Clinical and Laboratory Characteristics of Herpes Zoster in Patients With HIV/AIDS and Those With Juvenile Systemic Lupus Erythematosus

Evaluation of paediatric herpes zoster cases: Comparison of herpes zoster attacks in children with and without underlying conditions

AIM

Herpes zoster is rarely seen in children, but is more common and more severe in those with underlying medical conditions. The purpose of this study was to comprehensively evaluate cases of herpes zoster in all paediatric patients and to detail the clinical course and complications of this disease in children with and without underlying health problems in terms of similarities and differences.

METHODS

The course of paediatric patients diagnosed with herpes zoster in a tertiary university hospital over a 19-year period was evaluated from the time of diagnosis, divided into groups with and without underlying disease.

RESULTS

In our study, where we evaluated 150 herpes zoster attacks in 143 children, 79.3% of the patients (n = 119) had underlying diseases, while 20.7% (n = 31) were healthy children. The age at the time of primary varicella-zoster virus and herpes zoster was significantly younger in the group without an underlying disease compared to the group with an underlying disease. Pain was reported more in the healthy group, and the duration of symptoms was longer. Ophthalmic nerve involvement was significantly higher in the group without a known disease. Treatment was administered in 90% of all attacks. In the group with underlying diseases, the duration of intravenous treatment and hospital stay were significantly higher as expected.

CONCLUSIONS

This study shows that herpes zoster attacks in healthy children can also progress with severe symptoms and complications. Approaches to reduce the burden of herpes zoster should be adopted and developed for all paediatric patients.

The clinical course of herpes zoster is similar in immunocompetent and immunocompromised paediatric patients

AIM

We aimed to compare the clinical manifestation of HZ in immunocompetent and immunocompromised children.

METHODS

Medical charts of all consecutive children hospitalized and/or consulted in the Regional Hospital for Infectious Diseases in Warsaw due to HZ were retrospectively analysed. Age, history of varicella, time interval between varicella and HZ, underlying diseases, immunosuppresive therapy, dermatome involvement and HZ complications were analyzed in both groups.

RESULTS

In total 152 children were included in the analysis, 56 (36.84%) of them were hospitalsed, whereas 96 (63.16%) were consulted and discharged home due to good general condition. The median age was 10 years (IQR 5.75-12), there were 73 (48.03%) boys and 79 (51.97%) girls. In 16/152 (10.5%) one or more complications occurred, including: skin bacterial superinfection (16/17, 94.2%), sepsis (1/17, 5.9%), meningitis (1/17, 5.9%). Thoracic dermatomes were the most commonly affected (81/152, 53.29%). Most of the children didn't have any immunodeficiencies 118/152 (77.6%), and 34/152 (22.4%) of them were immunocompromised (and had been treated with intravenous acyclovir). The clinical picture of the disease was similar in both groups (Table 1). However, immunocompromised children more often had sacral dermatomes affected (5/35, 14.3% vs. 1/117, 0.9%, p < 0.001), and less often thoracic dermatomes were involved in this group (12/35, 34.3% vs. 69/117, 59%, p = 0.0102).

CONCLUSIONS

To conclude, herpes zoster occurs in both immunocompetent and immunocompromised children. Clinical manifestations are similar. Serious complications, although uncommon, affect not only immunocompromised patients but also otherwise healthy children.

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

OBJECTIVE

This study aimed to build and validate a nomogram model to predict the risk of incomplete immune reconstitution in people living with HIV (PLWH).

METHODS

Totally 3783 individuals with a confirmed diagnosis of HIV/AIDS were included. A predictive model was developed based on a retrospective set (N = 2678) and was validated using the remaining cases (N = 1105). Univariate and multivariate logistic regression analyses were performed to determine valuable predictors among the collected clinical and laboratory variables. The predictive model is presented in the form of a nomogram, which is internally and externally validated with two independent datasets. The discrimination of nomograms was assessed by calculating the area under the curve (AUC). Besides, calibration curve and decision curve (DCA) analyses were performed in the training and validation sets.

RESULTS

The final model comprised 5 predictors, including baseline CD4, age at ART initiation, BMI, HZ and TBIL. The AUC of the nomogram model was 0.902, 0.926, 0.851 in the training cohort, internal validation and external cohorts. The calibration accuracy and diagnostic performance were satisfactory in both the training and validation sets.

CONCLUSIONS

This predictive model based on a retrospective study was externally validated using 5 readily available clinical indicators. It showed high performance in predicting the risk of incomplete immune reconstitution in people living with HIV.