Varicella Pneumonia Research Articles

Varicella Pneumonia in Young Adult Male: A Case Report

Varicella infection is a common disease in pediatric age group but is uncommon in adult. Varicella pneumonia is the dreaded complication in these patients leading to mortality, which is more pronounced in adult patients. This is a case report of a young adult male, presenting with Varicella pneumonia in severe hypoxic respiratory failure, which was successfully managed with oxygen therapy, acyclovir, and steroids.

Clinical and radiological features of a cluster of immunocompetent adolescents with varicella pneumonia: a descriptive study.

Varicella pneumonia is one of the most common and severe complications of chickenpox infection. This study aimed to describe the clinical and radiological features of varicella pneumonia in a cluster of immunocompetent adolescents. A retrospective analysis was conducted on a cohort of adolescent patients diagnosed with varicella pneumonia at Wuhan Jinyintan Hospital between February 2023 and May 2023. The clinical and imaging data were collected and analyzed. A total of 116 patients were divided into two groups by the absence (group 1, n=57) or presence (group 2, n=59) of lower respiratory symptoms for data comparison. Among 116 patients (median age, 16 years; 60 males), rash (100%) was the most prevalent clinical symptom. The most common respiratory symptom and sign were fever (42.2%) and coarse breath sounds (41.4%). Chest computed tomography (CT) performed within five days of symptoms onset revealed multiple (89.7%), peripheral (51.7%), and ill-defined (73.3%) lung nodules in most patients, which gradually improved 6-10 days after symptom onset. Group 2 had higher levels of interleukin-6 (P<0.001), C-reactive protein (P=0.02), serum amyloid-A protein (P=0.002), longer hospital stays (P=0.04), more involved lung lobes (P=0.02), and a higher incidence of multiple nodules (P=0.043) than those of group 1. In immunocompetent adolescents, clustered varicella pneumonia often presents as mild and more uniform in clinical and radiological presentations than sporadic cases. The most common CT findings were multiple pulmonary nodules. Patients with lower respiratory symptoms exhibited more severe clinical and radiological manifestations. Generally, it is not recommended that patients undergo frequent CT scans in a short period.

Case Report on Ustekinumab-Induced Varicella Zoster Infection

Ustekinumab is a human monoclonal antibody typically used to treat moderate to severe plaque psoriasis, psoriatic arthritis, moderate to severe Crohn's disease, or moderate to severe ulcerative colitis (inflammatory bowel disease). Ustekinumab mediates the body's T-cell response by acting as an antagonist against interleukin-12 (IL12) and interleukin-23 (IL23). Although rare, the emergence of severe infections or exacerbation/reactivation of existing infections (bacterial, mycobacterial, fungal, viral) is possible for Ustekinumab. We report a case of a 29-year-old female patient who was prescribed Ustekinumab for Crohn’s disease management. After the commencement of the drug for two doses she developed Varicella pneumonia with ARDS which was subsequently managed.

Association between emphysema and other pulmonary computed tomography patterns in primary varicella pneumonia: A retrospective cohort study.

This study aims to evaluate chest computed tomography (CT) findings in hospital patients with primary varicella pneumonia (PVP). We retrospectively analyzed CT images of 77 PVP patients using 3D Slicer, an open-source software, to model lesions and lungs. This retrospective cohort study was approved by the Institutional Review Board (Ethical Committee, Renmin Hospital, Hubei University of Medicine, Shiyan, China) and waived the requirement for written informed consent. The left lung was more frequently and severely affected in PVP, with significant differences between the 2 groups in CT involvement percentage of each lung region, except for total lung inflation. Group A showed higher median percentages of lung collapse compared to Group B. The extent of left lung involvement is a critical predictor of emphysema in PVP patients, highlighting the importance of also monitoring the right lung for more severe cases. Lower emphysema levels correspond to more collapsed and infiltrated lung segments, suggesting a more severe clinical presentation.

Pulmonary Involvement during Varicella in a Patient with Sickle Cell Disease: Diagnosis and Treatment

Introduction: Pulmonary involvement during chickenpox is one of the most serious complications. However, it can be difficult to distinguish between varicella pneumonia, bacterial superinfection and an acute chest syndrome. We report a case of varicella complicated by pneumonia in a young adult with sickle cell disease.&#x0D; Observation: It was a 24-year-old woman with sickle cell disease. Examination on admission revealed generalized skin lesions of varying ages, associated with scratching lesions. On day 3 of hospitalization, she presented an acute respiratory distress associated with fever (40°C). Thoracic CT angiography revealed diffuse pulmonary nodules and micronodules in both lung fields. Blood culture isolated Staphylococcus spp. The patient was put on oxygen therapy combined with antiviral treatment and antibiotic therapy. The course was marked by symptoms regression, with disappearance of respiratory distress on day 2 and apyrexia on day 3 of treatment. The follow-up chest CT scan carried out at month 4, came back normal.&#x0D; Conclusion: Although pneumonia is one of the most common complications of varicella, it can be difficult to diagnose in patients with sickle cell disease, considering the frequency of pulmonary involvement of various etiologies

Interferon autoantibodies as signals of a sick thymus.

Type I interferons (IFN-I) are key immune messenger molecules that play an important role in viral defense. They act as a bridge between microbe sensing, immune function magnitude, and adaptive immunity to fight infections, and they must therefore be tightly regulated. It has become increasingly evident that thymic irregularities and mutations in immune genes affecting thymic tolerance can lead to the production of IFN-I autoantibodies (autoAbs). Whether these biomarkers affect the immune system or tissue integrity of the host is still controversial, but new data show that IFN-I autoAbs may increase susceptibility to severe disease caused by certain viruses, including SARS-CoV-2, herpes zoster, and varicella pneumonia. In this article, we will elaborate on disorders that have been identified with IFN-I autoAbs, discuss models of how tolerance to IFN-Is is lost, and explain the consequences for the host.

Prevalence and progression of pneumonia in immunocompetent adults with varicella

Pneumonia is the most common complication of varicella infections. Although previous studies have tended to focus mainly on immunocompromised patients, varicella pneumonia can also occur in healthy adults. Therefore, in this study, we aimed to assess the progression of varicella pneumonia in immunocompetent hosts. This retrospective study involved immunocompetent adult outpatients with varicella who attended the adult Fever Emergency facility of Peking University Third Hospital from April 1, 2020, to October 31, 2022. Varicella pneumonia was defined as a classic chickenpox-type rash in patients with infiltrates on chest computed tomography. The study included 186 patients, 57 of whom had a contact history of chickenpox exposure. Antiviral pneumonia therapy was administered to 175 patients by treating physicians. Computed tomography identified pneumonia in 132 patients, although no deaths from respiratory failure occurred. Seventy of the discharged patients were subsequently contacted, all of whom reported being well. Follow-up information, including computed tomography findings, was available for 37 patients with pneumonia, among whom 24 reported complete resolution whereas the remaining 13 developed persistent calcifications. Notably, we established that the true incidence of varicella pneumonia is higher than that previously reported, although the prognosis for immunocompetent hosts is generally good.

Varicella Pneumonia in Immunocompetent Adult: Clinical Case

Introduction: Chickenpox is a viral infection that is highly contagious and typically mild during childhood. However, in adults, it can lead to multivicseral complications, such as varicella pneumonia. Case report: A new case of varicella pneumonitis in an 18-year-old immunocopetent female patient was reported. The patient presented with acute respiratory distress, fever, and generalized maculopapular lesions. Chest imaging showed bilateral micronodular and nodular opacities. The diagnosis of Varicella pneumonia complicated with acute respiratory distress syndrome was confirmed after further investigations. Biologically, the patient had a thrombocytopenia, hepatic cytolysis and elevated lactate dehydrogenase levels. Treatment with antiviral treatment and oxygen therapy led to a positive outcome. Conclusion: Varicella pneumonia is the most frequent and serious complication of varicella in adults. It is often favourable under antiviral treatment.

An Atypical Presentation of Disseminated Varicella Infection

Abstract We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.

Hyper‐IgE syndrome presenting with early life craniosynostosis in monozygotic twin sisters

<scp>Hyper‐IgE</scp> syndrome presenting with early life craniosynostosis in monozygotic twin sisters

Varicella Pneumonia in an Immunocompetent Middle-aged Adult Male: A Case Report.

chickenpox; pneumonia; skin eruptions.

Varicella Pneumonia with Acute Kidney Injury in an Immunocompetent Host

Chicken pox is mostly a benign infection of childhood and is caused by Varicella Zoster Virus which generally does not lead to any serious complication in an immunocompetent host. Severe and potentially lethal complications like varicella pneumonia, encephalitis and acute kidney injury are known entity in adults but are very rare in paediatric age group. We present a case of Acute Kidney Injury (AKI) in the form of tubulointerstitial nephritis induced by varicella infection in a young immunocompetent child with varicella pneumonia.

P6‐39: A case of consecutive pneumocystis pneumonitis and varicella pneumonia during the treatment of miliary tuberculosis

P6‐39: A case of consecutive pneumocystis pneumonitis and varicella pneumonia during the treatment of miliary tuberculosis

VARICELLA PNEUMONIA: ADULT COMPLICATIONS OF A CHILDHOOD DISEASE

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Varicella has drastically declined since 1995 when vaccination was introduced in the United States. Children accounted for the majority of cases but adults were more likely to develop complicated disease. Pneumonia has been shown to be disproportionally present in adults and we present two such cases of varicella pneumonia. CASE PRESENTATION: A 25-year-old male who recently immigrated from Guatemala presented with a rash that began on his face and spread down to his trunk. He noted a dry cough, shortness of breath, fevers, sore throat and lethargy. He was febrile and tachycardic with a widespread vesicular rash, and lesions in varying stages of healing. His CT noted nodular opacities in the mid and upper lungs with a prominent 13mm nodule in the right apex. He was found to have a bandemia and a positive varicella IgM. He was treated with a course of IV acyclovir and was discharged with a plan to obtain repeat imaging to follow up the nodules.A 38-year-old man with polysubstance use and asthma presented with shortness of breath and a rash that started on his scalp and descended to his chest and back associated with a burning sensation. He had a cough without sputum production. He was afebrile on exam and had a diffuse rash over the face and trunk consistent with chickenpox. The initial CXR showed bilateral infiltrates and CT chest noted numerous pulmonary nodules throughout both lung fields. Atypical infection was the initial concern but a broad workup was otherwise unrevealing other than a positive zoster IgM. He was treated with valacyclovir and discharged with a plan for repeat imaging. DISCUSSION: With varicella vaccination efforts, incidence, hospitalizations and deaths have all decreased since 19954. Adults are more prone to pneumonia, which has been reported as the leading cause of complicated disease in adults, up to 1/400 patients, but total incidence is likely difficult to assess as many patients with mild symptoms may not have radiographs. Smoking, pregnancy, immunosuppression and male sex are considered risk factors for pneumonia. On xray diffuse bilateral infiltrates and nodularity can be seen, while CTs can show nodular opacities, patchy ground glass opacities, or even a miliary pattern that generally resolve as the rash does, but can persist as calcified nodules. CONCLUSIONS: These cases highlight the need for providers to be able to recognize vaccine preventable diseases, especially in patients not born in the United States. With the current climate of vaccine hesitancy, it is likely health care providers will experience the ill effects of adult varicella in the future as unvaccinated children become adults susceptible to more invasive disease. REFERENCE #1: Alanezi, M. (2007). Varicella pneumonia in adults: 13 Years' experience with review of literature. Annals of Thoracic Medicine, 2(4), 163–165. https://doi.org/10.4103/1817-1737.36551 REFERENCE #2: Franquet, T. (2011). Imaging of pulmonary viral pneumonia. Radiology, 260(1), 18–39. https://doi.org/10.1148/radiol.11092149 REFERENCE #3: Guris, D., Jumaan, A. O., Mascola, L., Watson, B. M., Zhang, J. X., Chaves, S. S., Gargiullo, P., Perella, D., Civen, R., & Seward, J. F. (2008). Changing varicella epidemiology in active surveillance sites - United States, 1995-2005. Journal of Infectious Diseases, 197(SUPPL. 2), 71–75. https://doi.org/10.1086/522156 DISCLOSURES: No relevant relationships by Jacqueline Burnell, source=Web Response No relevant relationships by Rohit Gupta, source=Web Response No relevant relationships by Truong-An Ho, source=Web Response

Varicella Pneumonia in an Elderly Patient

Varicella pneumonia is a common complication in adults, while it is a mild and self-limiting disease inchildren. Elderly patients may have severe manifestations compared to adults due to the weakening oftheir immune system in clearing the virus. Treatment with intravenous acyclovir and varicella-zosterimmunoglobulin (VZIG) offers a good prognosis, while the use of steroids is still debated. Despite standardmanagement, our case presents a fatality in an older woman with varicella pneumonia.

Varicella Zoster in pregnancy

Chickenpox during pregnancy can cause serious complications for both mother and fetus. This includes varicella pneumonia in the mother, fetal varicella syndrome and varicella of newborn. Primary prevention includes vaccination against varicella infection and is part of standard childhood immunisation programme in many countries. Timely post-exposure prophylaxis of susceptible pregnant women with varicella zoster immunoglobulin is key to preventing chickenpox during pregnancy and its adverse fetomaternal sequelae. Antiviral therapy and appropriate supportive treatment improve maternal and neonatal outcomes

Various Complications of Chickenpox in Admitted Patients; 2017 Perspective

Background: Chickenpox is a benign disease occurring in both children and adults. Common symptoms of disease include fever, generalized body rash, itching, fatigue, headache and body aches. The complications of the disease include respiratory, gastrointestinal, neurological, hematological and cardiac complications. These complications are more common in adult population. Estimated mortality from chickenpox is 31/100,000 in adults. Chickenpox pneumonia is the most serious complication followed by encephalitis. Objective: To highlight the various complications of chickenpox present in adult population of Faisalabad and its adjoining cities. Study Design: retrospective cross-sectional observational study. Settings: Department of Medicine, Allied Hospital, Faisalabad Pakistan. Duration: One year, January 2017 to December 2017. Methodology: Record of the admitted 350 patients was obtained, and Patients’ charts were reviewed with special emphasis on various complications of chickenpox. The patients included were above the age of 14 years and the diagnosis of chickenpox was made on clinical grounds. The diagnosis of complications was made with the help of laboratory and radiological investigations. Results: In our study 350 patients facing complications from chickenpox, from various regions of Faisalabad. Majority of them suffered from secondary bacterial skin infection i.e. 75 patients. Sepsis and ARDS turned out to be some of the major concerns for patients as well, as 31patients developed Sepsis and 29 patients suffered from ARDS respectively. Hepatitis, Myocarditis and Encephalitis were among the major issues affecting 11, 12 and 9 patients respectively. Conclusion: Chicken Pox can present with life threatening complications in adult population. Awareness of general population about the disease, its prevention, early detection and start of appropriate treatment can prevent development of complications and help reduce mortality and morbidity from the disease.

Alveolar barrier disruption in varicella pneumonia is associated with neutrophil extracellular trap formation.

Primary varicella-zoster virus (VZV) infection in adults is often complicated by severe pneumonia, which is difficult to treat and is associated with high morbidity and mortality. Here, the simian varicella virus (SVV) nonhuman primate (NHP) model was used to investigate the pathogenesis of varicella pneumonia. SVV infection resulted in transient fever, viremia, and robust virus replication in alveolar pneumocytes and bronchus-associated lymphoid tissue. Clearance of infectious virus from lungs coincided with robust innate immune responses, leading to recruitment of inflammatory cells, mainly neutrophils and lymphocytes, and finally severe acute lung injury. SVV infection caused neutrophil activation and formation of neutrophil extracellular traps (NETs) in vitro and in vivo. Notably, NETs were also detected in lung and blood specimens of varicella pneumonia patients. Lung pathology in the SVV NHP model was associated with dysregulated expression of alveolar epithelial cell tight junction proteins (claudin-2, claudin-10, and claudin-18) and alveolar endothelial adherens junction protein VE-cadherin. Importantly, factors released by activated neutrophils, including NETs, were sufficient to reduce claudin-18 and VE-cadherin expression in NHP lung slice cultures. Collectively, the data indicate that alveolar barrier disruption in varicella pneumonia is associated with NET formation.

Varicella pneumonia in an immunocompromised adult: Not always fatal !

Varicella pneumonia in an immunocompromised adult: Not always fatal !

A case of varicella pneumonia in healthy adult

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