Late-Onset Concurrent Infection of Vaccine Strain VZV and HSV-1 after Varicella Vaccination in a Child with Natural killer T Cell Deficiency

Abstract

We describe a case with natural killer cell deficiency of late-onset Oka vaccine varicella zoster virus (VZV) strain and Herpes simplex virus-1 (HSV-1) dual infection resulting in fatal clinical course. An 18-month-old boy presented with a papulovesicular rash, mucocutaneous candidiasis, encephalopathy, and severe respiratory distress 6 months after receiving varicella vaccine. VZV and HSV-1 were analysed by real-time reverse-transcriptase polymerase chain reaction (RT-qPCR) and Oka vaccine strain of VZV by gene sequencing. HSV-1 and VZV dual infection was detected in the blood and skin samples by RT-qPCR. Gene sequencing of VZV isolated from vesicular lesions was compatible with the Oka vaccine strain. Flow cytometry revealed a natural killer deficiency, but whole exome analysis failed to identify an associated genetic defect. Vesicular rashes in immunocompromised patients who were inadvertently vaccinated should be taken seriously, and antiviral therapy should be prompt and aggressive.

Keywords

varicella zoster virus - vaccine strain VZV - HSV-1 - natural killer T cell deficiency

Publikationsverlauf

Eingereicht: 13. September 2023

Angenommen: 16. April 2024

Artikel online veröffentlicht:
21. Juni 2024

• References

• 1 Dhiman N, Wright PA, Espy MJ, Schneider SK, Smith TF, Pritt BS. Concurrent detection of herpes simplex and varicella-zoster viruses by polymerase chain reaction from the same anatomic location. Diagn Microbiol Infect Dis 2011; 70 (04) 538-540
• 2 Ouwendijk WJ, Laing KJ, Verjans GM, Koelle DM. T-cell immunity to human alphaherpesviruses. Curr Opin Virol 2013; 3 (04) 452-460
• 3 Alexander KE, Tong PL, Macartney K, Beresford R, Sheppeard V, Gupta M. Live zoster vaccination in an immunocompromised patient leading to death secondary to disseminated varicella zoster virus infection. Vaccine 2018; 36 (27) 3890-3893
• 4 Dutmer CM, Asturias EJ, Smith C. et al. Late onset hypomorphic RAG2 deficiency presentation with fatal vaccine-strain VZV infection. J Clin Immunol 2015; 35 (08) 754-760
• 5 Jarosinski KW. Dual infection and superinfection inhibition of epithelial skin cells by two alphaherpesviruses co-occur in the natural host. PLoS ONE 2012; 7 (05) e37428
• 6 Giehl KA, Müller-Sander E, Rottenkolber M, Degitz K, Volkenandt M, Berking C. Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection. J Eur Acad Dermatol Venereol 2008; 22 (06) 722-728
• 7 Bergqvist C, Abi Aad Y, Nassar D, El Zein S, Kanj SS. Disseminated herpes simplex virus and varicella zoster virus co-infection in a patient with idiopathic thrombocytopenic purpura. J Infect Public Health 2019; 12 (03) 438-441
• 8 Levy O, Orange JS, Hibberd P. et al. Disseminated varicella infection due to the vaccine strain of varicella-zoster virus, in a patient with a novel deficiency in natural killer T cells. J Infect Dis 2003; 188 (07) 948-953
• 9 Bhalla P, Forrest GN, Gershon M. et al. Disseminated, persistent, and fatal infection due to the vaccine strain of varicella-zoster virus in an adult following stem cell transplantation. Clin Infect Dis 2015; 60 (07) 1068-1074
• 10 Sabry A, Hauk PJ, Jing H. et al. Vaccine strain varicella-zoster virus-induced central nervous system vasculopathy as the presenting feature of DOCK8 deficiency. J Allergy Clin Immunol 2014; 133 (04) 1225-1227
• 11 Tillieux SL, Halsey WS, Thomas ES, Voycik JJ, Sathe GM, Vassilev V. Complete DNA sequences of two oka strain varicella-zoster virus genomes. J Virol 2008; 82 (22) 11023-11044
• 12 Sloutskin A, Yee MB, Kinchington PR, Goldstein RS. Varicella-zoster virus and herpes simplex virus 1 can infect and replicate in the same neurons whether co- or superinfected. J Virol 2014; 88 (09) 5079-5086
• 13 Tang YW, Espy MJ, Persing DH, Smith TF. Molecular evidence and clinical significance of herpesvirus coinfection in the central nervous system. J Clin Microbiol 1997; 35 (11) 2869-2872
• 14 Haytoğlu Z, Özgür Gündeşlioğlu Ö, Kocabaş E. Evaluation of hospitalizations among children with varicella between 2012 and 2017 at an University Hospital. Turkish J Pediatr Dis 2020; 14: 102-107
• 15 Bobrowski AE, Muller WJ. Varicella infection following vaccination in a pediatric kidney transplant recipient. Pediatr Transplant 2020; 24 (04) e13667
• 16 Leung J, Broder KR, Marin M. Severe varicella in persons vaccinated with varicella vaccine (breakthrough varicella): a systematic literature review. Expert Rev Vaccines 2017; 16 (04) 391-400