BibTex RIS Cite

Çocukluk Döneminde Herpes Zoster Enfeksiyonu: 24 Olgunun Değerlendirilmesi

Year 2017, Volume: 11 Issue: 4, 233 - 238, 01.12.2017

Abstract

Amaç: Herpes zoster(HZ), dorsal kök gangliyonlarında latent olarak kalan varisella zoster virüsünün reaktivasyonuyla oluşmaktadır. HZ çocuklarda, özellikle immünkompetan çocuklarda nadir görülmektedir. Bu çalışmada dermatoloji polikliniğimizde HZ tanısı alan çocukların demografik özellikleri, klinik bulguları ve komplikasyonlarının incelenmesi amaçlanmıştır.Gereç ve Yöntemler: Dermatoloji polikliniğinde Ekim 2012-Eylül 2013 tarihleri arasında HZ tanısı alan, 18 yaşından küçük hastaların verileri retrospektif olarak incelendi. Hastalar yaş, cinsiyet, geçirilmiş varisella öyküsü, varicella aşısı, tetikleyici faktörler, klinik bulgular, eşlik eden hastalık, immünsüpresif ilaç kullanımı, enfeksiyonun ortaya çıktığı ay, komplikasyon gelişimi ve tedavi açısından değerlendirildi.Bulgular: HZ tanısı konulan 24 çocuk hastanın 8’i kız (%33.3), 16’sı erkekti(%66.6). Hastaların ortanca yaşları 13 yıl (2-17yaş) olarak saptandı. On altı (%66.6) hastada torakal dermatom tutulurken, 3 (%12.5) hastada servikal, 2 (%8.3) hastada servikotorakal, 3 (%12.5) hastada lumbal dermatom tutulumları izlendi. Hastalarımızın hiçbirinde disseminasyon gelişmedi. Sekiz hastada bölgesel lenfadenopati saptandı. Hastaların hemen tamamında kaşıntı ve/veya ağrı yakınması mevcuttu. On sekiz (%75) hastada kaşıntı ve ağrı birlikteydi. Hastalığı tetikleyebilecek faktörler olarak 11 hastada emosyonel stres (okul/aile), ateşli hastalık, cerrahi operasyon ve uzun süreli açlık öyküsü vardı. Hastaların hiçbirinde immünsüpresyon yaratacak bir hastalık veya ilaç kullanımı yoktu. En sık şubat ayında (8 hasta, %33.3) olmak üzere her mevsimde HZ olguları görüldü. Hastaların hiçbiri varisella aşısı olmamıştı. Suçiçeği geçirme öyküsü hastaların sadece 8’inde (%33.3) vardı. On beş (%62.5) hastaya sistemik antiviral tedavi verildi. Hastalarda postherpetik nevralji veya majör bir komplikasyon görülmedi.Sonuç: HZ sağlıklı çocuklarda da görülebilmektedir. Erişkin hastalara benzer şekilde en sık torakal dermatom etkilenir. Aile veya okul kaynaklı stres, cerrahi operasyon, ateşli hastalık ve oruç tutma gibi uzun süreli açlık sağlıklı çocuklarda HZ’nin gelişimini kolaylaştırabilir. Sağlıklı çocuklarda HZ’ye bağlı postherpetik nevralji veya majör komplikasyon genellikle gelişmez.

References

  • Mendoza N, Madkan V, Sra K, Willison B, Morrison LK, Tyring SK. Human Herpes viruses. In: Bolognia JL, Jorizzo JL, Schaffer JV (eds). Dermatology. 3rd ed. China: Elsevier Saunders 2012;1321- 43.
  • McCrary ML, Severson J, Tyring SK. Varicella zoster virus. J Am Acad Dermatol 1999;41:1-14.
  • Ramdass P, Mullick S, Farber HF. Viral skin diseases. Prim Care 2015;42:517-67.
  • Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: A multidisciplinary perspective. Ther Adv Vaccines 2015;3:109-20.
  • Feder HM, Hoss DM. Herpes zoster in otherwise healthy children. Pediatr Infect Dis J 2004;23:451-7.
  • Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: Four case reports and a review of infantile herpes zoster. Arch Dermatol 2004;140:1268-72.
  • Özuğuz P, Kaçar SD, Polat S, Karaca S, Kundak A. Çocukluk çağı zona zoster: 12 olgu sunumu. Abant Medical Journal 2014;3:253- 6.
  • Tepe B, Bucak İH, Almış H. Sağlıklı çocuklarda herpes zoster: Retrospektif bir çalışma. Turk J Dermatol 2016;10:65-9.
  • Grote V, vonKries R, Rosenfeld E, Belohradsky BH, Liese J. Immunocompetent children account for the majority of complications in childhood herpes zoster. J Infect Dis 2007;196:1455-8.
  • Goh CL, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol 1997;36:667-72.
  • Saçar H, Uyar B, Saçar T. Suçiçeği aşısı sonrası gelişen herpes zoster olgusu. Dermatoz 2014;5:1-4.
  • Topkarcı Z, Erdoğan B, Erkum T, Yılmaz M. Sağlıklı çocuklarda herpes zoster infeksiyonu. Bakırköy Tıp Dergisi 2012;8:178-81.
  • Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(Suppl 1):S1-26.
  • Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc 2009;84:274-80.
  • Katakam BK, Kiran G, Kumar U. A prospective study of herpes zoster in children. Indian J Dermatol 2016;61:534-9.
  • A ve ark. Önceden sağlıklı çocuklarda Türkiye ulusal bağışıklama çizelgesinde (Ulusal Aşı Takvimi) yer alan ve almayan aşılara ilişkinuygulama önerileri-2015. J Pediatr Inf 2015;9:1-11.
  • Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, et al. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis 2013;208:1859-68.

Herpes Zoster Infection in Childhood: An Evaluation of 24 Cases

Year 2017, Volume: 11 Issue: 4, 233 - 238, 01.12.2017

Abstract

Objective: Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus that resides in a dorsal root ganglion. HZ is rare in immunocompetent children. The purpose of this study was to evaluate the demographic features, clinical manifestations and complications of children diagnosed as HZ at our dermatology clinic. Material and Methods: Patients under 18 years who presented with HZ to our dermatology clinic between October 2012 and September 2013 were retrospectively investigated. Age, gender, history of chickenpox, varicella vaccination, predisposing factors, clinical manifestations, associated diseases, use of immunosuppressive drugs, month of onset, complications and treatment were evaluated.results: Among the 24 patients diagnosed with HZ, 8 were girls (33.3%) and 16 were boys (66.6%). The median age was 13 years (2-17 years). While 16 (66.6%) patients had thoracic dermatome involvement, the rest had cervical (n=3, 12.5%), cervicothoracic (n=2, 8.3%), lumbar (n=3, 12.5%) dermatome involvement. None of the patients had disseminated eruption. Eight patients had local lymphadenopathy. All patients had pruritus and/or pain and eighteen patients had both pruritus and pain. Eleven patients had triggering factors such as emotional stress (originating from school or home), surgery, febrile illness and fasting. None of the patients had immunosuppression. HZ occurred in all seasons but most commonly in February. None of the patients had undergone varicella vaccination. A history of chickenpox was recorded in only 8 (%33.3) patients. Fifteen patients (%62.5) were given systemic antiviral treatment. Postherpetic neuralgia or major complications were not observed. conclusion: HZ can be seen in healthy children. Similar to adults, the common places of involvement are thoracic dermatomes. Stress, surgery, febrile illness and long-term hunger such as fasting can facilitate the development of HZ in healthy children. Postherpetic neuralgia or major complications do not usually occur in healthy children

References

  • Mendoza N, Madkan V, Sra K, Willison B, Morrison LK, Tyring SK. Human Herpes viruses. In: Bolognia JL, Jorizzo JL, Schaffer JV (eds). Dermatology. 3rd ed. China: Elsevier Saunders 2012;1321- 43.
  • McCrary ML, Severson J, Tyring SK. Varicella zoster virus. J Am Acad Dermatol 1999;41:1-14.
  • Ramdass P, Mullick S, Farber HF. Viral skin diseases. Prim Care 2015;42:517-67.
  • Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: A multidisciplinary perspective. Ther Adv Vaccines 2015;3:109-20.
  • Feder HM, Hoss DM. Herpes zoster in otherwise healthy children. Pediatr Infect Dis J 2004;23:451-7.
  • Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: Four case reports and a review of infantile herpes zoster. Arch Dermatol 2004;140:1268-72.
  • Özuğuz P, Kaçar SD, Polat S, Karaca S, Kundak A. Çocukluk çağı zona zoster: 12 olgu sunumu. Abant Medical Journal 2014;3:253- 6.
  • Tepe B, Bucak İH, Almış H. Sağlıklı çocuklarda herpes zoster: Retrospektif bir çalışma. Turk J Dermatol 2016;10:65-9.
  • Grote V, vonKries R, Rosenfeld E, Belohradsky BH, Liese J. Immunocompetent children account for the majority of complications in childhood herpes zoster. J Infect Dis 2007;196:1455-8.
  • Goh CL, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic. Int J Dermatol 1997;36:667-72.
  • Saçar H, Uyar B, Saçar T. Suçiçeği aşısı sonrası gelişen herpes zoster olgusu. Dermatoz 2014;5:1-4.
  • Topkarcı Z, Erdoğan B, Erkum T, Yılmaz M. Sağlıklı çocuklarda herpes zoster infeksiyonu. Bakırköy Tıp Dergisi 2012;8:178-81.
  • Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(Suppl 1):S1-26.
  • Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc 2009;84:274-80.
  • Katakam BK, Kiran G, Kumar U. A prospective study of herpes zoster in children. Indian J Dermatol 2016;61:534-9.
  • A ve ark. Önceden sağlıklı çocuklarda Türkiye ulusal bağışıklama çizelgesinde (Ulusal Aşı Takvimi) yer alan ve almayan aşılara ilişkinuygulama önerileri-2015. J Pediatr Inf 2015;9:1-11.
  • Weinmann S, Chun C, Schmid DS, Roberts M, Vandermeer M, Riedlinger K, et al. Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009. J Infect Dis 2013;208:1859-68.
There are 17 citations in total.

Details

Other ID JA35NU83NN
Journal Section Research Article
Authors

Münevver Güven This is me

Emel Çiçek Bozkurt This is me

Publication Date December 1, 2017
Submission Date December 1, 2017
Published in Issue Year 2017 Volume: 11 Issue: 4

Cite

Vancouver Güven M, Bozkurt EÇ. Herpes Zoster Infection in Childhood: An Evaluation of 24 Cases. Türkiye Çocuk Hast Derg. 2017;11(4):233-8.


The publication language of Turkish Journal of Pediatric Disease is English.


Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.


The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.