title: The yield of monitoring for HSV and VZV viremia in pediatric hematopoietic stem cell transplant patients.
abstract: Reactivation of HSV and VZV is common following HSCT. Consensus guidelines do not support the use of routine screening for viremia following HSCT in adults, but no such clear guidelines exist in pediatrics. In our center, routine practice was to screen patients weekly for HSV and VZV viremia until engraftment in autologous transplant patients and up to day +100 in allogeneic transplant patients. We conducted a retrospective study of over 500 patients to establish whether this screening identified any patients with HSV or VZV viremia who would not have been identified by clinical signs or symptoms. Over a 4.5-yr period, routine screening identified three cases of HSV viremia and one case of VZV viremia. Two patients had persistent, unexplained fever and two patients had skin or mucosal lesions suggestive of HSV/VZV. We conclude that routine screening for HSV and VZV viremia in pediatric HSCT patients has a very low yield and that viremia can be reliably identified by targeted testing in patients with vesicular skin lesions, oral or genital ulceration, unexplained fever, neurological symptoms, or unexplained abnormal liver transaminases.
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Katharine
authors.initials: K
authors.lastname: Patrick
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Richardson
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Gassas
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Maarten
authors.initials: M
authors.lastname: Egeler
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Joerg
authors.initials: J
authors.lastname: Krueger
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Lowry
authors.affiliation: The Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Tal
authors.initials: T
authors.lastname: Schechter
mesh_terms: D000293:Adolescent; D002644:Chickenpox / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006561:Herpes Simplex / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000821:virology; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014766:Viremia / Q000175:diagnosis* / Q000209:etiology
keywords: Human herpes virus; hematopoietic stem cell transplantation; screening; varicella