Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis

In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZV-infections in our center and compare them to published data. Furthermore, we report three instructive cases.Hospitalization rate of referred children with VZV-infections was 45%, among these 17% with malignancies and 9% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroid-dependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h.Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.Infections with varicella-zoster virus (VZV) are usually considered benign infections. However, severe complications including bacterial superinfections, coagulopathies, and central nervous system manifestations with a potentially fatal or long term disabling outcome can occur [1,2]. The classical clinical presentation is characterized by mucocutaneous involvement and a low mortality rate in immunocompetent children. In contrast, primary varicella-infections are potentially life-threatening in immunocompromised patients, especially in those whose immune system has been suppressed by diseases such as acute lymphoblastic leukaemia (ALL) or by m