Çocukluk Çağında Herpes Zoster Enfeksiyonu:21 Olgunun Prospektif Değerlendirilmesi

Öz

Amaç:Herpes zoster(HZ), dorsal kök ganglionunda latent olarak kalan Varicella zoster virüs’ün reaktivasyonu sonucunda gelişen bir hastalıktır. HZ çocukluk çağında nadir görülen bir hastalıktır. HZ, çocukluk çağında immünsupresif ilaç kullanımı, immünyetmezlik ve  malignite durumlarında daha sık olarak karşımıza çıkabilir. Bu çalışmada polikliniğimize başvuran HZ tanısı konulan çocuk hastaların klinik özellikleri ve eşlik eden hastalıklar incelendi.

Materyal ve Metot: Hastanemiz deri ve zührevi hastalıkları polikliniğine Ocak 2017- Temmuz 2018  tarihleri arasında  başvuran  ve HZ  tanısı konulan  18 yaşından küçük 21 hasta prospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, tutulan dermatom, geçirilmiş varisella öyküsü, varicella aşısı öyküsü,  eşlik eden hastalıklar, komplikasyon gelişimi ve tedavi açısından değerlendirildi.

Bulgular: HZ tanısı konulan 21 çocuk hastanın 12(%57,1)’si erkek, 9 (%42,9)’ u kız idi.  Hastaların yaş ortalaması 10,1 yıl (6-16 yaş) olarak saptandı. On dört  (%66,6) hastada torakal dermatom tutulurken, 5 (%23,8) hastada servikal ve 2 (%9,5) hastada lomber dermatom tutulumu izlendi. İki hasta ALL tanısı nedeniyle sistemik kemoterapi almaktaydı.  Hastaların hiçbirinde  varisella aşısı olma öyküsü yoktu. Varisella geçirme öyküsü hastaların 15(%71,4)’inde  vardı. On altı (%76,1) hastaya sistemik antiviral tedavi verildi. Hastalarımızın hiçbirinde disseminasyon gelişmedi. Hastalarda postherpetik nevralji veya majör bir komplikasyon görülmedi. 

Sonuç: HZ,  immünsupresyonu olan çocuk hastalarda sıklıkla görülmesine rağmen sağlıklı çocuklarda da görülebilmektedir. Erişkin hastalara benzer şekilde en sık torakal dermatom  tutulumu görülür. Sağlıklı çocuklarda HZ’ ye  bağlı postherpetik nevralji gibi komplikasyonlar  nadir olarak görülür. 

Anahtar Kelimeler

• Çocukluk çağı,herpes zoster,varisella zoster virüs

Herpes Zoster Infection In Childhood: Prospective Evaluation of 21 Cases

Öz

Background: Herpes zoster (HZ) is a disease caused by the reactivation of varicella zoster virus, which remains latent in the dorsal root ganglion. HZ is a rarely seen disease in childhood. HZ is more common in pediatric patients with immunosuppressive drug use, immunodeficiency and malignancy. This study examined the clinical characteristics of children with HZ.

Methods: Twenty one pediatric patients admitted to our dermatology clinic between January 2017 and July 2018 and diagnosed with HZ were evaluated prospectively. Patients were evaluated in term of age, sex, affected dermatome, history of previous varicella, varicella vaccine, accompanying disease, complication development and treatment.

Results: Twelve (57.1%) of the 21 pediatric patients with HZ were male and 9 (42.9%) were female. The mean age of the patients was 10.1 years (6-16 years).  Fourteen (66.6%) patients had thoracic dermatome involvement, 5 (23.8%) patients had cervical involvement, and 2 (9.5%) patients had lumbar dermatome involvement.  Two patients were receiving systemic chemotherapy for ALL. In our study 71.4% of patients had a history of varicella and there was no history of varicella vaccine in any of the patients. None of the patients developed dissemination and no major complication was observed.

Conclusion: In conclusion, while HZ is also seen in healthy children, children who are immunosuppressed are more affected.  Similar to adult disease, thoracic dermatomal involvement is the most common. Complications such as postherpetic neuralgia due to HZ in healthy children are rarely seen.

Anahtar Kelimeler

• Childhood,Herpes Zoster,Varicella zoster virus

Kaynakça

1. 1.Ozuguz P, Kacar SD, Polat S, et al. Childhood Zona Zoster Infection: 12 Case Reports. Abant Med J 2014;3(3):253-6.
2. 2.Gilde DH, Cohrs RJ, Mahalingam R.Clinical and molecular pathogenesis of varicella virus infection.Viral Immunol 2003;16(3):243-58.
3. 3.Gershon AA: Varicella-Zoster Virus Infections. Pediatr Rev 2008;29(1):5-11.
4. 4.Arvin AM. Varicella-zoster virus: molecular virology and virus-host interactions. Curr Opin Microbiol 2001;4(4):442-449.
5. 5.Rahsan M, Evans SE, Sahin S. Herpes zoster infection in childhood: Retrospective study of 15 cases.Turkiye Klinikleri J Dermatol 2005;15(3):121-124
6. 6.Guven M, Bozkurt EC. Herpes Zoster Infection in Childhood: An Evaluation of 24 Cases.Turkish J Pediatr Dis 2017;4:233-8
7. 7.Prabhu S, Sripathi H, Gupta S, et al. Chilhood Herpes Zoster: A Clustering of ten Cases. Indian J Dermatol 2009;54(1):62–4.
8. 8.Yalaki Z, Ozturk A, Tasar MA. Herpes Zoster Infections In Healthy Children. J Pediatr Inf 2010;4:96-9.

9. 9.Colgecen E, Kucuk O, Balcı M.Clinical Features of Herpes Zoster Infections in Childhood.Turkderm 2012;46:26-8.
10. 10.Lin YH, Huang LM, Chang IS, et al. Disease burden and epidemiology of herpes zoster in pre-vaccine Taiwan. Vaccine. 2010;28(5):1217-1220.
11. 11.Guess HA, Broughton DD, Melton LJ III, et al. Epidemiology of herpes zoster in children and adolescents: a populationbased study. Pediatrics 1985;76(4):512– 517.
12. 12.Terada K, Kawano S, Yoshihiro K, et al.Characteristics of herpes zoster in otherwise normal children. Pediatr Infect Dis J 1993;12(11):960– 961.
13. 13.Wehrle PF. Bilateral herpes Zoster in a child following exposure to chicken pox. JAMA 1976; 235:2238.
14. 14.Wurzel CL, Kahan J, Heitler M, et al. Prognosis of herpes zoster in healthy children. Am J Dis Child 1986;140(5):477-478.
15. 15.Petursson G, Helgason S, Gudmundsson S, et al. Herpes zoster in children and adolescents. Pediatr Infect Dis J 1998;17(10):905- 8.
16. 16.Smith CG, Glaser DA. Herpes zoster in childhood: case report and review of literature. Pediatr Dermatol 1996;13(3):226-9.
17. 17. Van Hoek AJ, Melegaro A, Zagheni E, et al. Modelling the impact of a combined varicella and zoster vaccination programme on the epidemiology of varicella zoster virus in England. Vaccine 2011;29(13):2411-20.
18. 18.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(10):1268-72.
19. 19.Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: A multidisciplinary perspective. Ther Adv Vaccines 2015;3(4):109-20.
20. 20.Morgan R, King D. Shingles: a review of diagnosis and management. Hosp Med 1998; 59(10):770-6.
21. 21.Grote V, Von Kries R, Rosenfeld E, et al. Immunocompetent children account for the majority of complications in childhood herpes zoster. J Infect Dis 2007;196(10):1455-8.
22. 22.Takayama N, Yamada H, Kaku H, et al. Herpes zoster in immunocompetent and immunocompromised Japanese children. Pediatr Int 2000;42(3):275-9.
23. 23.Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc 2009;84(3):274-80.
24. 24.Katakam BK, Kiran G, Kumar U. A prospective study of herpes zoster in children. Indian J Dermatol 2016;61(5):534-9.
25. 25.Hong SM, Yang YS. A case of optic neuritis complicating herpes zoster ophthalmicus in a child. Korean J Ophthalmol 2010;24(2):126- 30.