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Megaloblastic anemia is a risk factor for childhood herpes zoster:

Megaloblastic anemia is a risk factor for childhood herpes zoster:

Megaloblastic anemia is a risk factor for childhood herpes zoster finds a new study published in Indian Journal of Dermatology, Venereology and Leprology.

Herpes Zoster is a predominantly
dermatomal disease occurring due to reactivation of varicella zoster virus in
the dorsal root ganglia. It commonly occurs in older age, diabetics and immunosuppressed
people. Recent studies from Indian set up are showing a conspicuous rise in
cases of childhood herpes zoster in immunocompetent children. Recently a study
assessing the risk factors for such a presentation was published in the Indian Journal
of Dermatology, Venereology and Leprology.

This was a case-control study of 30
patients and 30 age- and sex matched controls in Indian patients to study the clinical
presentation, complications and the association of various risk factors with
childhood herpes zoster. Cases included were of age ≤14 years, who were
clinically diagnosed with herpes zoster and had multinucleated giant cells on
Tzanck smear. Equal number of age- and sex-matched controls were selected from
the healthy children who did not have a history of having the disease and accompanied
other patients in the outpatients’ department.

Patients were tested for HIV and complete
blood count, chest X-ray and ultrasonography of abdomen were done to rule out
any underlying malignancy. Anemia was diagnosed on the basis of both peripheral
blood smear and mean corpuscular volume according to WHO guidelines.2

Results

  • 21
    out of 30 cases had megaloblastic anemia which was significantly associated
    with occurrence of childhood herpes zoster (odds ratio: 21; 95% confidence
    interval: 3.9–112.7).
  • Varicella
    during early life, history of maternal varicella during pregnancy and history
    of contact with chickenpox patients have been considered as important risk
    factors in many previous studies but these did not show a statistically
    significant association in the present study.1
  • A
    greater number of patients in the study group had immunosuppression with
    respect to the control group but the difference was statistically
    insignificant.

The study found a strong
significant association between megaloblastic anemia and pediatric herpes
zoster. The most common cause of megaloblastic anemia is deficiency of vitamin
B12 or folic acid which may cause immature
immune response leading to low levels of natural killer cells, lymphocytes and
cytokines along with virus-specific immunoglobulins which may be the cause of
inability to maintain varicella zoster virus latency, leading to appearance of
herpes zoster at an early age.

In conclusion this is the 1st
study to report a possibility of association of anemia with pediatric herpes
zoster. Further prospective population-based studies are required to confirm
this association.

Source-

  1. Sahu
    P, Dayal S. Association of various risk factors with childhood herpes zoster: A
    case–control study in Indian patients. Indian J Dermatol Venereol
    Leprol2021;87:725-8.
  2. WHO/UNU/UNICEF.
    Iron Deficiency Anaemia: Assessment, Prevention and Control, a Guide for
    Programme Managers. Geneva, Switzerland: World Health Organization; 2001.
    Available from: https:// www.who.int›ida_assessment_prevention_control.

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