Clinical relevance of quantitative varicella-zoster virus (VZV) DNA detection in plasma after stem cell transplantation.
Detection of Varicella-Zoster virus (VZV) DNA in plasma can facilitate the early recognition of complicated VZV-infection in immunocompromised hosts. The correlation of VZV-DNA in plasma with clinical presentations of VZV-infection and subsequent aciclovir treatment in allogeneic stem cell transplant (allo-SCT) recipients was studied. In 81 consecutive VZV-IgG positive allo-SCT recipients, VZV-DNA was measured at regular time points (1, 2 and 4 months) following allo-SCT and patient records were screened for VZV-related symptoms and aciclovir treatment. Subsequently, possible VZV-cases were studied in detail for the course of VZV-DNA and treatment effects. During the initial screening, VZV-DNA was detectable in seven patients. The survey of VZV-related symptoms revealed five additional possible VZV-cases. In cases where suitable plasma samples were available (10 out of 12), VZV-DNA was present almost simultaneously with the first clinical manifestations. No evidence of a preceding phase detectable by VZV-DNA only could be observed. Treatment with aciclovir was associated with a prompt reduction of VZV-DNA load. Detection of VZV-DNA in plasma in allo-SCT recipients accurately reflected the clinical presentation of VZV-infection and treatment with aciclovir. VZV-DNA detection in plasma of allo-SCT recipients appears clinically relevant as this may support early recognition and therapeutic management of VZV-infections following allo-SCT.
Kalpoe
J S
JS
Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
Kroes
A C M
AC
Verkerk
S
S
Claas
E C J
EC
Barge
R M Y
RM
Beersma
M F C
MF
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006562:Herpes Zoster / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014766:Viremia / Q000097:blood / Q000175:diagnosis
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir