Severity of Illness and Outcome in Adult Patients with Primary Varicella Pneumonia

Abstract

Background: Varicella pneumonia is a serious complication of primary varicella infection in adults that often results in respiratory failure and death. Objective: To analyze the clinical and laboratory manifestations of primary varicella pneumonia in patients admitted to our intensive care unit (ICU). Methods: Retrospective study on patients treated in our ICU with a diagnosis of primary varicella pneumonia during a period of 15 years. We recorded age, gender, smoking habits, clinical and laboratory findings, arterial blood gases, chest radiograph, illness severity (SAPS II), length of stay, necessity for mechanical ventilation, complications, therapy and survival. We examined the influence of the duration of respiratory symptoms and rash prior to admission, and the influence of illness severity on outcome. Results: There was a statistically significant difference in duration of respiratory symptoms, duration of rash and SAPS II on admission between: (a) mechanically ventilated patients vs. spontaneously breathing patients (p < 0.007, p < 0.00, p < 0.00), (b) patients who survived vs. patients with poor outcome (p < 0.001, p < 0.000, p < 0.000), and (c) mechanically ventilated patients with poor outcome vs. mechanically ventilated patients who survived (p < 0.001, p < 0.00, p < 0.000). Overall mortality was 13.6%; death occurred only in mechanically ventilated patients (mortality 33.3%). Conclusions: Primary varicella pneumonia remains a critical problem with significant mortality. When recognized before respiratory failure ensues and mechanical ventilation becomes mandatory, patients could have an excellent outcome. Adult patients who delay asking for medical support, the disease may lead to the need for mechanical ventilation and severe complications with a fatal outcome.

Dexamethasone as adjunctive therapy for treatment of varicella pneumonia

“…In this study, we observed that all patients in both groups are associated with mild hepatitis, as reported by others [15,16]. The haematological changes in chickenpox are not uncommon, particularly thrombocytopenia.…”

“…Varicella pneumonia is the most common complication in adults and its incidence has been reported variably. Gregorakos et al [15] reported the incidence of varicella pneumonia as high as 50%. As it was observed in this study, most reported cases of varicella pneumonia in both groups have occurred in cigarette smokers.…”

Chickenpox complications in Saudi Arabia: Is it time for routine varicella vaccination?

“…[1][2][3] The disease can be benign and self-limiting in children, but in adults and immunocompromised hosts, it can be severe with high morbidity and mortality. [4][5][6] The epidemiology of chickenpox in Saudi Arabia is unique in many ways. Firstly, chickenpox is a common disease and reported cases have increased in the last three years.…”

“…[8][9][10] This represents a high susceptibility and infection rate among adults, and subsequently higher morbidity and mortality associated with chickenpox. 5 Thirdly, although chickenpox is often a benign and self-limiting childhood illness, the disease can be associated with a variety of serious and potentially fatal complications in both immunocompetent and immunocompromised patients. [11][12][13][14] There have been questions about the complications of chickenpox in Saudi Arabia, in comparison to cases reported from developed countries, 15 yet there are no studies that have examined the rate and severity of these complications among healthy individuals in Saudi Arabia.…”

Persistent Multiple Pulmonary Nodules in a Nonimmunocompromised Woman after Varicella-Related Myelitis Treated with Acyclovir

“…VZV pneumonia is usually contemporary with varicella skin lesions but can also appear up to 10 days after the appearance of vesicles and is most often accompanied by the respiratory symptoms of coughing and dyspnea (2). Even though clinical symptoms usually clear up within 2 or 3 days, this pathology is a true concern in adults and can even be fatal despite the advent of parenteral acyclovir (1,6,7,8,12,13).…”