Varicella-zoster virus: Pathogenesis, immunity, and clinical management in hematopoietic cell transplant recipients

VZV Infectivity for T Cells and SkinIn addition to causing characteristic skin lesions, VZV can be detected in peripheral blood mononuclear cells f rom healthy and immunocompromised patients with varicella and from immunodeficient patients with herpes z o s t e r.Using the SCID-hu mouse model, we have demonstrated that VZV infects CD4 + and CD8 + human T cells and thus shares pathogenic mechanisms characteristic of the lymphotropic and n e u ro t ropic herpesviruses (Figure 2) [5,6].Infectivity for T cells is a critical component of the risk that VZV presents in HCT recipients, since it underlies susceptibility to cutaneous and visceral dissemination.Conditions in the SCID-hu model are similar to those in the period immediately after HCT, since SCIDhu mice lack the capacity to develop VZV-specific immun i t y.When VZV reactivates in the human host, it re p l icates efficiently in the skin, producing high titers of infectious virus in the cutaneous vesicles.During acute herpes zoster, T cells may become infected at the site of Varicella-Zoster Virus: Pathogenesis, Immunity, and Clinical Management in Hematopoietic Cell Transplant Recipients