Severe adult chickenpox infection requiring intensive care

Abstract

Introduction: Chickenpox (varicella) in adults can be severe with increased mortality. This study investigated the clinical presentation and outcome of 12 adult chickenpox patients requiring intensive care.

Materials and methods: A retrospective, observational study was performed in an adult medical intensive care unit of a university-affiliated hospital involving consecutive patients with varicella admitted over 4 years (1997-2000).

Results: The 12 patients had a mean +/- SD age of 40 +/- 20 (range, 15 to 86) years. Two patients were above 65 years old (aged 73 and 86 years). All but 1 were male. None had previous varicella vaccination. Six patients had direct exposure to persons with chickenpox infection. Four patients had underlying pulmonary pathology: past pulmonary tuberculosis (2), emphysema (1) and recurrent right pleural effusion from autoimmune serositis (1). The mean APACHE II score was 14.2 (range, 6 to 26). Ten patients had varicella pneumonia (of whom 2 had acute respiratory distress syndrome and 5 had acute lung injury), 1 had chickenpox encephalitis and 1 patient presented concomitantly with diabetic ketoacidosis. The median duration of stay in the intensive care unit (ICU) was 11 days (range, less than 1 day to 76 days). Nine patients (75%) required mechanical ventilation (median duration, 14 days; range, less than 1 day to 79 days). All patients were treated with acyclovir. There were 3 deaths (25%); 2 were above 65 years old and 1 was 37 years old with acute myeloid leukaemia on chemotherapy.

Conclusion: Patients with varicella infection requiring intensive care carry significant mortality. In our series, old age appears to be associated with increased mortality (P = 0.045).