The authors declare that they have no competing interests.
LLL, FFV and SMS participated in the proposal, design, and drafted the manuscript. All authors read and approved of the final manuscript.
We describe a patient with end stage renal failure (ESRF) on hemodialysis who was admitted to our department for primary varicella infection complicated by varicella pneumonia and encephalitis. Varicella infections results in serious morbidity and mortality in ESRF dialysis and transplant patients. Evidence published thus far suggests that live attenuated varicella vaccines are effective and safe in ESRF and renal transplant patients. Worldwide a few countries have instituted guidelines for the varicella immunisation in ESRF patients. However, in the Asia Pacific Region, it has not been widely given due to the lack of national consensus guidelines. Our case depicts that primary varicella infection can occur at any time in immunosupressed patients and thus suffer serious consequences from it. With increasing burden of chronic kidney disease, Renal Physicians and Family Physicians in the Asia Pacific Region should meet and study the epidemiological data in each individual country and decide on the consensus guidelines on how the varicella vaccination can be targeted for those at risk.
Ooi PL, Goh KT, Doraisingham S, Ling AE: Prevalence of varicella-zoster virus infection in Singapore. Southeast Asian J Trop Med Public Health 1992, 23(1):22–25. PubMed
Ernest WH, Imelda LE, Masitah I, Yeo CL: Knowledge, attitudes, and practices regarding chickenpox disease and its prevention in Singapore: comparison between parents and medical students. Proc Singapore Healthc 2012, 21(4):257–264. CrossRef
Kim CE, De Fijter CW: Herpes Zoster-associated encephalitis in a patient undergoing CAPD: Case report and literature review. Perit Dial Int 2007, 27(4):391–394.
David Beckham J, Tyler KL: Encephalitis. Mandell, Douglas, and Bennett’s Principles and practice of infectious disease 2010, 2: 1243–1264. CrossRef
Preblud SR: Age specific risks of varicella complications. Pediatrics 1981, 68(1):14–17. PubMed
Fleisher G, Henry W, McSorley M, Arbeter A, Plotkin S: Life threatening complications of varicella. Am J Dis Child 1981, 135(10):896–899. PubMed
Fairley CK, Miller E: Varicella Zoster virus epidemiology – a changing scene? J Infect Dis 1996, 174(3):314–319. CrossRef
Longo , Fauci , Kasper , Hansen , Jameson : Varicella-Zoster virus infections. Harrison’s principles of internal medicine 2011, 18: 2426–2432.
Cinque P, Bossolasco S, Vago L, Fornara C, Lipari S, Racca S, Lazzarin A, Linde A: Varicella-zoster virus (VZV) DNA in cerebrospinal fluid of patients infected with human immunodeficiency virus: VZV disease of the central nervous system in subclinical reactivation of VZV infection? Clin Infect Dis 1997, 25(3):634–639. 10.1086/513754 CrossRefPubMed
Mohammed A: Varicella pneumonia in adults: 13 years’ experience with review of literature. Ann Thorac Med 2007, 2(4):163–165. 10.4103/1817-1737.36551 CrossRef
Drugs for non-HIV viral infections Treat Guidel Med Lett 2005, 3(32):23–32.
Chaves Tdo S, Lopes MH, De Souza VA, Dos Santos SS, Pereira LM, Reis AD, David-Neto E: Seroprevalance of antibodies against Varicella-zoster virus and response to the varicella vaccine in pediatric renal transplant patients. Pediatr Transplant 2005, 9(2):192–196. 10.1111/j.1399-3046.2005.00279.x CrossRefPubMed
Furth SL, Sullivan EK, Neu AM, Tejani A, Fivush BA: Varicella in the first year after renal transplantation: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 1997, 1(1):37–42. PubMed
Verena W, Judith S, Meinrad B, Benedikt W, Stefan G, Girschick HJ, Johannes L, Schlegel PG, Matthias E: Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis. BMC Pediatr 2011, 11: 31. 10.1186/1471-2431-11-31 CrossRef
Fardrowski JJ, Furth SL: Varicella zoster virus: vaccination and implications in children with renal failure. Expert Rev Vaccines 2004, 3(3):291–298. 10.1586/147605184.108.40.2061 CrossRef
Nicholas JA W, Fitzpatrick MM, Highes DA, Brocklebank TJ, Judd BA, Lewis MA, Postlethwaite RJ, Smith PA, Gerald Corbitt on behalf of the Trans-pennine Paediatric Nephrology Study Group: Immunization against varicella in end stage & pre-end stage renal failure. Arch Dis Child 2000, 82: 141–143. 10.1136/adc.82.2.141 CrossRef
Ministry of Health: Immunisation Handbook 2011. Wellington: Ministry of Health; 2011. http://www.moh.govt.nz
U.S. Department of Health and Human Services. Centers for Disease Control and Prevention: Recommended Adult Immunization Schedule – United States 2013. 2013.
Rodby RA, Trenholme GM: Vaccination of the dialysis patient. Semin Dial 1991, 4(2):102–105. CrossRef
Barril G, Teruel JL: Vaccination scheme in advanced chronic kidney disease. Nefrol 2008, 28(Suppl 3):95–99.
Ministry of Health: Kidney Dialysis. MOH Information Papers. Statistics, Publications and Resources. Singapore: Ministry of Health; 2006.
Vathsala A: Twenty-five facts about kidney disease in Singapore: in remembrance of world kidney day. Ann Acad Med 2007, 36(3):157–160.
Choong HL: Seventh report of the Singapore Renal Registry 2007/2008. 2008.
- Varicella encephalitis and pneumonia in a patient with end stage renal failure
Lian Leng Low
Farhad Fakhrudin Vasanwala
Sufi Muhammad Suhail
- BioMed Central
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