Altta yatan Komorbiditeleri Olan Çocuklarda Herpes Zoster: 10 Yıllık Retrospektif Tek Merkez Deneyiminin Değerlendirilmesi

Öz

Amaç: Altta yatan ek hastalığı olan Herpes zoster (HZ) tanısı almış çocuk hastaların komplikasyonlarının ve prognozlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde 01.01.2011-01.01.2021 tarihleri arasında 0-18 yaş arası altta yatan ek hastalığı bulunan ve HZ tanısı konularak takip ve tedavi edilmiş hastalar retrospektif olarak değerlendirildi. Sosyodemografik özellikleri, klinik bulguları, hastane yatışları süresince uygulanan tedaviler ve takipte gelişen komplikasyonları ve prognozları dosya kayıtlarından elde edildi. Bulgular: Ortalama yaş 9,25±4,79 yıl olup hastaların %53.4’ü erkek idi. En yaygın semptom döküntü iken bunu ağrı ve kaşıntı izlemekteydi. En sık olarak 23 (%51.1) hasta ile torakal dermatom tutulumu mevcuttu. Dört (%8.8) hastada birden fazla dermatom tutulumu vardı. Hastaların hiçbirinde disseminasyon gelişmedi. Hastaların %8,9’u suçiçeği geçirmiş, %4,4’ü suçiçeği aşısı olmuş, %48’inin varisella-zoster virus geçirme öyküsü bilinmiyordu. Akut lösemi ve kemik iliği nakli olmuş olma en sık altta yatan ek durumlardandı. Semptomların başlama ve tanı koyma arasındaki ortanca süre 3 (min-max=1-10) gündü. Hastaların tümüne asiklovir tedavisi başlandı. Yatış ortanca süresi 7 (min-max=3-21) gün, toplam tedavi süresi ortalama 9,33±3,58 gündü. Sadece 4 hastada sekonder cilt enfeksiyonu geliştiği, 44 hastanın şifa ile iyileştiği ve 1 hastanın primer hastalığı nedeniyle exitus olduğu saptandı. Sonuç: HZ sağlıklı çocuklarda nadir iken alta yatan hastalığı olanlarda ciddi komplikasyonlarla seyredebilir. İmmunkompromise hastalarda veziküllerin ayırıcı tanısında HZ’i düşünmek, erken tanı konularak tedavi başlamak; gelişebilecek komplikasyonlar ve prognoz açısından büyük öneme sahiptir.

Anahtar Kelimeler

• Herpes zoster
• çocuk
• altta yatan hastalık
• immunkopromise
• prognoz

Herpes Zoster in Children with Underlying Comorbidities: Evaluation of the 10-Year Retrospective Single Center Experience

Öz

Aim: It was aimed to evaluate the complications and prognosis of pediatric patients diagnosed with Herpes zoster(HZ) with an underlying comorbidity. Materials and Methods: Between 01.01.2011-01.01.2021 in our clinic; patients aged 0-18 years, with underlying comorbidities and diagnosed with HZ, who were followed up and treated, were evaluated retrospectively. Sociodemographic characteristics, clinical findings, treatments applied during hospitalization, complications developed during follow-up and prognosis were obtained from hospital file archive records. Results: The mean age was 9.25±4.79 years, and 53.4% of patients were male. The most common symptom was rash, followed by pain and itching. Most commonly, 23 (51.1%) patients had thoracic dermatome involvement. Dissemination did not develop in any of the patients. 8.9% of the patients had chickenpox, 4.4% had varicella vaccine, and 48% had no history of varicella-zoster virus transmission. Acute leukemia and having had a bone marrow transplant were the most common co-existing conditions. Median time between onset of symptoms and diagnosis was 3 (min-max=1-10) days. Median length of hospitalization was 7 (min-max=3-21) days, and the mean total treatment time was 9.33±3.58 days. It was determined that only 4 patients developed secondary skin infection, 44 patients were cured, and 1 patient died due to the primary disease. Conclusion: While HZ is rare in healthy children, it can progress with serious complications in those with an underlying disease. To consider HZ in differential diagnosis of vesicles in immunocompromised patients, to start treatment with early diagnosis; It is of great importance in terms of complications and prognosis that may develop.

Anahtar Kelimeler

• Herpes zoster
• child
• underlying disease
• immunocompromise
• prognosis

Kaynakça

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