Discussion:
Kidney transplantation is a therapeutic choice for end-stage renal
disease. Kidney transplantation offers the patients a better quality of
life as they are free from fluid and potassium restriction, better
metabolic function and normal hemoglobin as normal kidney function
return6. Immunosuppressants are essential for the
allograft function to be successful. These medications functions by
reducing the allograft rejection response and are used for maintenance,
treating rejection reactions, and induction (strong immunosuppression in
the early days after transplantation). However, using immunosuppressants
also has drawbacks6. The body will be more vulnerable
to a variety of opportunistic infections due to the body’s immune system
being suppressed, which can both jeopardize the outcome of kidney
transplants and result in fatalities7, 8. Up to
44.9–82% of recipients of kidney transplants get infections
postoperatively, including viral infections like cytomegalovirus and
varicella as well as urinary tract infections and pneumonia. The highest
percentages of infections among patients who are on immunosuppressants
are caused by bacteria, fungi, and viruses in 50%, 30%, and 5%,
respectively; while 15% of infections are considered as
polymicrobial9 . Fever, pneumonia, enteritis,
meningitis, and encephalitis are some of the clinical manifestations of
viral infections. As a result, the immune system is suppressed, which
raises the risk of opportunistic infections10.
For the past three years, our patient has been living with a
transplanted kidney and during that time there have been no complaints.
He was using corticosteroids, mycophenolate mofetil, and tacrolimus as
his three immunosuppressants.
Rapid diagnosis is necessary to select the appropriate antiviral therapy
in immunocompromised patients at the time of acute VZV infection. Tissue
culture can be used to isolate VZV; this technique is not, however,
quick enough to affect therapeutic decision-making. The virological
assay to identify VZV antigens using monoclonal antibodies is the
quickest test. Due to a lack of resources, neither culture isolation nor
any other techniques were used to diagnose this patient. The clinical
signs actually showed varicella infection (chickenpox)11.
Giving an antiviral medication as soon as possible, preferably within
the first 24 hours after the rash initially starts, will produce the
best results. Antiviral medication can be substituted orally if clinical
improvement occurs12.
Although being the high risk group for infections, Vaccinations had
never been administered to our patient before. Some recommendations call
for the delivery of vaccines to every patient receiving an organ
transplant. Seronegative individuals should receive two doses of
pre-transplant immunization, spaced four weeks apart, to help prevent
serious infection. The chosen vaccine must be suitable for chronic
kidney disease patients13.