Varicella-zoster virus pneumonia in an adult population: Has mortality decreased?

Abstract

Varicella-zoster virus (VZV) pneumonia is one of the most serious complications of this infection in adults. The objective of this study was to analyze the epidemiological and clinical characteristics in a large sample of patients with VZV pneumonia. This was a 10-y retrospective, descriptive, observational study. We studied 46 patients with VZV pneumonia, 21 men and 25 women, with a mean age 36 +/-11 y. A contact with an index case was observed in 57%, 76 were active smokers, 6.5% consumed drugs and 2 women were pregnant. The symptoms were: fever (83%), cough (83%), dyspnoea (63%), pleuritic pain (70%), and haemoptysis (6%) and started 3-5 days after the onset of blisters, except in 11% in whom respiratory symptoms appeared first. Arterial blood gases showed a mean PO(2)/FiO(2) of 308 +/-101 and 30 patients had a PO(2) of <55 mmHg--11 of these (4%) were admitted to the ICU, 8 required mechanical ventilation. Comparison of patients in the ICU with those on the general ward showed differences in the duration of fever (6.1 +/- 4.2 vs 3.2 +/- 1.1 days, p <0.001), mean stay (16.8+/-9.3 vs 7.2+/-2.4 days, p <0.001) and complications such as acute renal failure (p = 0.01) and acute respiratory failure (p < 0.001). Despite the severity of disease, no patient died. Once diagnosed, 98% were treated with acyclovir, combined with steroids in 6 and with antibiotics in 3 complicated with bacterial pneumonia. The prevalence for the period was 0.33 cases/100,000 inhabitants/y. In conclusion, VZV pneumonia has a severe course and accounts for a high percentage of admissions to the intensive care unit. The absence of mortality may be related to early treatment with acyclovir. Smoking was a risk factor for VZV pneumonia.

Pneumonia Complicating Pregnancy

“…A recent series from Spain indicated that among the 46 patients studied with varicella pneumonia, 24% were treated in the ICU but none of them died, including 2 females who were pregnant. 60 Varicella-zoster (VZ) is a DNA virus that usually causes a benign, self-limited illness in children (chickenpox), but up to 10% of the adult population is susceptible to primary infection. 17 Studies show that the infection rate in pregnant women is as high as 4% to 6.8%, but after a close exposure, the risk of infection may be as high as 70%.…”

Varicella encephalitis and pneumonia in a patient with end stage renal failure

“…Varicella pneumonia typically develops insidiously with symptoms of progressive dyspnea and dry cough. Patients demonstrate impaired gas exchange with progressive hypoxemia and are at high risk for respiratory failure and need for admission to intensive care for mechanical ventilation [14,15]. Mortality rates approach 50% in patients with respiratory failure who require mechanical ventilation, despite institution of aggressive therapy and appropriate support measures [16,17].…”

Skin infections in pregnancy

“…Varicella tends to have a more serious course in pregnant women, especially during the third trimester. 2,3,5,12 For example, the risk for severe pneumonia is 10%, with a correlation to the severity of the exanthem and increasing gestational age. 2,5,13 The onset of pneumonia can A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 6 be expected between 3-5 days of the onset of the exanthem.…”