A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy

Akinao Okamoto, Akihiro Abe, Masataka Okamoto, Tsukane Kobayashi, Yoko Inaguma, Masutaka Tokuda, Masamitsu Yanada, Satoko Morishima, Tadaharu Kanie, Yukiya Yamamoto, Motohiro Tsuzuki, Shuichi Mizuta, Yoshiki Akatsuka, Hiroshi Yatsuya, Tetsushi Yoshikawa, Nobuhiko Emi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Varicella, characterized by a vesicular rash, occurs primarily in young children. Although older individuals can also be affected or vaccinated, outbreaks among adults are rare. We investigated a small outbreak of varicella in B-cell lymphoma patients for elucidation of risk factor of the disease. We experienced four cases of varicella after an index herpes zoster case. All varicella cases were confirmed varicella zoster virus (VZV) infection by PCR. All varicella cases occurred in diffuse large B-cell lymphoma patients receiving rituximab-containing chemotherapy. On the other hand, only three of the 18 non-varicella patients in the same room were receiving rituximab-containing chemotherapy (P = 0.005). All varicella patients had detectable serum anti-varicella zoster virus IgG antibodies before chemotherapy. Even in the presence of neutralizing antibodies to the virus, lymphoma patients treated with rituximab-containing chemotherapy can possibly become re-infected with varicella. These findings suggest that zoster patients should be strictly isolated in hematology and oncology ward, and prophylactic acyclovir should be considered for such patients when exposed to zoster/varicella.

Original languageEnglish
Pages (from-to)774-777
Number of pages4
JournalJournal of Infection and Chemotherapy
Volume20
Issue number12
DOIs
Publication statusPublished - 01-01-2014

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Chickenpox
B-Cell Lymphoma
Disease Outbreaks
Drug Therapy
Herpes Zoster
Human Herpesvirus 3
Acyclovir
Lymphoma, Large B-Cell, Diffuse
Rituximab
Hematology
Virus Diseases
Exanthema
Neutralizing Antibodies
Lymphoma
Immunoglobulin G
Viruses
Polymerase Chain Reaction
Antibodies
Serum

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Okamoto, Akinao ; Abe, Akihiro ; Okamoto, Masataka ; Kobayashi, Tsukane ; Inaguma, Yoko ; Tokuda, Masutaka ; Yanada, Masamitsu ; Morishima, Satoko ; Kanie, Tadaharu ; Yamamoto, Yukiya ; Tsuzuki, Motohiro ; Mizuta, Shuichi ; Akatsuka, Yoshiki ; Yatsuya, Hiroshi ; Yoshikawa, Tetsushi ; Emi, Nobuhiko. / A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy. In: Journal of Infection and Chemotherapy. 2014 ; Vol. 20, No. 12. pp. 774-777.
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abstract = "Varicella, characterized by a vesicular rash, occurs primarily in young children. Although older individuals can also be affected or vaccinated, outbreaks among adults are rare. We investigated a small outbreak of varicella in B-cell lymphoma patients for elucidation of risk factor of the disease. We experienced four cases of varicella after an index herpes zoster case. All varicella cases were confirmed varicella zoster virus (VZV) infection by PCR. All varicella cases occurred in diffuse large B-cell lymphoma patients receiving rituximab-containing chemotherapy. On the other hand, only three of the 18 non-varicella patients in the same room were receiving rituximab-containing chemotherapy (P = 0.005). All varicella patients had detectable serum anti-varicella zoster virus IgG antibodies before chemotherapy. Even in the presence of neutralizing antibodies to the virus, lymphoma patients treated with rituximab-containing chemotherapy can possibly become re-infected with varicella. These findings suggest that zoster patients should be strictly isolated in hematology and oncology ward, and prophylactic acyclovir should be considered for such patients when exposed to zoster/varicella.",
author = "Akinao Okamoto and Akihiro Abe and Masataka Okamoto and Tsukane Kobayashi and Yoko Inaguma and Masutaka Tokuda and Masamitsu Yanada and Satoko Morishima and Tadaharu Kanie and Yukiya Yamamoto and Motohiro Tsuzuki and Shuichi Mizuta and Yoshiki Akatsuka and Hiroshi Yatsuya and Tetsushi Yoshikawa and Nobuhiko Emi",
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Okamoto, A, Abe, A, Okamoto, M, Kobayashi, T, Inaguma, Y, Tokuda, M, Yanada, M, Morishima, S, Kanie, T, Yamamoto, Y, Tsuzuki, M, Mizuta, S, Akatsuka, Y, Yatsuya, H, Yoshikawa, T & Emi, N 2014, 'A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy', Journal of Infection and Chemotherapy, vol. 20, no. 12, pp. 774-777. https://doi.org/10.1016/j.jiac.2014.08.006

A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy. / Okamoto, Akinao; Abe, Akihiro; Okamoto, Masataka; Kobayashi, Tsukane; Inaguma, Yoko; Tokuda, Masutaka; Yanada, Masamitsu; Morishima, Satoko; Kanie, Tadaharu; Yamamoto, Yukiya; Tsuzuki, Motohiro; Mizuta, Shuichi; Akatsuka, Yoshiki; Yatsuya, Hiroshi; Yoshikawa, Tetsushi; Emi, Nobuhiko.

In: Journal of Infection and Chemotherapy, Vol. 20, No. 12, 01.01.2014, p. 774-777.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A varicella outbreak in B-cell lymphoma patients receiving rituximab-containing chemotherapy

AU - Okamoto, Akinao

AU - Abe, Akihiro

AU - Okamoto, Masataka

AU - Kobayashi, Tsukane

AU - Inaguma, Yoko

AU - Tokuda, Masutaka

AU - Yanada, Masamitsu

AU - Morishima, Satoko

AU - Kanie, Tadaharu

AU - Yamamoto, Yukiya

AU - Tsuzuki, Motohiro

AU - Mizuta, Shuichi

AU - Akatsuka, Yoshiki

AU - Yatsuya, Hiroshi

AU - Yoshikawa, Tetsushi

AU - Emi, Nobuhiko

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Varicella, characterized by a vesicular rash, occurs primarily in young children. Although older individuals can also be affected or vaccinated, outbreaks among adults are rare. We investigated a small outbreak of varicella in B-cell lymphoma patients for elucidation of risk factor of the disease. We experienced four cases of varicella after an index herpes zoster case. All varicella cases were confirmed varicella zoster virus (VZV) infection by PCR. All varicella cases occurred in diffuse large B-cell lymphoma patients receiving rituximab-containing chemotherapy. On the other hand, only three of the 18 non-varicella patients in the same room were receiving rituximab-containing chemotherapy (P = 0.005). All varicella patients had detectable serum anti-varicella zoster virus IgG antibodies before chemotherapy. Even in the presence of neutralizing antibodies to the virus, lymphoma patients treated with rituximab-containing chemotherapy can possibly become re-infected with varicella. These findings suggest that zoster patients should be strictly isolated in hematology and oncology ward, and prophylactic acyclovir should be considered for such patients when exposed to zoster/varicella.

AB - Varicella, characterized by a vesicular rash, occurs primarily in young children. Although older individuals can also be affected or vaccinated, outbreaks among adults are rare. We investigated a small outbreak of varicella in B-cell lymphoma patients for elucidation of risk factor of the disease. We experienced four cases of varicella after an index herpes zoster case. All varicella cases were confirmed varicella zoster virus (VZV) infection by PCR. All varicella cases occurred in diffuse large B-cell lymphoma patients receiving rituximab-containing chemotherapy. On the other hand, only three of the 18 non-varicella patients in the same room were receiving rituximab-containing chemotherapy (P = 0.005). All varicella patients had detectable serum anti-varicella zoster virus IgG antibodies before chemotherapy. Even in the presence of neutralizing antibodies to the virus, lymphoma patients treated with rituximab-containing chemotherapy can possibly become re-infected with varicella. These findings suggest that zoster patients should be strictly isolated in hematology and oncology ward, and prophylactic acyclovir should be considered for such patients when exposed to zoster/varicella.

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