Varicella infection with childhood hematological malignancy: A single institution experience of 27 cases

Varicella remains a dangerous viral pathogen for pediatric cancer patients. The incidence of primary varicella infection in Eastern of Turkiye is still high because of low vaccination rate. Medical records of 27 pediatric patients with hematological malignancies that developed varicella/herpes zoster were retrospectively reviewed. All were treated at a single medical center in Eastern Turkiye between 1997 and 2006. Varicella (n = 22) or herpes zoster (n = 5) were diagnosed in 27 cases, of whom 14 had acute lymphoblastic leukemia (ALL), five had acute myeloblastic leukemia (AML), and eight had non-Hodgkin lymphoma (NHL). The mean age of the children was 5.7 ± 3.2 years. None of these children had evidence of disseminated disease. The mean total leukocyte count was 2600 ± 1500/mm3 in ALL group, 2300 ± 1800/mm3 in AML group, and 3100 ± 1700/mm3 in NHL group. While intravenous acyclovir was administered to 21 patients, remaining six patients were received oral acyclovir. Fever was reduced in mean 5.6 ± 2.1, 5.2 ± 1.7 and 4.4 ± 1.8 days in ALL, AML, and NHL groups, respectively. None of the 27 children worsened or developed features of visceral dissemination. Outcome of the patients were not different in terms of oral and intravenous acyclovir use. These results suggest that in our institution varicella is not associated with a high incidence of mortality in cancer patients. Early administration of acyclovir can prevent the visceral dissemination of varicella-zoster virus. Prednisolone usage during the incubation period of varicella did not result in increased severe varicella infection.