Varicella Complications Research Articles

PIN1 - The Chickenpox Complications and Financial Burden in Healthy Children and with Underlying a Comorbidity During the Pre Vaccine and Post Vaccine Era in a University Hospital

PIN1 - The Chickenpox Complications and Financial Burden in Healthy Children and with Underlying a Comorbidity During the Pre Vaccine and Post Vaccine Era in a University Hospital

Severe Varicella Pneumonia in an Immunocompetent Infant: A Case Report

Primary varicella infection (chickenpox) is a common and highly contagious infection caused by varicella-zoster virus (VZV) with a benign outcome during childhood. However, serious complications and death may occur in newborns, adults and in immunocompromised patients, and during pregnancy. VZV pneumonia is a common and life-threatening chickenpox-related complication, particularly in healthy adults. This complication occurs infrequently in children, is even more rarely in infants, and can result in fatal outcomes. We report a case of severe hypoxemic pneumonia occurring during the eruptive phase of varicella in a previously healthy 17-month-old infant, which was associated with a favorable clinical course. Based on the available data, we attempt to discuss the main aspects of diagnosis, treatment, prevention, and prognosis of this pulmonary complication of varicella.

Varicella complications and universal immunization

Varicella complications and universal immunization

Chickenpox and shingles: one virus, two diseases and current vaccination recommendations in Switzerland

Adults, pregnant women, premature babies and immunocompromised persons are at increased risk for varicella complications. Therefore the current Swiss vaccination recommendations against varicella include a general recommendation for 11 to 15 year old adolescents with a negative varicella history, as well as a specific recommendation for risk groups. The goal of both recommendations is to reduce varicella complications in persons most at risk. The vaccine is not universally recommended for all toddlers in Switzerland, while this is the case in some countries such as the United States. Pros and cons of different vaccination strategies, as well as possible short- and long-term effects on herpes zoster incidence are taken into account. In the United States, there was a marked decline in incidence and hospitalisations, but an increased herpes zoster incidence in the short term. Finally, public health aspects of herpes zoster, post-herpetic neuralgia and possible vaccination strategies are outlined.

Varicella complications and universal immunization

Varicella complications and universal immunization

Chicken pox infection in patients undergoing chemotherapy: A retrospective analysis from a tertiary care center in India.

There is paucity of data on the incidence, severity and management of chicken pox in patients receiving active chemotherapy for cancer. From October 2010 to October 2011, patients were included in this study if they developed a chicken pox infection during their chemotherapy. The details of patients' cancer diagnosis and treatment along with clinical and epidemiological data of the chicken pox infections were assessed from a prospectively maintained database. Twenty-four patients had a chicken pox infection while receiving chemotherapy and/or radiotherapy. The median age of the patients was 21 years, and two-thirds of the patients had solid tumor malignancies. Overall, eight (33%) patients had complications, six (25%) patients had febrile neutropenia, four (17%) had diarrhea/mucositis, and four (17%) had pneumonia. The median time for recovery of the infection and complications in the patients was 9.5 days (5-29 days), whereas for neutropenic patients, it was 6.5 days (3-14 days). The median time for recovery from chicken pox infections in neutropenic patients was 10 days (5-21 days), compared with 8.5 days (0-29 days) in non-neutropenic patients (P=0.84). The median time for recovery from infections was 8.5 days in patients with comorbidities (N=4), which was the same for patients with no comorbidities. The clinical presentation and complication rates of chicken pox in cancer patients, who were on active chemotherapy, are similar to the normal population. The recovery from a varicella infection and complications may be delayed in patients with neutropenia. The varicella infection causes a therapy delay in 70% of patients. Aggressive antiviral therapy, supportive care and isolation of the index cases remain the backbone of treatment.

Postvaricella Bacterial Endocarditis Complicating as Cerebral Abscess—A Case Report

Chickenpox is generally a benign childhood illness. However, complications of chickenpox can endanger life if not recognized promptly. This is a report of a previously healthy 8-month-old female infant who presented with recrudescence of fever, irritability, and signs of congestive heart failure 2 weeks after initial varicella infection. Investigations revealed endocarditis and left frontal lobe cerebral abscess. She was managed effectively with antibiotics and supportive care. The case highlights the need for close follow-up of primary varicella and early recognition of its complications.

Complications of Varicella in Unvaccinated Children From Romania, 2002-2013: A Retrospective Study.

The epidemiologic and clinical pattern of varicella-related hospitalizations recorded during 2002-2013 in Romania showed the highest hospitalization rate in the 0-1 year age group. Younger age and diagnosis after 2007 were independent predictors of varicella-related complications, recorded in half of the hospitalized cases.

Varicella Gangrenosa of Abdominal Wall: Rare but Fatal Complication of Varicella Even in Immunocompetent Healthy Children

Introduction: Varicella gangrenosa is an uncommon but serious complication of chicken pox in young children. It should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area, along with increasing fever, erythema, lethargy, and irritability. Early surgical intervention with intensive antibiotic therapy is essential to prevent fatal consequences. Case Presentation: We describe a case of a previously healthy child who presented with sepsis due to varicella gangrenosa. While she initially responded well to a conservative antibiotic and acyclovir treatment, her subsequent rapid deterioration required urgent and repeated debridement. Conclusions: This report highlights the significance of prompt diagnosis and early surgical intervention for management of varicella gangrenosa.

A commentary on “Varicella pneumonia in an immunocompetent adult: A case report”

Clinicians are typically quite familiar with chickenpox and with pneumonia, but not necessarily pneumonia due to varicella-zoster virus (VZV). In the US, prior to the varicella vaccine being released in 1995, chicken pox was nearly universal in children less than 15 years of age. This left few people to get chicken pox as an adult, and even less who actually got pneumonia; hence, many physicians are unfamiliar with varicella pneumonia. There were approximately 4 million cases yearly [1]. Mortality for chickenpox has always been low with only about 2 deaths per 100,000 cases. Because it is more severe in adults, the mortality rate is slightlyhigher at 15 deaths per 100,000 cases. A typical case involves a characteristic rash, fever and malaise. The “pox” are 5 mm raised, well-circumscribed, fleshcolored, erythematous vesicles that progress to ooze serous fluid, then become nodular, centrally umbilicated, and eventually crust over. They can coalesce to form patches. The various lesions spread centrifugally starting on the face and trunk, and are in different stages of progression, which distinguishes them from the uniform lesions of smallpox. There are several complications of chickenpox that can occur weeks or even decades later. Herpes zoster, or shingles, is the reactivation of VZV from a dorsal root ganglion or cranial nerve ganglion resulting in a painful, vesicular rash along the dermatome of the associated ganglion. Subsequently to that, cerebral angiitis can occur after reactivation of VZV from the trigeminal ganglion along the V 1 cranial nerve. Most complications, however, occur at the time of the initial chickenpox infection. Neurologic complications typically involve ataxia, which may be accompanied most notably by vomiting, vertigo, tremor, and dysarthria. When it occurs it is usually in children and is reversible. Encephalitis may also occur and is more serious with an altered sensorium, headaches, vomiting, fever and frequent seizures. Between 5 and 20% of those patients die, and up to 15% have neurologic sequelae. Varicella pneumonia is another serious complication in adults that can occur as a complication of chickenpox. Significant pneumonia typically occurs in immunosuppressed children or adults, but if it is in adults it accounts for a greater degree of morbidity and mortality. It only affects 2.3 of 400 cases of adult patients with chickenpox [2]. Once the rash starts, if pneumonia ensues, it is usually one to six days later. Symptoms include tachypnea, a nonproductive cough, dyspnea and fever. They may be worse in pregnant patients. The chest radiograph shows diffuse involvement of both lungs with interstitial pneumonitis, possibly with a nodular

Chickenpox: An update

Chickenpox, caused by the varicella-zoster virus, is mostly a mild disease in healthy children, but can be debilitating in immunocompromised individuals or susceptible adults. The disease is highly contagious. The lesions start as rose-colored macules, and progress rapidly to become papules, vesicles with the classic “dew drop on a rose petal” appearance, pustules and, finally, crusts. The distribution of the lesions is typically central, with the greatest concentrations on the trunk. Characteristically, lesions are intensely pruritic and appear in crops. The most common complication associated with chickenpox is secondary bacterial infections of the skin followed by post-inflammatory scarring of the lesions. The diagnosis is mainly clinical and treatment symptomatic. Oral acyclovir should be considered in high-risk individuals. Intravenous acyclovir is effective for the treatment of chickenpox in immunocompromised individuals and for serious complications of chickenpox in normal patients. To eradicate chickenpox, universal childhood immunization with varicella vaccine is the way to go. The Advisory Committee for Immunization Practices of the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend a routine two-dose varicella vaccination program for children, with the first dose administered at 12 to 18 months and the second dose at 4 to 6 years of age. The Advisory Committee on Immunization Practices further recommends two doses of varicella vaccine, 4 to 8 weeks apart, for all susceptible adolescents and adults and a catch-up second dose for everyone who received one dose of varicella vaccine previously.

Rare complications of chickenpox in children

Chickenpox, caused by varicella-zoster virus, is a common infection of childhood, especially in developing countries like India, where immunization coverage is low. Fifty percent of children are infected by 5 years of age and 90% by 12 years of age. Though the disease usually runs a benign, self limited course, yet in severe infections life threatening complications may develop. Deep vein thrombosis and spreading infective necrotizing fascitis are very rare complications of this disease. We report here two cases of surgical emergencies associated with varicella and review the literature.

Hospitalization for varicella in Israel in the pre vaccination era

Although varicella is considered a common benign childhood infection, it accounts for significant morbidity and, in rare cases, may cause death. During the last years, a live attenuated vaccine is available, but has not been routinely incorporated into the vaccination program in Israel. In order to determine the magnitude of varicella complications and the epidemiology of the disease, we retrospectively studied records of 304 children with varicella hospitalized in a single medical center in Israel over a six-year period. Mean age of the patients was 2 years and 9 months (range: 2 weeks-21 years), and mean hospital stay was 4.5 days. Two hundred thirty-three patients (77%) were otherwise healthy and 71 (23%) had an underlying disease. The majority of children (n = 252, 83%) were hospitalized because of complications, mainly skin and soft tissue bacterial infections (n = 142, 47%), followed by pneumonia or pneumonitis (n = 56, 18%), gastrointestinal symptoms (n = 44, 14%), and central nervous system complications (n = 40, 13%), including febrile seizures (n = 25, 8%). Thirty-four children (11%) were immunocompromised and were hospitalized mainly for intravenous acyclovir treatment. There were no varicella-related deaths. Varicella continues to cause substantial morbidity and poses a significant economic burden in Israel. Further studies are needed to examine the cost-effectiveness of varicella vaccination in Israel.

Varicella paediatric hospitalisations in Belgium: a 1-year national survey.

BackgroundVaricella universal vaccination (UV) has been implemented in many countries for several years. Nevertheless, varicella UV remains debated in Europe and few data are available on the real burden of infection. We assessed the burden of varicella in Belgium through analysis of hospitalised cases during a 1-year period.MethodsData on children admitted to hospital with varicella were collected through a national network from November 2011 to October 2012. Inclusion criteria were either acute varicella or related complications up to 3 weeks after the rash.ResultsParticipation of 101 hospitals was obtained, covering 97.7% of the total paediatric beds in Belgium. 552 children were included with a median age of 2.1 years. Incidence of paediatric varicella hospitalisations reached 29.5/105 person-years, with the highest impact among those 0–4 years old (global incidence and odds of hospitalisation: 79/105 person-years and 1.6/100 varicella cases, respectively). Only 14% (79/552) of the cohort had an underlying chronic condition. 65% (357/552) of children had ≥1 complication justifying their admission, 49% were bacterial superinfections and 10% neurological disorders. Only a quarter of children (141/552) received acyclovir. Incidence of complicated hospitalised cases was 19/105 person-years. Paediatric intensive care unit admission and surgery were required in 4% and 3% of hospitalised cases, respectively. Mortality among Belgian paediatric population was 0.5/106 and fatality ratio 0.2% among our cohort.ConclusionsVaricella demonstrated a substantial burden of disease in Belgian children, especially among the youngest. Our thorough nationwide study, run in a country without varicella UV, offers data to support varicella UV in Belgium.

Complications of Varicella in Healthy Children: Is It Increasing?

Complications of Varicella in Healthy Children: Is It Increasing?

Prospective surveillance of hospitalisations associated with varicella in New Zealand children.

Varicella is a vaccine-preventable disease not notifiable in New Zealand (NZ), and varicella vaccine is not funded in the National Immunisation Schedule (NIS). Hospitalisations can occur because of bacterial secondary infection and other complications, which can result in long-term sequelae. Varicella may not be acknowledged in discharge coding when complications occur weeks after infection. Using the New Zealand Paediatric Surveillance Unit (NZPSU), the aim of this study was to document the hospitalisation burden of this disease. Cases (0-14 years) of varicella and post-varicella complications requiring hospitalisation, including stroke syndromes where varicella occurred in the preceding 6 months, were notified to NZPSU between 1 November 2011 and 31 October 2013. Herpes zoster cases were excluded. Questionnaires were used to capture demographics, clinical features, management and short-term outcomes. One hundred seventy-eight notifications were received and 144 were confirmed cases. Overall incidence was 8.3/100,000 children per year. Fifty-two percent were women with a median age of 2.4 years. Māori and Pacific Island (PI) children accounted for 74% of hospitalisations, with incidence rate ratios compared with European children of 2.8 and 3.9, respectively (P < 0.01). Complications included: infection (75%), respiratory (11%), neurological (11%), electrolyte disturbance (6%) and haemorrhagic varicella (4%). Nine percent were immunocompromised. Median duration of hospital admission was 4 days with 9% requiring intensive care admission. There were no reported deaths; however, 19% had ongoing problems at discharge. Varicella has more associated morbidity than commonly perceived in immunocompetent children. Māori and PI children are more likely to have complications. This surveillance gives support for inclusion of universal varicella vaccine in the NZ NIS.

Sağlıklı Çocuklarda Suçiçeği Komplikasyonları

Sağlıklı Çocuklarda Suçiçeği Komplikasyonları

Bacterial Complications of Chickenpox in Children

We performed retrospective cohort study to identify factors associated with bacterial complications of chickenpox in children. We included 128 children with chickenpo x who were hospitalized between 2000 and 2014. Binary logistic regression was used to reveal factors associated with bacterial complications. Male gender and age 3 to 6 years were positively associated with occurrence of invasive bacterial complications. We found association between atopic dermatitis and pyoderma (noinvasive bacterial complications of chickenpox). Prescribtion of acyclovir decreased the odds of invasive bacterial complications.

Autologous Peripheral Blood Stem Cells and &amp;lt;i&amp;gt;γ&amp;lt;/i&amp;gt;/&amp;lt;i&amp;gt;δ&amp;lt;/i&amp;gt; T Cells May Improve Immunity in Treating Secondary Bacteremic Infection in HIV Infected Patient

Opportunistic bacteremia in adult HIV-infected patients is a normal co-infectious condition caused by Gram-negative bacilli. Respiratory infections, including cough, shortness of breath, and chest pain and skin infection with eruptions, pustules and itchiness, are common complaints in the setting of late HIV infection. The variety of infections ranges from mild, self-limited viral, bacteremia and fungal infections to severe, life-threatening demanding urgent care and hospitalization. Varicella pneumonia, for instance, is the most severe complication of chickenpox in HIV infected adults, potentially refractory, fulminant respiratory failure can ensue. Patients with impaired immune status and chronic lung disease are at an increased risk. In the United States as well as in Vietnam, bacterial/viral pneumonia and skin infection are the two most common HIV-associated conditions. While globally the incidence of opportunistic infection has decreased since the introduction of highly active antiretroviral therapy during the last 3 decades, HIV-associated diseases remain a significant source of mortality, thus any manifestation must be taken seriously. This study will present the most common HIV-related pulmonary and skin infections and provide an overview of the epidemiology, characteristic clinical and chest radiograph findings, diagnosis, treatment, and prevention globally as well in Vietnam. Though the extensive efforts of the Vietnamese Government during last decade contributed to a valuable decrease, yet epidemic in Vietnam still remains high, ranking Vietnam 5th in the South-East region. The second part of the study focuses on a unique and severe HIV case report of a 35-year-old man, with a rare form of pneumonia caused by Acitenobacter spp. concomitant with a prolonged and disseminating skin infection. The case has been treated with a combination of conventional anti-retroviral medication and autologous peripheral blood stem cells, the results showed that within 5 months there was an impressive amelioration of HIV viral activity together with a total recovery from pneumonia and skin infection.

Post varicella angiopathy-a case report

Chickenpox is a common viral illness in children. In most of the immunocompitent children it’s a self-limiting disease and seldom causes complications. Neurological complications are one of the rare complications of chickenpox. These complications may present as hemiparesis, focal deficits and arterial ischemic strokes (AIS). These Ischemic strokes may be a manifestation of post varicella angiopathy. Here we present a case of 11 year old girl who presented with left hemiparesis with left sided facial nerve palsy 15 days after chickenpox. An MRI was done which was suggestive of multiple infarcts in cortical and subcortical regions and MR angiography was suggestive of narrowing of right middle cerebral artery. Patient was treated with aspirin and LMW heparin in addition to supportive measures.