Fatal varicella in an immunocompromised adult associated with a European genotype E2 variant of varicella zoster virus

Abstract Varicella zoster virus (VZV) seronegative patients under immunosuppressive therapy are at risk for severe life-threatening varicella. A 25-year-old male patient presented with rash and hepatitis. He had been known to suffer from Crohn's disease and received immunosuppressive treatment...

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Bibliographic Details
Published in:Journal of clinical virology 2009-01, Vol.44 (1), p.70-73
Main Authors: Springfeld, C, Sauerbrei, A, Filusch, A, Konstandin, M, Hartschuh, W, Sauer, P, Encke, J, Stremmel, W, Schnitzler, P
Format: Article
Language:English
Subjects:
Adult
Allergy and Immunology
Azathioprine - adverse effects
Azathioprine - therapeutic use
Biological and medical sciences
Blood - virology
Chickenpox - pathology
Chickenpox - physiopathology
Chickenpox - virology
Crohn Disease - complications
Crohn Disease - drug therapy
DNA, Viral - genetics
Fatal Outcome
Fundamental and applied biological sciences. Psychology
Genotype
Hepatitis
Herpesvirus
Herpesvirus 3, Human - classification
Herpesvirus 3, Human - genetics
Herpesvirus 3, Human - isolation & purification
Human viral diseases
Humans
Immunocompromised Host
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Infectious Disease
Infectious diseases
Liver failure
Male
Medical sciences
Microbiology
Miscellaneous
Multiple Organ Failure
Sequence Analysis, DNA
Shock, Septic
Trachea - virology
Vaccination
Varicella
Varicella zoster virus (VZV)
Varicella-zoster virus
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
Virology
VZV genotype E2
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Summary:Abstract Varicella zoster virus (VZV) seronegative patients under immunosuppressive therapy are at risk for severe life-threatening varicella. A 25-year-old male patient presented with rash and hepatitis. He had been known to suffer from Crohn's disease and received immunosuppressive treatment with azathioprine. The patient showed dyspnoea, and presented with a generalized rash with vesicular lesions typical for herpesvirus infections. He was started immediately on acyclovir therapy. Varicella infection was determined in this VZV seronegative patient in rash vesicles, blood and tracheal secretions and a high VZV viral load was detected in these specimens. The causative agent was genotyped by sequencing of several genes as a variant of the European genotype E2 containing several unique single nucleotide polymorphisms. Despite all measures, there was progressive septic shock, and the patient died due to multi-organ failure. Immunocompromised adults without varicella history are at high risk to develop life-threatening complications of varicella. Antiviral therapy with acyclovir can only be successful when administered as early as possible on suspicion of varicella infection in this group of patients. The most effective method to prevent severe varicella in immunocompromised patients is active immunization prior to immunosuppressive therapy.
ISSN:1386-6532
1873-5967
DOI:10.1016/j.jcv.2008.10.004