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VOLUME 22 , ISSUE 3 ( 2018 ) > List of Articles

ORIGINAL ARTICLE

Severe Varicella Pneumonia in Adults: Seven Years′ Single-center Experience from India

Sunil K Gupta, Akashdeep Singh, Siddharth Parkash, R. K. Soni

Keywords : respiratory failure, varicella pneumonia,Mechanical ventilation

Citation Information : Gupta SK, Singh A, Parkash S, Soni RK. Severe Varicella Pneumonia in Adults: Seven Years′ Single-center Experience from India. Indian J Crit Care Med 2018; 22 (3):162-167.

DOI: 10.4103/ijccm.IJCCM_495_17

License: CC BY-ND 3.0

Published Online: 00-03-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: Varicella pneumonia is a rare but a serious complication of chickenpox in adults. There is paucity of data on varicella pneumonia from India. Aims: The aim of this study is to describe the clinical manifestations, hospital course, treatment, and outcome of adult patients with severe varicella pneumonia. Settings and Design: This was a retrospective, observational study of patients with severe varicella pneumonia attending a tertiary care teaching hospital. Subjects and Methods: The cases of varicella were identified by a computerized search of the medical record for the period between January 2010 and December 2016. During this period, 137 patients got admitted with varicella of which 22 had severe varicella pneumonia. Statistical Analysis: Mean and standard deviation were computed. Fisher\'s Z-test of proportions and analysis of variance were applied. Results: There were 17 (77.3%) men and 5 (22.7%) women. The mean age of the patients was 33.4 ± 10.8 years. History of contact with an infected person followed by high-grade fever and typical rash was present in all patients. Forty-five percent (10/22) of patients were immunosuppressed. All the patients received intravenous acyclovir. Forty-five percent (10/22) of patients received invasive mechanical ventilation. The various factors associated with the need for mechanical ventilation were partial pressure of oxygen:fraction of inspired oxygen ratio <150, quick sequential (sepsis-related) organ failure assessment (qSOFA) >2, and early bacterial coinfection. The mean Intensive Care Unit and hospital stay were 7 days (range; 1–16) and 9 days (range; 4–21), respectively. The overall mortality was 22.7% and reached 50% in those requiring invasive ventilation. The mortality was higher among patients with qSOFA >3, mean arterial blood pressure <60 mmHg, and severe acute respiratory distress syndrome at presentation. Conclusions: Patients with severe varicella pneumonia are at an increased risk of respiratory failure and death.


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  1. Kimberlin D, Brady MT, Jackson MA, Long SS. Red Book. 30th ed. USA: American Academy of Pediatrics; 2015. p. 846-60.
  2. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450-8.
  3. Mohsen AH, McKendrick M. Varicella pneumonia in adults. Eur Respir J 2003;21:886-91.
  4. Gnann JW Jr. Varicella-zoster virus: Atypical presentations and unusual complications. J Infect Dis 2002;186 Suppl 1:S91-8.
  5. Mandell GL, Douglas GR, Bennett JE. Principal and Practice of Infectious Diseases. 5th ed. Philadelphia: Churchill Livingston; 2015. p. 1731-7.
  6. Nilsson A, Ortqvist A. Severe varicella pneumonia in adults in Stockholm county 1980-1989. Scand J Infect Dis 1996;28:121-3.
  7. Centers for Disease Control and Prevention (CDC). Varicella-related deaths among adults – united States, 1997. MMWR Morb Mortal Wkly Rep 1997;46:409-12.
  8. Feldman S. Varicella-zoster virus pneumonitis. Chest 1994;106:22S-27S.
  9. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The berlin definition. JAMA 2012;307:2526-33.
  10. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the Intensive Care Unit. JAMA 2017;317:290-300.
  11. Ho BC, Tai DY. Severe adult chickenpox infection requiring intensive care. Ann Acad Med Singapore 2004;33:84-8.
  12. Frangides CY, Pneumatikos I. Varicella-zoster virus pneumonia in adults: Report of 14 cases and review of the literature. Eur J Intern Med 2004;15:364-70.
  13. Zhou F, Harpaz R, Jumaan AO, Winston CA, Shefer A. Impact of varicella vaccination on health care utilization. JAMA 2005;294:797-802.
  14. Alanezi M. Varicella pneumonia in adults: 13 years' experience with review of literature. Ann Thorac Med 2007;2:163-5.
  15. Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D'Souza GA, Gupta D, et al. Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci 2006;48:37-42.
  16. Cesario TC. Viruses associated with pneumonia in adults. Clin Infect Dis 2012;55:107-13.
  17. Domínguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A(H1N1) in Mexico. JAMA 2009;302:1880-7.
  18. Adhami N, Arabi Y, Raees A, Al-Shimemeri A, Ur-Rahman M, Memish ZA, et al. Effect of corticosteroids on adult varicella pneumonia: Cohort study and literature review. Respirology 2006;11:437-41.
  19. Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008;63:42-8.
  20. Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Viral infection in adults hospitalized with community-acquired pneumonia: Prevalence, pathogens, and presentation. Chest 2008;134:1141-8.
  21. Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, et al. Viral infection in patients with severe pneumonia requiring Intensive Care Unit admission. Am J Respir Crit Care Med 2012;186:325-32.
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