Gül ÖZÇELİK, Tülay OLGUN, Doğan Sema VURAL, Gülnur TOKUÇ, Ela ERDEM, Ceylani Seda GÜLEÇ

Çocuk onkoloji hastalarımızda varisella-zoster virüs enfeksiyonları

AMAÇ Varisella-zoster virüs enfeksiyonu kanserli hastalarda ciddi komplikasyonlara ve ölüme neden olabilir. Aşılama ve antiviral proflaksiyle komplikasyonları azaltmayı amaçlayan çalışmalar olmakla birlikte kesin protokoller yoktur. Çalışmamızda proflaksinin rutin kullanılmadığı kanserli hastalarda bu enfeksiyonun sıklığının ve klinik seyrinin belirlenmesi amaçlandı.GEREÇ VE YÖNTEM Çocuk onkolojisi kliniğinde Ocak 2001-Aralık 2004 arasında tedavi görürken varisella-zoster virüs enfeksiyonu saptanan 30 hastanın (12 kız, 18 erkek; ort. yaş 6 yıl; dağılım 1-13 yıl) kayıtları retrospektif olarak incelendi.BULGULAR Hastaların 23'ünde ateş saptandı. Cilt lezyonları yaygın, ancak hemorajik veya enfekte değildi; ortalama 6.5 günde kabuklandı. Karaciğer enzimleri yükselen bir hasta dışında sistemik yayılım olmadı. Ortalama sekiz gün intravenöz asiklovir alan hastalar komplikasyonsuz taburcu edildi. Gecikilmeden asiklovir tedavisi başlanılan hastalarda varisella-zoster virüs enfeksiyonları selim seyirli oldu. Ancak tedaviye rağmen ağır seyreden vakalar olabilmektedir.SONUÇ Sağlıklı çocuklarda rutin aşılamanın yapılmadığı ülkemizde onkoloji ve enfeksiyon kliniklerinin ortak çalışmaları ile daha geniş serilerin izlemi, proflaksinin gerekli olup olmadığını belirlemede yol gösterici olacaktır.

Varicella zoster virus infection in pediatric oncology patients

OBJECTIVES Varicella-zoster virus (VZV) infection may lead to serious complications and death in immunocompromised patients. Although there were researches which aim to decrease complications by vaccination and antiviral prophylaxis; there is stil no definitive protocols. In this study, we wanted to determine the frequency and clinical progress of VZV infections in patients with malignant diseases in whom prophylaxis was not used routinely during chemotherapy.METHODS Datas of 30 patients (12 females, 18 males; median age 6 years; range 1 to 13 years) in pediatric oncology department who were exposed to VZV during their chemotheraphy between January 2001 and December 2004 were retrospectively examined.RESULTS In 23 of patients there was fever. Skin lesions were widespread, but they were non-hemorhogic or infected and were crusted approximotely in 6.5 days. In one patient liver enzymes were eleveted. In others systemic complications were not seen. Patients taking approximately 8 days of intravenous acyclovir were discharged from hospital without any complication. In our patients VZV infections were benignly progressed. Early treatment with acyclovir might decrease the complications. But in spite of treatment there might be seriously progressed cases.CONCLUSION In our country where vaccination for VZV is not performed routinely to healthy children; observation of large series with multidisciplinary studies of oncology and infectious diseases clinics may aid us to determine if prophylaxis is needed or not.

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