Table 3 Impact of the disease: mortality and morbidity
From: Varicella infections in patients with end stage renal disease: a systematic review
Reference | Patient’s presentation | Results | Elaborations on results | Main conclusions | Study quality | ||
|---|---|---|---|---|---|---|---|
Complication | Length of stay (LOS) | Mortality | |||||
Ong CY, et al. (2018) [15] | -66 patients developed varicella in the 12-year review of all ESRD patients. -Age range: 19–89 years old (median:53) -37 male patients. -Timing of infection: 6 to 19 years post diagnosis of ESRD. | + | + | + | -24 patients developed at least one complication. Encephalitis, meningitis, pneumonia/pneumonitis. -LOS: median 10 days -9 died (13.6%) | -ESRD patients had significant morbidity and mortality associated with varicella infection. -Screen for seronegative patients and consider vaccinate them. | Level 3 |
Errasti P, et al. (1999) [19] | -31 y.o. Woman, 5Â years post-transplant, admitted for acute epigastric pain with 3Â days vesicular rash. | + | NA | + | -Multiorgan failure: -Fulminant hepatitis (post-mortem showed massive hepatic necrosis). -Died in 2Â days. | -Chickenpox often follows severe and often fatal course in adults with renal transplantation. -Vaccine appears to prevent clinical varicella following subsequent exposure. | Level 3 |
-29 y.o. Man, 17Â years post-transplant, admitted for confluent-haemorrhagic rash. | + | NA | + | -Encephalitis (post-mortem showed cerebral oedema). -Disseminated intravascular coagulation (DIC) with multiple bleeding sites. -Multiorgan failure. -Secondary Staphylococcus bacteraemia. -Patient died. | |||
−59 y.o. Man, 2 years post-transplant, had few vesicular rash. Exposed to his son who had varicella 4 weeks ago. | – | NA | – | -No complication | |||
-69 y.o. Woman, 8 months post-transplant, admitted for vesicular rash and fever. | – | NA | – | -No complication | |||
Ishikawa N, et al. (2000) [20] | -29 y.o. Man, 11 months post-renal transplantation. With papular and vesicular rash and abdominal pain. | + | NA | – | -DIC and gastrointestinal bleeding. | -Varicella vaccination should be administered before transplantation if patients had no past varicella infection based on history and antibody titre | Level 3 |
-36 y.o. Woman with a vesicular rash on face. Had renal transplant 3 years ago. | + | NA | – | -DIC | |||
Fehr T, et al. (2002) [5] | -51 y.o. man, 11 years post-transplantation, had abdominal pain, nausea, vomiting, and generalised pustulosis. | + | NA | – | -Pneumonitis and hypoxic respiratory failure. -Failure of graft 6 months later. | -Overall mortality of 34%. Mortality after 1990 with acyclovir and reduction of immunosuppressants were 22%. −82% of patients summarised had substantial mortality. -Vaccination is effective and has no severe side effects. -Routine VZV serology test for every ESRD patients before renal transplant. -Vaccination in those with negative or very low VZV antibody titres. | Level 3 |
-34 y.o. Man, 1.5 years post-transplant, had acute epigastric pain, nausea, vomiting, and vesicular rash. | + | NA | – | -DIC, hepatitis. | |||
-51 y.o. Man, 6 months post-transplant, admitted for progressive dyspnoea. | + | + | – | -Pneumonitis with respiratory failure. -LOS: 26 days. | |||
-23 y.o. Man, 6 months post-transplant, presented with vesicles whole body. | + | + | – | -Hepatitis -LOS: 10 days | |||
Lauzurica R, et al. (2003) [21] | -30 y.o. Man presented with vesicular-pustular rash, fever and abdominal pain, 3.5Â years post-transplant. | + | NA | + | -Pneumonitis with respiratory failure -Mild transaminitis. -Died 4Â days upon admission due to multiorgan failure: (hepatitis, myocarditis, DIC) | -Detecting VZV seronegative patients before the renal transplant is relevant because vaccination may minimise the risks of future infection. | Level 3 |
Sinha S, et al. (2003) [46] | -22 y.o. Woman, 42 months post-transplant, presented with abdominal pain 1 week after the development of chickenpox. | + | NA | – | -Pancreatitis. | -Acute pancreatitis as a consequent of viral infection is well known | Level 3 |
-36 y.o. Man, 10 days post-transplant, developed pancreatitis 2 weeks after pancreatitis. | + | NA | – | -Mild acute pancreatitis | |||
Robertson S, et al. (2005) [22] | -30 y.o. Man with a generalised maculopapular rash | + | NA | + | -Fulminant varicella with multiorgan involvement (acute renal failure, acute liver failure) - Died within 60Â h of admission | -Although regarded mild infection in children, chickenpox can cause fatality in adults and in the immunocompromised. -Screen potential renal transplant recipients for VZV susceptibility and offer vaccination to the seronegative patients. -Test for immunity for varicella as soon as progressive renal failure is diagnosed. | Level 3 |
RodrÃguez-Moreno A, et al. (2006) [13] | -Eight patients (1%) developed varicella (7 men, 1 women). -Age range: 32–64. -Median time from transplantation to infection was 32mths. | + | + | + | Complications: - 2 pneumonitis, 1 hepatitis, 1 thrombotic microangiopathy, 1 multiorgan failure - LOS: 11 days (median 3 to 21). - One (12.5%) death due to multiorgan failure | -Varicella infection in adult allograft recipients is unusual but highly morbid -Vaccination of seronegative pre-transplant candidates should be attempted | Level 3 |
Shahbazian H, et al. (2007) [47] | -37 y.o. Man, a year post-transplant, admitted for severe abdominal pain. | + | + | – | -Acute kidney injury -LOS: 10 days | -All renal transplant recipients should be screened for VZV immunity before transplant irrespective of previous VZV infection. - Seronegative patients should receive live VZV vaccine several months prior to transplant. | Level 3 |
-44 y.o. Man, 9 years post-transplantation, admitted for low back pain of 2 days duration. 2 days later he developed fever and papulovesicular rash 2 days later | – | + | – | -LOS: 15 days | |||
-34yo man, 8 years post-transplantation, admitted for acute abdominal pain with intractable nausea vomiting. Papulovesicular rash appeared on the face and trunk 48 h later before became generalised. | – | + | – | -LOS: 13 days | |||
Crowther N, et al. (2008) [31] | -43 y.o. Man, 16 years post-renal transplant. Acute renal failure detected at routine clinic review. He had scattered skin lesion after his children had chickenpox 2 weeks ago. | + | NA | – | -Diagnosis: late acute mediated rejection post-transplant precipitated by recurrent varicella infection. | – | Level 3 |
Kandasamy R et al. (2009) [48] | -58 y.o. Man with fever and progressive rash | + | NA | – | -Darrier disease related to disseminated varicella | – | Level 3 |
Sato A, et al. (2009) [27] | -36 y.o. Woman presented with an irritable cough | + | + | – | -Varicella pneumonia -LOS: 1 month and 10 days | -One should keep the possibility of VZV reinfection in mind, in Immunocompromised patients with past history of varicella. | Level 3 |
Assi M, et al. (2011) [29] | -68 y.o. man with kidney transplant 10 years ago, presented with 5-days fever, confusion and altered sensorium | + | NA | – | Varicella encephalitis, followed by Guillain-Barre syndrome (GBS). | – | Level 3 |
Mustapic Z, et al. (2011) [49] | -Two renal allograft patients developed varicella. Details unavailable. | NA | NA | NA | -Not available | -VZV infection is a rare but potentially serious complication in renal transplant recipients. -Active immunisation for VZV-seronegative patients before transplantation should be performed. | Level 3 |
Chiang E, et al. (2012) [50] | -42 y.o. Woman, unknown years post kidney transplant, had right eye redness, tearing, and blurred vision for 1 month. | + | NA | – | -Acute retinal necrosis | – | Level 3 |
Kaul A, et al. (2012) [9] | -23 patients developed varicella in the 10-year review of post renal transplant. -Age range: 21–54 years old (median:39) -17 male patients. -Timing of infection: < 15 days post-transplant to > 5 years post-transplant. | + | NA | + | -5 had graft dysfunction. - 7 had infections (6 bacterial, 1 fungal). - 3 had sepsis - 5 had gastritis - 2 had encephalitis - 2 had pancreatitis - 2 had orchitis - 2 died (8.6%) | -Primary varicella/chickenpox is a potentially fatal infection in adult renal transplant recipients. -Varicella vaccination in the high-risk groups, especially during the pre-ESRD stage, may reduce the number of varicella infection. | Level 3 |
Inokuchi R, et al. (2013) [23] | -A 69 y.o. Woman (20Â years ESRD on dialysis, then 1Â month post renal transplantation) presented with generalised rash one day. | + | NA | + | -Varicella pneumonia with respiratory failure. -Demised at Day 28 illness (despite change of antiviral to foscarnet on day10, mechanical ventilation on day3) | -Patients with VZV pneumonia with deep and vast ulcerations on bronchoscopy had fatal outcomes. | Level 3 |
Low LL, et al. (2014) [30] | -58 y.o. Man on haemodialysis, presented with fever and cough. Subsequently developed a papulovesicular rash on the 4th day of admission. | + | NA | – | -Varicella pneumonia -Varicella encephalitis | -Renal Physicians and Family Physicians in the Asia-Pacific region should study the epidemiological data in each country. -Consensus guidelines needed and how the varicella vaccination program can be targeted for those at risk. -Live attenuated varicella vaccine is has been proven to be safe when administered to adult ESRD patients regardless of RRT mode. | Level 3 |
Nabi S, et al. (2014) [26] | -73 y.o. Woman with kidney transplantation and recent CMV infection, presented with altered mental status. | + | NA | – | -Varicella encephalitis | -Disseminated VZV with encephalitis is rare, but a life-threatening condition | Level 3 |
Sampathkumar K, et al. (2015) [24] | -34 y.o. Man had kidney transplant 10 months ago, came with fever ×  2 weeks and bitemporal headache. | + | NA | – | -VZV induced central nervous system angiopathy | – | Level 3 |
Depledge D, et al. (2016) [25] | -55y.o. Man post renal transplant day23 presented with abdominal pain, macular rash and abnormal liver function test. | + | NA | – | -VZV pneumonitis, hepatitis | -Risk of airborne transmission of VZV is evident, especially when viral load is high. - Immunocompromised patients are vulnerable to serious infection. - Need for pre-transplant vaccination. | Level 3 |
-61y.o. Man post renal transplant day25 presented with 4Â days fever, vesicular rash and abnormal liver function. | + | NA | + | -VZV hepatitis. - Died on day 6 admission (3Â days in ICU) | |||
Chhabra P, et al. (2017) [51] | -33y.o. Man, 3 years post-transplant, had severe epigastric pain for 7 days. | + | NA | – | -Varicella pancreatitis and hepatitis | – | Level 3 |
Momani H, et al. (2017) [52] | -One patient developed varicella -Details unavailable | + | NA | – | -Varicella pneumonitis | – | Level 3 |