varicella are viruses that often cause infections in patients
who are getting treatment for cancer. Herpes appears as fever
blisters and varicella is seen as chicken pox or shingles.
Most of us have been exposed to these viruses at some time in
our lives. When our immune systems are normal, the viruses are
simply ‘‘in our system’’ and do not cause any problems.
During treatment for leukemia or lymphoma and bone marrow
transplants or other organ transplants, the normal functions of
the immune system are damaged. During this time, the viruses can
become active (‘‘reactivated’’) and can cause fever
blisters, shingles, or more serious problems such as lung
Often, these viruses will become active in the patient
without any symptoms that can be seen. They may cause fever, a
flulike symptom, or pain and redness at the site(s) where they
are starting. Herpes occurs around the mouth or the genitals.
Shingles appears along a nerve track and so seems to be
following a line on the skin. Tear-shaped blisters may form at
the sites of redness. If blisters occur, they will dry and
become crusty within 10 days after the start of treatment.
Learning Needs Your doctor will tell you if you are
likely to have an infection with a herpes or varicella virus.
You should inform your doctor or nurse if any of these occur:
- Temperature greater than 38.5° C or 101.3° F
- Pain or redness of the skin or mucous membranes of the
mouth or genitalia or in a line anywhere on the body
- You are around anyone who has fever blisters, chicken pox,
- You are around anyone who has been exposed to someone with
the active virus
Prevention If you have ever had fever blisters, shingles,
or chicken pox, please inform your health care team. Also, you
may have blood samples taken at the start of your treatment to
see if you have been exposed to these viruses in the past.
Herpes and varicella are catching during the first stages,
until the blisters become crusty. Since your immune system is
not working well, the most likely way the virus spreads to you
is from visitors or members of the health care team. You should
- Anyone with a cold sore, chicken pox, or shingles
- Children who have not had chicken pox and are in day care
or grade school. They can often be exposed to the virus
without knowing it.
Management The diagnosis of herpes or varicella is made
by what the blister looks like and by taking a test or ‘‘culture.’’
The goals of treatment are to relieve symptoms and to control
the growth of the virus. Acyclovir is the medicine used most
often for treatment. Acyclovir can be given as a pill or through
the vein, or put on the blisters as a cream. It is important to
take the medicine just the way the doctor has written the
Follow-up As the immune function improves, the infection
slowly heals. At this time, it is said to be ‘‘dormant’’
or at rest and should no longer cause any problems.