Varicella and secondary pneumonia in a healthy child: is it time to introduce varicella vaccine in the UK?

Abstract

A previously healthy 8-month-old boy presented to the emergency department with a 1-week history of chickenpox infection. His routine immunizations were up-to-date. His parents reported a high temperature (up to 39.5°C) in the preceding 48 hours and that he also had a mild cough, episodes of vomiting and loose stools. He had fed poorly in the 24 hours before presentation. Clinical assessment revealed a temperature of 36.7°C, heart rate 130/min, respiratory rate of 34/min and crusted chickenpox lesions. The infant was alert, smiling and playful, and systemic examination was otherwise unremarkable. He was admitted for monitoring of his fluid intake and temperature. As the infant continued to vomit intermittently in the 6 hours post admission, blood investigations were done and intravenous fluids were commenced. Laboratory investigations did not reveal biochemical evidence of dehydration, but they did show raised inflammatory markers: white blood cell count 24.8 × 109/litre, neutrophil count 19.8 × 109/litre and C-reactive protein 227mg/litre. In view of these results and the ongoing high fever, a chest X-ray was performed, revealing right upper lobe consolidation and collapse (Figure 1). Oral amoxicillin and flucloxacillin were started and oral feeding was successfully reestablished over the next 24 hours. He was discharged home after 48 hours, to complete a full 7-day course of oral antibiotics.