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Varicella zoster virus infection in inflammatory bowel disease

Authors

  • Garret Cullen MD,

    Corresponding author
    1. Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Harvard Medical School, Boston, Massachusetts
    • Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215
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  • Rachel P. Baden MD,

    1. Harvard Medical School, Boston, Massachusetts
    2. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Adam S. Cheifetz MD

    1. Center for Inflammatory Bowel Disease, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Harvard Medical School, Boston, Massachusetts
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  • Financial disclosures: A.S.C.: UCB (advisory board), Abbott (advisory board), Janssen (advisory board); the remaining authors have no relevant financial disclosures.

Abstract

Background:

The risk of viral infection is increased in immunosuppressed inflammatory bowel disease (IBD) patients. Varicella zoster virus (VZV) is of particular interest in IBD because of a number of reports of severe, disseminated, and occasionally fatal varicella infection in immunosuppressed IBD patients.

Methods:

We reviewed publications describing VZV infection in IBD patients and combined these data with a review of the current literature relating to both primary and secondary varicella in IBD.

Results:

Twenty cases of primary varicella infection and 32 cases of herpes zoster infection have been reported in IBD. Additional cases are reported in clinical trials. The risk of VZV infection is increased with all immunosuppressants used in IBD, but corticosteroids and combination immunosuppression appear to be a particular risk.

Conclusions:

Healthcare providers need to be aware of the various manifestations of primary and secondary VZV infection in immunosuppressed IBD patients. Patients should be screened for VZV immunity and vaccinated prior to commencing immunosuppression. (Inflamm Bowel Dis 2012;)

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