Lung function tests and risk factors for pneumonia in adults with chickenpox

Abstract

Background-Varicella is 25 times more likely to be complicated by pneumonia in adults than in children. Data on changes in lung function following pneumonia are limited. This study was undertaken to describe the epidemiological factors associated with pneumonia and to investigate lung function up to 1 year following chickenpox. Methods-Thirty eight consecutive suitable patients admitted to a university hospital were enrolled in the study; 19 had pneumonia and 19 did not. Epidemiological data and density of rash were recorded, spirometric tests were performed, and carbon monoxide transfer factor was measured. Results-Varicella pneumonia was associated with the presence of respiratory symptoms (p=0.006), current smoking (p=0.003), and history of close contact (p=0.009). There was a trend towards patients with pneumonia having a more severe rash. No association was observed between pneumonia and age or sex. Current smokers had a higher mean number of spots than non-smokers (p=0.005). Carbon monoxide transfer factor at hospital discharge was reduced in 27 patients (71%), more markedly in the group with pneumonia (p=0.009). Nine patients (seven with pneumonia) still had a reduced carbon monoxide transfer factor (mean reduction 36%) at 12 months. Conclusion-Chickenpox may result in a defect in carbon monoxide transfer factor for at least a year after acute illness. (Thorax 2001;56:796-799)

Varicella pneumonia in adults

“…The incidence of pneumonia in adults has been reported in two studies and varied between 0.32-1.36 cases per 100,000 person years [5,15]. Adults who develop chickenpox are at much greater risk of developing changes on their chest radiograph, with an incidence of 5-50% [3,[15][16][17][18][19]. A report of 110 chest radiographs from 114 USA army recruits who developed Varicella during basic training showed that 18 (16.3%) had interstitial and/or nodular infiltrates indicative of pneumonia [19].…”

“…However, chest symptoms may start before the appearance of the skin rash [16,24,25]. Physical findings are often minimal and chest radiographs typically reveal nodular or interstitial pneumonitis [16,19], as shown in figure 1.…”

“…However, chest symptoms may start before the appearance of the skin rash [16,24,25]. Physical findings are often minimal and chest radiographs typically reveal nodular or interstitial pneumonitis [16,19], as shown in figure 1. The presence of new chest symptoms has been shown to be strongly associated with the documentation of radiological pneumonia [16,26,27].…”

Varicella Pneumonia in Adults

“…However, pneumonia is the major and most frequent complication of varicella in healthy adults, with incidences being reported as high as 50% (1,2) and carries an overall mortality rate of between 10 and 30% (3). It has been reported that the susceptibility of varicella pneumonia in healthy adults is 25-fold greater than in children (4).…”

“…In a limited number of cases, pulmonary symptoms may be present before the appearance of the skin rash (2). Patients demonstrate impaired gas exchange with progressive hypoxemia.…”