The yield of monitoring for HSV and VZV viremia in pediatric hematopoietic stem cell transplant patients

Reactivation of HSV and VZV is common following HSCT. Consensus guidelines do not support the use of routine screening for viremia following HSCT in adults, but no such clear guidelines exist in pediatrics. In our center, routine practice was to screen patients weekly for HSV and VZV viremia until e...

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Bibliographic Details
Published in:Pediatric transplantation 2015-09, Vol.19 (6), p.640-644
Main Authors: Patrick, Katharine, Ali, Muhammad, Richardson, Susan E., Gassas, Adam, Egeler, Maarten, Krueger, Joerg, Lowry, Jane, Allen, Upton, Schechter, Tal
Format: Article
Language:English
Subjects:
Adolescent
Chickenpox - diagnosis
Chickenpox - etiology
Child
Child, Preschool
Follow-Up Studies
Hematopoietic Stem Cell Transplantation
Herpes Simplex - diagnosis
Herpes Simplex - etiology
Human herpes virus
Humans
Infant
Outcome Assessment (Health Care)
Postoperative Care - methods
Postoperative Complications - diagnosis
Postoperative Complications - virology
Retrospective Studies
screening
Transplantation, Autologous
Transplantation, Homologous
varicella
Viremia - diagnosis
Viremia - etiology
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Summary:Reactivation of HSV and VZV is common following HSCT. Consensus guidelines do not support the use of routine screening for viremia following HSCT in adults, but no such clear guidelines exist in pediatrics. In our center, routine practice was to screen patients weekly for HSV and VZV viremia until engraftment in autologous transplant patients and up to day +100 in allogeneic transplant patients. We conducted a retrospective study of over 500 patients to establish whether this screening identified any patients with HSV or VZV viremia who would not have been identified by clinical signs or symptoms. Over a 4.5‐yr period, routine screening identified three cases of HSV viremia and one case of VZV viremia. Two patients had persistent, unexplained fever and two patients had skin or mucosal lesions suggestive of HSV/VZV. We conclude that routine screening for HSV and VZV viremia in pediatric HSCT patients has a very low yield and that viremia can be reliably identified by targeted testing in patients with vesicular skin lesions, oral or genital ulceration, unexplained fever, neurological symptoms, or unexplained abnormal liver transaminases.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12551