Complications of primary varicella in adults – includes editor’s note – adapted from the Annals of Emergency Medicine 1996;28:165-9

Complications of primary varicella in adults – includes editor’s note – adapted from the Annals of Emergency Medicine 1996;28:165-9 – Tips from Other Journals

Richard Sadovsky

Primary varicella, or chickenpox, is a highly contagious disease. Only 5 to 10 percent of the U.S. population is still susceptible to varicella at age 15 years. Although only 2 percent of all cases occur in persons older than 20 years of age, almost one-half of all varicella-related deaths occur in this age group. The most common complication of varicella in adults is pneumonia. Pregnant women and immunocompromised persons are thought to be at higher risk of complications. Baren and associates conducted a study to evaluate the rate of complications associated with varicella in adults.

The study included a series of patients with varicella who visited an emergency Complications of Primary Varicella in Adults

Primary varicella, or chickenpox, is a highly contagious disease. Only 5 to 10 percent of the U.S. population is still susceptible to varicella at age 15 years. Although orlly 2 percent of all cases occur in persons older than 20 years of age, almost one-half of all varicella-related deaths occur in this age group. The most common complication of varicella in adults is pneumonia. Pregnant women and immunocompromised persons are thought to be at higher risk of complications. Baren and associates conducted a study to evaluate the rate of complications associated with varicella in adults.

The study included a series of patients with varicella who visited an emergency

department over a 31-month period. The records of patients with primary varicella were retrospectively reviewed to assess the impact of the disease during pregnancy and the incidence of pneumonia and other complications. Medical records were also reviewed for documentation of follow-up visits. If follow-up information was not available, telephone follow-up was attempted.

Of the 130 patients in the series with varicella, 13 (10 percent) had pneumonia. Other complications rarely occurred. Twelve patients were admitted to the hospital; all 12 of these patients had pneumonia or were pregnant. Compared with the 117 patients without pneumonia, the 13 patients with pneumonia complained more frequently of shortness of breath and chest pain. The frequency of cough did not differ between the two groups. Two patients admitted with pneumonia died of respiratory failure. Both of these patients had chronic underlying disease processes.

Among the 28 pregnant patients with varicella, the rate of pneumonia was 3.6 percent. No congenital anomalies or perinatal complications were reported among the infants of the women who were pregnant when they had varicella. The number of immunocompromised patients with varicella was too small to draw any conclusions.

The authors conclude that adults with varicella who complain of chest pain or shortness of breath should be evaluated with a chest radiograph and either pulse oximetry or arterial blood gas measurement. Hospital admission should be reserved for patients who are hypoxic or highly symptomatic and for those with comorbid disease. Varicella-infected patients not meeting these criteria can be safely treated on an outpatient basis with oral acyclovir. Pregnant women do not appear to be at higher risk of developing varicella pneumonia. Since it is unclear if the course of pneumonia is more severe in pregnant patients, they should probably be admitted for observation, and acyclovir therapy should be considered. (Baren JM, et al. Primary varicella in adults: pneumonia, pregnancy, and hospital admission. Ann Emerg Med 1996;28:165-9.)

EDITOR’S NOTE: The use of the varicella vaccine in nonimmune adults is clearly appropriate, especially in pregnancy-age women. Physicians caring for patients from areas with a low incidence of varicella, such as the Caribbean, need to protect nonimmune women who may become pregnant. Adult recipients of the vaccine need to be cautioned to avoid pregnancy for two to three months following administration.

COPYRIGHT 1996 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group