Severity of illness and outcome in adult patients with primary varicella pneumonia.
BACKGROUND
Varicella pneumonia is a serious complication of primary varicella infection in adults that often results in respiratory failure and death.


OBJECTIVE
To analyze the clinical and laboratory manifestations of primary varicella pneumonia in patients admitted to our intensive care unit (ICU).


METHODS
Retrospective study on patients treated in our ICU with a diagnosis of primary varicella pneumonia during a period of 15 years. We recorded age, gender, smoking habits, clinical and laboratory findings, arterial blood gases, chest radiograph, illness severity (SAPS II), length of stay, necessity for mechanical ventilation, complications, therapy and survival. We examined the influence of the duration of respiratory symptoms and rash prior to admission, and the influence of illness severity on outcome.


RESULTS
There was a statistically significant difference in duration of respiratory symptoms, duration of rash and SAPS II on admission between: (a) mechanically ventilated patients vs. spontaneously breathing patients (p < 0.007, p < 0.00, p < 0.00), (b) patients who survived vs. patients with poor outcome (p < 0.001, p < 0.000, p < 0.000), and (c) mechanically ventilated patients with poor outcome vs. mechanically ventilated patients who survived (p < 0.001, p < 0.00, p < 0.000). Overall mortality was 13.6%; death occurred only in mechanically ventilated patients (mortality 33.3%).


CONCLUSIONS
Primary varicella pneumonia remains a critical problem with significant mortality. When recognized before respiratory failure ensues and mechanical ventilation becomes mandatory, patients could have an excellent outcome. Adult patients who delay asking for medical support, the disease may lead to the need for mechanical ventilation and severe complications with a fatal outcome.
Gregorakos
Leonidas
L
Athens University School of Nursing, Intensive Care Unit at Trauma Hospital of Athens, Kifisia, Athens, Greece. ektelestiko@pasok.gr
Myrianthefs
Pavlos
P
Markou
Nikolaos
N
Chroni
Despina
D
Sakagianni
Ekaterini
E
D000293:Adolescent; D000328:Adult; D002644:Chickenpox / Q000150:complications*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index