acyclovir and Nephrotic-Syndrome

Varicella, or chickenpox, is very communicable and has been shown to be transmitted to nearly 90% of household contacts. Severe varicella infections with fatal complications have been noted in children receiving corticosteroids despite the administration of varicella-zoster immune globulin (VZIG). The use of post-exposure acyclovir prophylaxis in immunocompetent children exposed to a household contact with varicella has been shown to decrease the transmission rate of varicella significantly. We studied the safety and efficacy of acyclovir prophylaxis as an adjunctive preventive measure in 8 children (10 separate exposures) receiving corticosteroids for renal disease. Four children (6 separate exposures) served as controls. No adverse reactions were reported with the acyclovir prophylaxis. The maximum change between pre- and study serum creatinine levels was 0.1 mg/dl. None of the 8 patients who received acyclovir prophylaxis developed chickenpox. One of these 8 patients developed humoral immunity to varicella despite the absence of clinical infection. One of 4 patients who received VZIG prophylaxis alone developed chickenpox. These data support the use of acyclovir prophylaxis as an adjunctive measure to VZIG for the prevention of potentially serious varicella infection in children receiving steroids.

Topics: Acyclovir; Adolescent; Adrenal Cortex Hormones; Antiviral Agents; Chickenpox; Child; Child, Preschool; Female; Graft Rejection; Humans; Kidney Diseases; Kidney Transplantation; Male; Nephrotic Syndrome

Primary infection with varicella zoster virus was assumed to confer lifelong immunity. Nevertheless, cases of varicella reinfection had been reported regardless of immune status. Here the authors described a case of 11-year old girl with nephrotic syndrome, currently on 80 milligrams of prednisolone for one month. She presented with one day of fever, diarrhea and acne-like rash at her forehead, nose and few on the neck. She had a past history of chickenpox. Her vesicles were examined by pediatric dermatologist and Tzanck smear was performed. Multinucleated giant cells were detected and diagnosis of varicella was made. This report infers that positive varicella history alone might not be sufficient to confer immunity, especially in immunocompromised host. Atypical presentation of recurrent varicella in immunocompromised host can be presented.

Topics: Acne Vulgaris; Acyclovir; Antiviral Agents; Chickenpox; Child; Diagnosis, Differential; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Nephrotic Syndrome; Prednisolone; Recurrence

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Herpes Zoster; Humans; Male; Nephrotic Syndrome; Treatment Outcome; Virus Activation

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child, Preschool; Female; Humans; Male; Nephrotic Syndrome

We report our experience with two patients with adult onset of chickenpox in the setting of longstanding steroid therapy for nephrotic syndrome. Ours is a 430-bed tertiary care teaching hospital, The Wellesley Hospital, Toronto, Ontario. Both patients presented as self-referrals to the emergency department.. The clinical suspicion of chickenpox was rapidly confirmed in both cases by a Tzanck smear preparation, by viral cultures of the vesicle, serology, and skin biopsy. In both patients therapy with high dose acyclovir, 10 mg/kg q8h, intravenously, was instituted based on clinical presentation.. Delay in clinical recognition and treatment in our first case resulted in death due to multiorgan failure (MOF). Improved awareness and rapid treatment of the second patient had a favorable outcome with no sequelae.. Chickenpox is not only a childhood illness. Although rare in the adult population, it is associated even in the nonimmunocompromised host with increased morbidity and mortality. Steroid therapy predisposes to early dissemination and a potentially fatal outcome. Adults with immunosuppression should receive prompt systemic treatment with acyclovir.

Topics: Acyclovir; Adult; Chickenpox; Fatal Outcome; Humans; Male; Multiple Organ Failure; Nephrotic Syndrome; Prednisone

Topics: Acyclovir; Ampicillin; Child; Child, Preschool; Cloxacillin; Drug Therapy, Combination; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Lupus Erythematosus, Systemic; Nephrotic Syndrome