Postexposure prophylaxis against varicella zoster virus infection among hematopoietic stem cell transplant recipients

Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
Biology of Blood and Marrow Transplantation (Impact Factor: 3.35). 11/2006; 12(10):1096-7. DOI: 10.1016/j.bbmt.2006.06.005
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    ABSTRACT: Antiviral agents play a key role in the prevention and treatment of varicella zoster virus (VZV) disease in immunosuppressed patients. Randomized trials show that aciclovir is effective in preventing VZV reactivation disease; however, no consensus exists on dose, duration and patient population for its use. The recent shortage of VZV-specific immunoglobulin has generated renewed interest in the use of antiviral agents as post-exposure prophylaxis. The use of antiviral agents for post-exposure prophylaxis is not supported by randomized trials, but uncontrolled experience suggests that it might be a reasonable alternative if varicella-specific immunoglobulin is not available. Current evidence on the use of antiviral agents in the prevention of reactivation disease and management of exposure to VZV is discussed.
    Herpes: the journal of the IHMF 12/2006; 13(3):60-5.
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    ABSTRACT: In severely immunocompromised patients, the diagnosis of viral infections relies on PCR/RT-PCR based methods. The availability of these modern diagnostic tools facilitates timely diagnosis and contributes to our increasing knowledge of the epidemiology and clinical spectrum of common and emerging viral pathogens in this highly susceptible population. Viral infections may result in life threatening disease in paediatric cancer patients after stem cell transplantation and also during conventional chemotherapy. Often, clinical symptoms are a consequence of endogenous reactivation of latent viral infection. Many of these viruses are easily transmitted between patients, relatives and health care workers. As prolonged symptomatic and asymptomatic viral shedding is a common feature in paediatric cancer patients, it is necessary to implement strategies for the prevention and control of these communicable pathogens in the hospital setting and in the outpatient clinic. Although no randomised controlled studies on paediatric cancer patients are available, physicians should be aware of potential treatment options since early treatment may prevent a complicated or fatal outcome and shorten the period of contagiosity.
    Archives of Disease in Childhood 07/2008; 93(10):880-9. DOI:10.1136/adc.2007.132225 · 2.91 Impact Factor
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    ABSTRACT: Solid organ and hematopoietic stem cell transplant recipients are more likely to develop skin and soft tissue infections, which may be caused by common or atypical pathogens. Skin and soft tissue anatomic abnormalities may act as portals of entry for infection, and may result from surgery, venous access, immunosuppressive medications, and other etiologies. Systemic infection may sometimes be recognized by investigation of skin manifestations. Many noninfectious processes of the skin and soft tissues can mimic infection, complicating the diagnosis. Prompt dermatologic consultation and skin biopsy are essential in this vulnerable population. Treatment of infection in transplant recipients may necessitate reduction of immunosuppression, in addition to other adjunctive therapies. Interesting and important new findings about skin and soft tissue infections in transplant recipients are the focus of this review.
    Current Infectious Disease Reports 10/2008; 10(5):387-93. DOI:10.1007/s11908-008-0063-2