Disseminated Varicella-Zoster Virus Infection in Organ Transplant Recipients: A 10-year Retrospective Study.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-10-21 DOI:10.1111/tid.70117

Ryosuke Yamamuro, Alba Romero, Ahsha Khandelwal-Young, Atul Humar, Deepali Kumar

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引用次数: 0

Abstract

Background: Data on disseminated herpes zoster (HZ) infections in solid organ transplant (SOT) recipients are limited. We aimed to investigate the clinical characteristics and outcomes of HZ infection in SOT patients presenting with microbiologically confirmed disease.

Methods: All SOT recipients who tested positive for varicella-zoster virus (VZV) from any sample type between January 2013 and December 2022 were included. Disseminated HZ was defined as skin lesions involving > 2 contiguous dermatomes or evidence of end organ disease. An analysis of risk factors associated with disseminated infection was performed.

Results: A total of 146 adult SOT patients with confirmed VZV infections were included in the study. Of these, 4 were primary varicella and 142 were HZ. Median time to HZ presentation was 1.8 years (range 0.02-27). Disseminated HZ was diagnosed in 55/142(38.7%). Post-herpetic neuralgia (PHN) occurred in 33(22.6%) patients and vaccine breakthrough in 5(3.5%). Hospitalization was in 101(71.6%) patients, and 5(3.5%) died within 30 days, none attributable to HZ. VZV DNAemia was detected in 12/13 (92.3%) patients with disseminated disease versus 11/29 (37.9%) with localized disease (p = 0.002). Recurrent HZ rate was 10/142 (7.0%) over a median follow-up of 4.1 years with 90% of recurrences occurring in thoracic transplant. On multivariable logistic regression, no clinical factors were associated with disseminated disease.

Conclusions: In a large cohort of SOT patients with VZV, disseminated disease and PHN were frequent. VZV DNAemia was noted in both disseminated and localized infections suggesting that subclinical detection of virus in blood is frequent. The implications of this require further study.

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器官移植受者弥散性水痘-带状疱疹病毒感染：10年回顾性研究

背景：关于实体器官移植（SOT）受者播散性带状疱疹（HZ）感染的数据有限。我们的目的是研究微生物学证实的SOT患者HZ感染的临床特征和结果。方法：纳入2013年1月至2022年12月期间所有水痘带状疱疹病毒（VZV）检测阳性的SOT接受者。弥散性HZ被定义为累及bbbb2相邻皮节的皮肤病变或终末器官疾病的证据。分析了与播散性感染相关的危险因素。结果：共纳入146例确诊VZV感染的成人SOT患者。其中4例为原发性水痘，142例为HZ。出现HZ的中位时间为1.8年（范围0.02-27）。弥散性HZ诊断为55/142（38.7%）。带状疱疹后神经痛33例（22.6%），疫苗突破5例（3.5%）。101例（71.6%）患者住院，5例（3.5%）患者在30天内死亡，无一例可归因于HZ。播散性疾病患者中有12/13（92.3%）检测到VZV dna血症，而局限性疾病患者中有11/29（37.9%）检测到VZV dna血症（p = 0.002）。在4.1年的中位随访中，复发HZ率为10/142(7.0%)，其中90%的复发发生在胸腔移植手术中。在多变量logistic回归中，没有临床因素与播散性疾病相关。结论：在大量伴有VZV的SOT患者中，播散性疾病和PHN是常见的。在播散性和局域性感染中都发现了VZV脱氧核糖核酸血症，这表明在血液中亚临床检测病毒是经常发生的。这其中的含义需要进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.