Herpes zoster in children
Keywords:
Herpes zoster, shingles, varicella, childrenAbstract
Objective To study the epidemiology and clinical features of childhood herpes zoster. Patients and methods The study was carried out from March 2008 till February 2012. Forty two cases of herpes zoster in children less than 12 years of age were enrolled from the outpatient departments of Lahore General Hospital and Jinnah Hospital Lahore. Patients were subjected to detailed history, physical examination and relevant investigations.  Results Out of 42 patients with herpes zoster, 57.1 % were males and 42.9 % were females. The mean age was 8 years with an age range of 18 days to 12 years. In most patients a single dermatome was involved (69%) and thoracic dermatome was involved in the majority (40.4%). The most common symptom was pruritus in 52%, followed by pain in 12%. A positive history of previous exposure to varicella was present in 31% patients only, and out of these 61% were exposed before the age of two years. Six patients gave history of chickenpox in mother during pregnancy. Majority of patients i.e. 83.3% showed no evidence of immunosuppression on history, examination and investigations. Three patients were anti-HCV positive (7.1%), two (4.6%) had tuberculosis, one (2.3%) patient was taking steroids and one (2.3%) was diagnosed as leukemia. Conclusion Most of the children with herpes zoster had no obvious evidence of immunosuppression. History of previous exposure to varicella was found in only 31% with majority being exposed below two years of age. Herpes zoster is a relatively mild disease in children with pruritus being the main symptom in 52% and pain occurred in only 12% of cases.   ÂReferences
Ragozzino MW, Melton L J III, Kurland LT et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore).1982;61:310-6.
Prabhu S, Sripathi H, Gupta S, Prabhu M. Childhood herpes zoster: A clustering of ten cases. Indian J Dermatol. 2009;54:62-4.
Takayama N, Yamada H, Kaku H, Minamitani M. Herpes zoster in immunocompetent and immunocompromised Japanese children. Pediatr Int. 2000;42:275-9.
Terada K. Characteristics of herpes zoster in otherwise normal children. Pediatr Infect Dis J. 1993;12:960-961
Berger R, Florent G, Just M. Decrease in the lymphoproliferative response to varicella-zoster virus antigen in the aged. Infect Immun.1981;32:24-7.
Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: Four case reports and a review of infantile herpes zoster. Arch Dermatol. 2004;140:1268-72.
Solomon AR. New diagnostic tests for herpes simplex and varicella zoster infection. J Am Acad Dermatol. 1988;18:218-21.
Guess HA, Broughton DD, Melton L J III, Kurland LT. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics. 1985;76:512-7.
Latif R, Shope TC. Herpes zoster in normal and immunocompromised children. Am J Dis Child. 1983;137:801-2.
Terada K, Tanaka H, Kawano S, Kataoka N. Specific cellular immunity in immunocompetent children with herpes zoster. Acta Paediatr. 1998;87:692-4.
Terada K, Kawano S, Yoshihiro K, Morita T. Varicella-zoster virus (VZV) reactivation is related to the low response of VZV-specific immunity after chickenpox in infancy. J Infect Dis. 1994;169:650-2.
Lewkonia IK, Jackson AA. Infantile herpes zoster after intrauterine exposure to varicella. BMJ. 1973;3:149.
Enders G, Miller E, Cradock-Watson J et al. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet. 1994;343:1548-51
Kakourou T, Theodoridou M, Mostrou G et al. Herpes zoster in children. J Am Acad Dermatol. 1998;39:207-10.
Smith CG, Glaser DA. Herpes zoster in childhood: case report and review of the literature. Pediatr Dermatol. 1996;13:226-9.
Baba K, Yabuuchi H, Takahashi M, Ogra PL. Increased incidence of herpes zoster in normal children infected with varicella zoster virus during infancy: community-based follow-up study. J Pediatr. 1986;108:372-7.
von Seidlin L, Gillette SG, Bryson MD et al. Frequent recurrence and persistence of varicella zoster virus infection in children infected with human immunodeficiency virus type 1. J Pediatr. 1996;128:52-7.
