title: Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience.
abstract: Herpes zoster (HZ), a varicella-zoster virus reactivation, frequently complicates hematopoietic stem cell transplantation (HSCT). Its incidence, complications, and associated risk factors in 310 children undergoing HSCT were reviewed. In all, 61 of 201(32%) patients who had undergone allogeneic and 10 of 109 (9%) patients who had undergone autologous HSCT developed HZ. Of 90 VZV seropositive allogeneic patients, 50 (53%) developed HZ. Seven (17%) of 41 VZV seropositive autologous patients developed HZ. Although a substantial number of patients develop HZ in the early post-HSCT period, risk for HZ persists and HZ can occur up to 5 years post-HSCT. Risk factors for HZ included age >10 years (P<0.0001), allogeneic HSCT (P<0.001), and total body irradiation (TBI) (P<0.059) in allogeneic recipients. Of 37, 22 (59%) patients experienced an elevated alanine aminotransferase (ALT), unassociated with GVHD, in the month preceding HZ. Of the 48/64 patients (75%) hospitalized for treatment (median stay, 6 days; range, 2-39), length of stay was unaffected by donor type but increased by cutaneous dissemination and visceral involvement (P=0.023 and 0.034, respectively) in allogeneic patients. Consideration of HZ infection particularly in patients >10 years of age with elevated ALT after TBI-conditioned allogeneic HSCT may permit earlier diagnosis and therapeutic intervention.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Berman
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.forename: W
authors.initials: W
authors.lastname: Berry
authors.forename: D S
authors.initials: DS
authors.lastname: Neuberg
authors.forename: E C
authors.initials: EC
authors.lastname: Guinan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000209:etiology; D006402:Hematologic Diseases / Q000097:blood* / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006562:Herpes Zoster / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D014645:Herpesvirus 3, Human; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D000637:Transaminases / Q000097:blood*; D014184:Transplantation, Homologous
chemical_list: D000637:Transaminases