Frequency of Oral Mucositis and Local Virus Reactivation in Herpes Simplex Virus Seropositive Children with Myelosuppressive Therapy

Abstract

Background: Oral mucositis (OM) is a common chemo- and radiotherapy adverse effect in oncological pediatric patients. Herpes simplex virus (HSV) infection can cause a severe clinical course. We hypothesize, that HSV seropositivity is a risk factor for local HSV-1 reactivation and increased frequency of OM in patients with myelosuppressive therapies.

Patients and Method: We evaluated the prevalence of seropositivity of HSV-1 between June 2011 and April 2014 in patients with potential oncological disease and correlated it to the frequency of OM and local viral reactivation in OM under myelosuppressive therapy.

Results: The overall rate of HSV-seropositivity in our cohort was 22%. 48 patients underwent myelosuppressive therapy. Of these, 7 were HSV-1 IgG positive and 41 negative. All patients with OM under myelosuppressive therapy and positive local swab for viral HSV (l-PCR) were HSV-1 IgG positive before the start of therapy (100%). The absolute risk for OM in HSV-1 IgG positive patients was increased by 58.5% (95%CI: 20.0  − 72.2%) corresponding to a relative risk (RR) of 2.4 (95%CI: 1.7–3.5, P=0.009). The multivariable adjusted OR to suffer 2 or more OM episodes in HSV-1 IgG positivity was 8.8 (95%CI: 1.5–95.8, P=0.014).

Discussion and Conclusion: In HSV-1 IgG positive patients half of the OM episode showed HSV reactivation, and the risk for multiple OM episodes was increased. These patients should be investigated for HSV-infection in every OM episode. Prophylactic and preemptive therapeutic measures should be discussed early, but prospective data on HSV prophylaxis and preemptive treatment is required.

Zusammenfassung

Hintergrund: Orale Mucositis (OM) ist eine bekannte Komplikation bei pädiatrisch-onkologischen Patienten unter Chemo- und Radiotherapie. Herpes simplex Virus (HSV)-Infektionen können zu schwerwiegenden klinischen Verläufen führen. HSV-1 seropositive Patienten scheinen unter myelosuppressiver Therapie ein erhöhtes Risiko für lokale HSV-1 Reaktivierung während OM Episoden zu haben und leiden häufiger an OM Episoden im Vergleich zu HSV-1 seronegativen Patienten.

Patienten und Methode: Wir haben die HSV-1 Prävalenz von Patienten mit potentiell onkologischer Erkrankung zwischen Juni 2011 und April 2014 ermittelt und in Korrelation zu OM-Frequenz und lokaler Virusreaktivierung in OM-Episoden unter myelosuppressiver Therapie gestellt.

Ergebnisse: Die Rate der seropositiven Patienten in unserer Kohorte war 22%. Alle Patienten mit OM unter myelosuppressiver Therapie und lokal positivem HSV-Abstrich (1-PCR) waren vor Beginn der Therapie HSV-1 IgG positiv (100%). Das absolute Risiko einer OM in HSV-1 IgG positiven Patienten betrug 58% (95%CI: 20.0–72.2%), entsprechend einem relativen Risiko (RR) von 2.4 (95% CI: 1.7–3.5, P=0.009). Die Multivariabel-angepasste OR im Falle von HSV-1 Seropositivität an 2 oder mehr OM zu leiden, betrug 8.8 (95% CI: 1.5–95.8, P=0.014).

Diskussion und Schlussfolgerung: In HSV-1 IgG positiven Patienten konnten in der Hälfte aller OM Episode eine HSV-Reaktivierung beobachtet werden. Das Risiko von multiplen OM Episoden war in dieser Patientengruppe erhöht. Diese Patienten sollten in jeder OM Episode bezüglich HSV-Infektion abgeklärt werden. Prophylaktische und präemptive Therapiemassnahmen sollten frühzeitig in Betracht gezogen werden; prospektive Studien bezüglich prophylaktischer und präemptiver Therapie sind erforderlich.

Key words

hsv-seroprevalence - hsv-reactivation - oral mucositis - myelosuppressive therapy - hsv-1 - children

Schlüsselwörter

hsv-Seroprävalenz - hsv-Reaktivierung - orale mucositis - myelosuppressive therapie - hsv-1 - kinder

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