Original articleVaricella-zoster virus pneumonia in adults: report of 14 cases and review of the literature
Introduction
Varicella, more commonly known as chickenpox, is due to varicella-zoster virus. It is usually a mild childhood disease with most cases occurring in children below 13 years of age [1]. Less than 20% of all cases of VZV infection occurs in adults [2]. Adult morbidity and mortality are 10–20 times more common than in children because the otherwise healthy adults have a 20-times higher risk of complications [3], [4]. A serious and life-threatening complication is the development of varicella-zoster virus pneumonia (VZVP), which occurs most often in adults and in the immunocompromised host. The incidence of VZVP in otherwise healthy adults has been estimated to range from 0.3% to 50% [5], [6], [7], [8]. VZVP has a reported mortality of between 2.15% and 20% in the general population, but in pregnancy, it may be as high as 41% [5], [9], [10], [11], [12], [13], [14], [15], [16], [17].
In this retrospective study, we determine the clinical, laboratory, and radiological features of all adult patients with VZVP treated in our departments during the last 5 years. Important therapeutic and evolutive features are also reported.
Section snippets
Materials and methods
In this retrospective study, we examined all medical records of adult patients with a diagnosis of varicella who had been hospitalized in our two hospitals during the last 5 years. The medical records were obtained for those with a varicella diagnosis that could include VZVP. We defined the diagnosis of VZVP as a patient with a typical clinical history of varicella, a positive chest X-ray consisting mainly of ill-defined nodular or reticular densities of various sizes scattered throughout both
Results
A total of 92 adults were admitted to our hospitals because of varicellla-zoster virus (VIZ) infection during the last 5 years. Of these, 14 had a clinical diagnosis of VZVP (Table 1). Eleven (77%) were males (mean age of 36.4 years, range of 22–66 years) and three (23%) were females (mean age of 34.3 years, range of 17–61 years). In only three of our patients had the clinical diagnosis of VZV infection been confirmed serologically, and in only one was VZV DNA detected in the serum by the
Discussion
VZVP is the most common severe complication of VZV infection and sometimes leads to death. It is estimated that VZVP is the cause of hospitalization in at least 1 of 400 cases of this infection [24], with a reported mortality ranging from 2.15% to 50% [5], [9], [10], [11], [12], [13], [14], [15], [16], [17]. Reported incidences of VZVP have varied from 5% to as much as 50% [5], [7], [8], [19], [20], [21]. However, other studies suggest that the incidence in adults may be much lower: 5% or less
Uncited references
[34]
[44]
[51]
[60]
References (76)
- et al.
Primary varicella in adults: pneumonia, pregnancy, and hospital admission
Ann. Emerg. Med.
(1996) - et al.
Varicella pneumonitis: clinical presentation and experience with acyclovir treatment in immunocompetent adults
Int. J. Infect. Dis.
(1998) - et al.
Varicella pneumonia in adulthood: acyclovir therapy may be of benefit
Ann. Emerg. Med.
(1987) - et al.
CPAP mask management of varicella-induced respiratory failure
Chest
(1993) - et al.
Smoking and varicella pneumonia
J. Infect.
(1988) - et al.
Herpes zoster infection after autologous bone marrow transplantation
Blood
(1989) - et al.
Intensive care management of varicella pneumonia
Respir. Med.
(1997) Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on chickenpox on behalf of the British Society for the Study of Infection
J. Infect.
(1998)- et al.
Epidemiology, outcome and control of varicella-zoster infection
Rev. Med. Microbiol.
(1993) - et al.
Varicella-zoster virus
Chickenpox pneumonia, its complications and management
Anesthesia
Treatment of varicella in the immunocompetent adult
J. Med. Virol.
Severe varicella pneumonia in adults in Stockholm County 1980–1989
Scand. J. Infect. Dis.
Varicella complications: study of 117 patients admitted to the Emilio Ribas Hospital
AMB Rev. Med. Bras.
Varicella pneumonia in adults: report of seven cases and a review of literature
Medicine
Chickenpox pneumonia: experience with antiviral treatment
Thorax
Severe pulmonary varicella in 7 non-immunodepressed adults
Rev. Mal. Respir.
Epidemiology of chickenpox in England and Wales 1967–85
Br. Med. J.
Use of acyclovir for varicella pneumonia during pregnancy
Obstet. Gynecol.
Varicella pneumonia in adults
Orv. Hetil.
Varicella pneumonia in adults—clinical spectrum
Ann. Acad. Med. Singapore
Varicella infection and pneumonia among adults
Int. J. Infect.
The American–European Consensus Conference on ARDS: definatéons, mechanisms, relevant outcomes and clinical trial coordination
Am. J. Respir. Crit. Care
Varicella pneumonia: study of prevalence in adult men
JAMA
Varicella pneumonia
Ann. Intern. Med.
Varicella pneumonia in adults: a spectrum of a disease
Ann. Emerg. Med.
Review of adult varicella
Varicella zoster pneumonia and mechanical ventilation
Med. Annals (Greece)
Population-based studies of varicella complications
Pediatrics
Respiratory manifestation in chickenpox
Arch. Intern. Med.
Hemofiltration in severe adult respiratory distress syndrome associated with varicella
Intense Care Med.
Acute respiratory distress syndrome in chickenpox in three health adults
Ann. Med. Interne
Adult respiratory distress syndrome secondary to varicella infection in young adult
J. R. Army Med. Corps
Adult respiratory distress syndrome secondary to varicella pneumonia in an immunocompetent male
An. Med. Interna
Varicella pneumonia in a healthy adult presenting with severe respiratory failure
Intern. Med.
Varicella pneumonia complicated by acute respiratory distress syndrome in an adult
J. Formos. Med. Assoc.
A case of severe respiratory failure due to varicella pneumonia
Nippon Naika Gakkai Zasshi
Cited by (31)
Acute respiratory distress syndrome caused by varicella pneumonia in immunocompetent adult: Clinical case
2021, Annals of Medicine and SurgeryCitation Excerpt :Varicella is a highly contagious disease caused by Varicella-Zoster Virus, it's a common childhood self-limited disease but it can be a life-threatening situation in immunocompromised patients [1–3]. And despite its rarity, Varicella zona infection can lead to severe lethal complications in immunocompetent persons including varicella pneumonia that can rapidly progress to an acute respiratory distress syndrome despite conventional support [4–6]. In this paper; we will report the clinical case of a 63 years old man, with no medical history, admitted to the critical care unit for acute respiratory distress syndrome due to Varicella pneumonia.
Review of Non-Bacterial Infections in Respiratory Medicine: Viral Pneumonia
2015, Archivos de BronconeumologiaVaricella pneumonia associated with bilateral pleurisy in an immunocompetent adult
2013, Revue de Pneumologie CliniqueContribution of microbiological investigations to the diagnosis of lower respiratory tract infections
2006, Medecine et Maladies Infectieuses