[CIS-PAGID] Adult with recurrent "Zoster"

[Church, Joseph]

Anne:  
 
Thank you for your thoughts.  I too am leaning toward immunizing him.
 
The patient's outbreaks have not been associated with chicken pox exposure.  

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Junker, Anne
Sent: Tue 1/4/2011 3:36 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] Adult with recurrent "Zoster"



We conducted detailed immune investigations (including VZV-IgG subclass, antibody avidity and immunoblotting; and CMI) on cases with recurrent varicella (Ped Infec Dis J 1991;10:569-75; J Med Virology 1994;43:119-124).  Most of our cases had recurrent chickenpox, but a few had recurrent zoster as well.  We found no glaring defects in general or VZV-specific immune investigations.  Sequential follow-up of patients showed some who lost specific VZV antibody or cell-mediated immune responses over time.  We speculated on a defect of immune memory. 

 

As to vaccination: the literature includes several reports of VZV-seropositive individuals who develop chickenpox; and there is no clear relationship between the amount (or presence or absence) of immunity to individual varicella proteins and the risk of developing varicella infection.  I suggest there would be no harm to immunization in this individual, and it is possible you could stimulate or boost important responses. 

 

As an aside - have any of the episodes of zoster in your patient occurred after exposure to chickenpox? Or are they exposed to a lot of kids?   We saw a school-teacher a few years ago with a similar history to your patient's.  It is an odd epidemiologic feature of zoster that episodes can be temporally related to exposure to chickenpox.

 

 

Anne K. Junker, MD, FRCP(C)

Associate Professor, Pediatrics

Director, Clinical Immunology Service, BC Children's Hospital

Director, Clinical & Population Studies, Child & Family Research Institute

Director, Maternal Infant Child Youth Research Network of Canada/Reseau de Recherche en Sante des Enfant et des Meres (MICYRN)

K4-223 4480 Oak Street

Vancouver, British Columbia

Canada  V6H 3V4

phone: 604-875-3591

fax: 604-875-2414

email: ajunker at cw.bc.ca

 

 

 

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Jason W. Caldwell
Sent: Tuesday, January 04, 2011 8:10 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Adult with recurrent "Zoster"

 

Maybe look at a VZV titer first.  If it is positive, I wouldn't think the vaccine would be helpful.  When we get new jobs and our titers are checked, people are not boosted if the titers are positive.

 

Jason W. Caldwell DO

Assistant Professor of Internal Medicine & Pediatrics

Section Pulmonary, Critical Care, Allergy, and Immunological Diseases

Wake Forest University School of Medicine

Medical Center Boulevard

Winston-Salem, North Carolina, 27157

Office Phone: 336-716-5166

Fax:  336-716-7277

E-mail:  jcaldwel at wfubmc.edu

 

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Tuesday, January 04, 2011 11:00 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Adult with recurrent "Zoster"

 

Thank you all for your comments and suggestions regarding the patient described below.

 

A fellow rotating with us suggested we immunize him with VZV vaccine.  Opinions?

 

Joe Church

 

________________________________

From: Church, Joseph 
Sent: Wednesday, December 29, 2010 4:09 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Adult with recurrent "Zoster"

 

Colleagues:

 

A 57yo man was referred for recurrent Herpes zoster.   Lesions have recurred ~ 2 times a year for 20 years.  They affect the same facial location (right ear).  Outbreaks are associated with increased stress and missing Valtrex prophylaxis.  He has absolutely no other infectious history and is otherwise healthy.  

 

NORMAL laboratory findings include the following:

*	CBC, CMP, sed rate, CRP 
*	IgG, IgA, IgM 
*	Antibody responses to tetanus, hepatitis A and Pneumovaxtm 
*	T, B and NK numbers 
*	PHA and PWM LPAs 
*	Tetanus, Candida and VZV LPAs 
*	NK cytotoxicity (Cincinnati Children's) 
*	CTL cytotoxicity (Cincinnati Children's) 

 

Other than the possibility that these episodes are not VZV-related, does anyone have any other ideas?

 

Joe Church

Children's Hospital Los Angeles

 

 


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