From the Guidelines
A patient with disseminated varicella-zoster virus (VZV) infection can be removed from isolation when all lesions have scabbed over, as recommended by the KDIGO clinical practice guideline for the care of kidney transplant recipients 1. This approach is based on the principle that the crusting of lesions indicates that the virus is no longer actively replicating and shedding, significantly reducing the risk of transmission to others.
- The guideline recommends that treatment be continued at least until all lesions have scabbed, which applies to both uncomplicated and disseminated herpes zoster cases 1.
- It's essential to note that some patients, particularly those who are immunocompromised, may require a longer isolation period as their lesions may take more time to crust over completely.
- Healthcare workers should perform a thorough skin examination to confirm that all lesions have indeed scabbed before discontinuing isolation precautions.
- Patients should be advised to avoid close contact with high-risk individuals (pregnant women without varicella immunity, newborns, and immunocompromised persons) until all lesions have completely healed, even after formal isolation has ended.
- The use of antiviral medications such as oral acyclovir or valacyclovir, or intravenous acyclovir in severe cases, can help reduce the duration and severity of the illness, but isolation precautions should remain in place until all lesions have scabbed 1.
From the Research
Disseminated Varicella-Zoster Virus Infection
- Disseminated varicella-zoster virus (VZV) infection is a severe condition that can occur in both immunocompromised and immunocompetent patients 2, 3, 4.
- The infection can cause a range of symptoms, including diffuse rash, encephalitis, hepatitis, and pneumonitis 2, 3, 4.
Treatment and Management
- Antiviral therapy, such as acyclovir, valacyclovir, famciclovir, brivudine, and foscarnet, can be effective in treating VZV infection 5, 6.
- Treatment should be initiated within 72 hours of rash onset to significantly shorten viral replication and reduce complications 5.
- In cases of acyclovir-resistant VZV infection, foscarnet may be a potentially effective alternative 6.
Isolation Precautions
- There is no specific guidance on when it is safe to remove a patient with disseminated VZV from isolation in the provided studies.
- However, it is generally recommended to isolate patients with VZV infection until the rash has crusted over, which usually occurs within 6-7 days of onset 3.