by testing peripheral blood mononuclear cells using polymerase chain reaction and was documented in 19% of 37 patients. When reactivation was defined as herpes zoster and/or subclinical VZV viremia, 41% of VZV-seropositive BMT recipients experienced VZV reactivation. None of 12 patients tested before VZV reactivation had T lymphocyte proliferation to VZV antigen (mean stimulation index, 1.0 +/- 0.42 [SD] at less than 100 days; 12.0 +/- 6.03 at greater than 100 days [P = .003]). Among patients tested at greater than 100 days, 5 (63%) of 8 with detectable T cell proliferation had subclinical or clinical VZV reactivation compared with none of 6 who lacked VZV T cell responses. Recovery of VZV-specific cytotoxic T lymphocyte function was observed in 50% of BMT patients, but BMT recipients had significantly fewer circulating cytotoxic T lymphocytes that recognized VZV immediate early protein (P = .03) or glycoprotein I (P = .004) than did healthy VZV immune subjects. In vivo reexposure to VZV antigens due to subclinical VZV viremia or symptomatic VZV reactivation may explain the recovery of virus-specific T cell immunity after BMT.
Wilson
A
A
Department of Pediatrics, Stanford University School of Medicine, CA 94305.
Sharp
M
M
Koropchak
C M
CM
Ting
S F
SF
Arvin
A M
AM
D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000276:immunology; D016026:Bone Marrow Transplantation; D016516:CD4-CD8 Ratio; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007111:Immunity, Cellular; D008213:Lymphocyte Activation; D008875:Middle Aged; D012008:Recurrence; D013601:T-Lymphocytes / Q000276:immunology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology; D014766:Viremia / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology
D000956:Antigens, Viral