ABSTRACT
In a comprehensive review of varicella in children with lymphoproliferative malignancy and solid tumors, Feldman and colleagues found that 32% of these patients developed visceral dissemination of varicella-zoster virus (VZV), varicella pneumonia occurred in 20% of cases, and the mortality rate was 7%. Although symptomatic fetal infection is rare, herpes zoster in infancy and the presence of VZV-specific immunity in asymptomatic infants indicate that the virus does reach the fetus during second and third trimester maternal varicella with approximately the same frequency as in the first trimester. Neonatal varicella was reported following household exposure of two infants whose mothers were apparently immune to VZV. The clinical differences between varicella in immunocompromised children and varicella in otherwise healthy children include a prolonged period of new lesion formation and visceral dissemination manifesting as varicella pneumonia, hepatitis, encephalitis, and disseminated intravascular coagulopathy. Natural killer cell cytotoxicity provides the nonimmune host with an immediate cellular immune response to primary VZV infection.
