Adult varicella pneumonia requiring intensive care

Introduction

Varicella pneumonia is the most common severe complication of chickenpox in adults.

Method

In this retrospective case series, we reviewed the clinical presentation and outcomes of all adult varicella pneumonia patients who were admitted to the Medical Intensive Care Unit of a university-affiliated general hospital from 1997 to 2000.

Results

The 10 patients had a mean ± SD age of 44 ± 20 (range: 26–86) years; two patients were above 65 years old (ages 73 and 86). All but one were male. None had previous varicella vaccination. Five patients had direct exposure to persons with chickenpox infection. Four patients had underlying pulmonary pathology: past pulmonary tuberculosis (two), emphysema (one) and recurrent right pleural effusion from autoimmune serositis (one). Two patients had a background history of immunocompromised states (systemic lupus erythematosus and acute myeloid leukaemia). There were four cigarette smokers, two ex-smokers, two non-smokers and two did not have their smoking history documented. The mean respiratory rate was 30 ± 8 breaths per minute (range: 18–42). The mean Acute Physiology and Chronic Health Evaluation II score was 15.7 ± 6.2 (range: 7 to 26). Two patients had acute respiratory distress syndrome and five had acute lung injury. The mean ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 261 ± 60 (range: 171–351). The median duration of stay in the ICU was 15 days (range: less than 1 day to 76 days). Eight patients (80%) required mechanical ventilation. The median duration of mechanical ventilation was 16.5 days (range: less than 1 day to 79 days). All patients were started on acyclovir and empirically treated with cloxacillin and ceftriaxone. There were three deaths (30%); two were above 65 years old and the third had acute myeloid leukaemia on chemotherapy. Two patients had acute renal failure and both died.

Conclusion

Varicella pneumonia carries a high mortality. Old age, an immunocompromised state and acute renal failure appear to be associated with increased mortality in our series.