title: Disseminated vaccine-strain varicella as initial presentation of the acquired immunodeficiency syndrome: a case report and review of the literature.
abstract: Varicella-zoster virus (VZV) infections have declined in many industrialized countries due to vaccination with the attenuated Oka strain virus. Rare cases of severe, disseminated vaccine-strain VZV infection have occurred in the immunocompromised, although rarely in HIV-infected persons. We describe a man with previously-undiagnosed human immunodeficiency virus (HIV) infection who received VZV vaccination and subsequently presented to a combat hospital in Afghanistan with disseminated varicella, respiratory failure, and sepsis. The patient recovered with ventilator and hemodynamic support, intravenous acyclovir, and empiric antibiotic therapy. DNA sequencing detected Oka strain virus from patient blood specimens. Although safe in most populations, the VZV vaccine may cause life-threatening disease in immunocompromised patients. Improved detection of HIV infection may be useful in preventing such cases.
authors.affiliation: NATO Role 3 Multi-National Medical Unit, Kandahar Airfield, Afghanistan; Division of Infectious Diseases, Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA, USA; Department of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, CA, USA. Electronic address: ryan.maves@med.navy.mil.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Maves
authors.affiliation: NATO Role 3 Multi-National Medical Unit, Kandahar Airfield, Afghanistan; Department of Pulmonary and Critical Care Medicine, Naval Medical Center San Diego, San Diego, CA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Tripp
authors.affiliation: 82nd Airborne Division, Fort Bragg, NC, USA.
authors.forename: Trevor G
authors.initials: TG
authors.lastname: Dell
authors.affiliation: 82nd Airborne Division, Fort Bragg, NC, USA; Military Malaria Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Bennett
authors.affiliation: 82nd Airborne Division, Fort Bragg, NC, USA; United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA.
authors.forename: Jaspal S
authors.initials: JS
authors.lastname: Ahluwalia
authors.affiliation: NATO Role 3 Multi-National Medical Unit, Kandahar Airfield, Afghanistan; Naval Medical Research Center, Silver Spring, Maryland, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Tamminga
authors.affiliation: Applied Technology Center, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Baldwin
authors.affiliation: Applied Technology Center, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA.
authors.forename: Clarise Rivera
authors.initials: CR
authors.lastname: Starr
authors.affiliation: Applied Technology Center, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Grinkemeyer
authors.affiliation: NATO Role 3 Multi-National Medical Unit, Kandahar Airfield, Afghanistan; Applied Technology Center, United States Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, OH, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dempsey
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis*; D000346:Afghanistan; D002644:Chickenpox / Q000150:complications* / Q000821:virology*; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine
keywords: AIDS; HIV-1; Operation Enduring Freedom; Varicella; Varicella vaccine