scholarly journals Occupational Exposure to Varicella Zoster in a Tertiary-Care Healthcare Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s333-s334
Author(s):  
Zachary Yetmar ◽  
Debra Apenhorst ◽  
Priya Sampathkumar ◽  
Elena Beam
Keyword(s):  
Occupational Exposure ◽  
Varicella Zoster Virus ◽  
Tertiary Care ◽  
Occupational Exposures ◽  
Inpatient Setting ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Varicella Zoster ◽  
Delayed Initiation ◽  
Immunosuppressed Patients

Background: Disseminated varicella zoster virus (dVZV) infection is a feared complication of varicella zoster virus (VZV) reactivation in immunocompromised patients. The CDC recommends contact and airborne precautions for localized VZV in immunocompromised patients until dissemination has been ruled out. Pre-emptive isolation can be problematic for medical centers without access to negative-pressure rooms. When we identify a case of dVZV at our facility, we perform an investigation to identify occupational exposures. Methods: We conducted a retrospective, descriptive review of occupational exposure investigations related to dVZV from January 2016 to December 2018. We collected baseline characteristics of the dVZV patient, and we evaluated whether the exposure occurred due to a delay in diagnosis or a progression from “localized” to disseminated VZV disease. Results: We identified 21 immunosuppressed patients with dVZV whose infection resulted in an occupational exposure during the specified study period. Average age was 58.6 years, with 10 males and 12 females. The immunocompromised patients included 11 with hematologic malignancy, 5 with solid-organ malignancy, 3 with rheumatologic disease on immunosuppressive therapy, and 2 with a solid-organ transplant. Most of the exposures (72.7%) occurred in an inpatient setting. The exposures resulted from either delayed recognition of dVZV or delayed initiation of appropriate precautions for all of the immunosuppressed patients. Two additional exposures occurred as a result of a change from “localized” to “disseminated” VZV. These patients whose diagnosis changed from localized to dVZV were considered previously immunocompetent, and dissemination took place 2 days after seeking healthcare evaluation. Conclusions: Most occupational exposures to varicella zoster are the result of delayed initiation of appropriate isolation precautions due to delayed diagnosis of dVZV infection or failure to recognize the need for instituting precautions in disseminated disease. Instituting preemptive airborne precautions for immunocompromised patients with localized varicella zoster would be unlikely to reduce occupational exposures.Funding: NoneDisclosures: Consulting fee- Merck Priya Sampathkumar

scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

scholarly journals Occupational exposure to varicella zoster in a tertiary-care healthcare setting

2020 ◽  
pp. 1-2
Author(s):  
Zachary A. Yetmar ◽  
Debra K. Apenhorst ◽  
Melanie D. Swift ◽  
Priya Sampathkumar ◽  
Elena Beam
Keyword(s):  
Occupational Exposure ◽  
Tertiary Care ◽  
Healthcare Setting ◽  
Varicella Zoster

Usefulness of a Rapid Human Immunodeficiency Virus-1 Antibody Test for the Management of Occupational Exposure to Blood and Body Fluid

2005 ◽  
Vol 26 (9) ◽  
pp. 768-774 ◽  
Author(s):  
Michael L. Landrum ◽  
Clarissa H. Wilson ◽  
Luci P. Perii ◽  
Sandra L. Hannibal ◽  
Robert J. O'Connell
Keyword(s):  
Occupational Exposure ◽  
Medical Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Occupational Exposures ◽  
Antibody Test ◽  
Stress Reaction ◽  
Post Exposure Prophylaxis ◽  
Potential Cost ◽  
Tertiary Care Medical Center

AbstractObjective:To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms.Design:Before-and-after analysis.Setting:A 269-bed, tertiary-care medical center with adjacent clinics.Participants:All source-patients and HCWs experiencing an occupational exposure during the study period.Methods:Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms.Results:After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of $6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P= .049).Conclusion:Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HJV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.

scholarly journals Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Verena Wiegering ◽  
Judith Schick ◽  
Meinrad Beer ◽  
Benedikt Weissbrich ◽  
Stefan Gattenlöhner ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Immunocompromised Patients ◽  
Virus Infections ◽  
Single Centre ◽  
Varicella Zoster

Reactivation of varicella-zoster virus in two immunosuppressed patients

2018 ◽  
Vol 151 (2) ◽  
pp. 87
Author(s):  
Jon Badiola ◽  
José Manuel Puerta-Puerta ◽  
Leopoldo Muñoz-Medina ◽  
Alejandro Molina-Leyva
Keyword(s):  
Varicella Zoster Virus ◽  
Varicella Zoster ◽  
Immunosuppressed Patients
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