Abstract
We describe a patient with end stage renal failure (ESRF) on hemodialysis who was admitted to our department for primary varicella infection complicated by varicella pneumonia and encephalitis. Varicella infections results in serious morbidity and mortality in ESRF dialysis and transplant patients. Evidence published thus far suggests that live attenuated varicella vaccines are effective and safe in ESRF and renal transplant patients. Worldwide a few countries have instituted guidelines for the varicella immunisation in ESRF patients. However, in the Asia Pacific Region, it has not been widely given due to the lack of national consensus guidelines. Our case depicts that primary varicella infection can occur at any time in immunosupressed patients and thus suffer serious consequences from it. With increasing burden of chronic kidney disease, Renal Physicians and Family Physicians in the Asia Pacific Region should meet and study the epidemiological data in each individual country and decide on the consensus guidelines on how the varicella vaccination can be targeted for those at risk.
Highlights
Our case report illustrates the serious complications of varicella in a patient with end stage renal failure and emphasizes the need for consensus guidelines on varicella vaccinations in such patients in the Asia Pacific region
With the increasing burden of chronic kidney disease, family physicians need to be alert for these complications of varicella and can play a big role in facilitating varicella vaccination in patients with end stage renal failure
The use of steroids as adjunctive therapy for treatment of life-threatening varicella pneumonia is still controversial and should be further examined in rigorous controlled trials [19]. In immunosuppressed hosts such as end stage renal failure (ESRF) patients or immunocompetent patients with disseminated disease such as pneumonia or encephalitis, varicella should be treated with IV acyclovir [20]
Summary
Our case report illustrates the serious complications of varicella in a patient with end stage renal failure and emphasizes the need for consensus guidelines on varicella vaccinations in such patients in the Asia Pacific region. Literature review provides evidence on the safety and efficacy of varicella vaccination in end stage renal failure patients. With the increasing burden of chronic kidney disease, family physicians need to be alert for these complications of varicella and can play a big role in facilitating varicella vaccination in patients with end stage renal failure. Case presentation Our patient is a 58 year old construction supervisor with background of hypertension and ESRF on haemodialysis three times per week. Day, his oxygen saturation decreased, and worsening of the consolidation was noted on repeat chest radiograph He developed vivid visual hallucinations, became restless and agitated and disorientated to time, place and person. The frequency of dialysis was increased with continuation of the renal adjusted dose of acyclovir Throughout the admission, his hemodialysis continued and he completed 2 weeks of IV acyclovir. His functional status improved back to the pre-morbid levels on discharge
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