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Shah HA, Meiwald A, Perera C, Casabona G, Richmond P, Jamet N. Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis. Infect Dis Ther 2024; 13:79-103. [PMID: 38117427 PMCID: PMC10828225 DOI: 10.1007/s40121-023-00899-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Varicella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates. METHODS Two databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis. RESULTS Pooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13-37.77), skin-related complications (20.12%; 95% CI 15.48-25.20), and infection-related complications (10.03%; 95% CI 7.47-12.90). Cardiovascular (0.55%; 95% CI 0.08-1.33), genitourinary (1.17%; 95% CI 0.55-1.99), and musculoskeletal (1.54%; 95% CI 1.06-2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses. CONCLUSION Results suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease.
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Affiliation(s)
| | | | | | | | - Peter Richmond
- University of Western Australia School of Medicine, Telethon Kids Institute and Perth Children's Hospital, Nedlands, Australia
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Denny JT, Rocke ZM, McRae VA, Denny JE, Fratzola CH, Ibrar S, Bonitz J, Tse JT, Cohen S, Mellender SJ, Kiss GK. Varicella Pneumonia: Case Report and Review of a Potentially Lethal Complication of a Common Disease. J Investig Med High Impact Case Rep 2018; 6:2324709618770230. [PMID: 29707592 PMCID: PMC5912273 DOI: 10.1177/2324709618770230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 01/31/2023] Open
Abstract
Varicella zoster virus causes varicella (chickenpox). It can be reactivated endogenously many years later to cause herpes zoster (shingles). Although varicella is usually a benign disease in healthy children, it resulted in over 11 000 hospitalizations and over 100 deaths every year, in all ages, in the United States. Morbidity was considerably worse in older teenagers and adults. Between 5% and 15% of cases of adult chickenpox will produce some form of pulmonary illness. Progression to pneumonia risk factors include pregnancy, age, smoking, chronic obstructive pulmonary disease, and immunosuppression. Typically, pulmonary symptoms occur 1 to 6 days after varicella zoster infection. They often include cough, fever, and dyspnea. Treatment is a 7-day course of intravenous acyclovir for varicella pneumonia. Early intervention may modify the course of this complication. This review illustrates practical features with a case of a 34-year-old female with severe varicella pneumonia. Despite the lack of significant past medical history and absence of immunosuppression, her pneumonia worsened and by using continuous positive airway pressure mask, intubation was avoided. More important, the radiographic progression of severe varicella pneumonia is shown. This highlights how a common disease of varicella can progress in an adult and manifest with significant organ malfunction.
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Affiliation(s)
| | - Zoe M Rocke
- St. George's University, St. George, Grenada
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Tong T, Wong O, Kwan G, Chan K. A Case of Severe Varicella Pneumonia Requiring Extracorporeal Membrane Oxygenation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 35-year-old male Nigerian suffered from severe varicella pneumonia, which was complicated by severe acute respiratory distress syndrome, acute kidney injury and acute hepatitis. He developed persistent hypoxia despite maximum mechanical ventilation support requiring veno-venous extracorporeal membrane oxygenation. He recovered well with the treatment and the pulmonary infiltrates in the chest X-ray resolved within 5 days after the onset of respiratory failure. He was eventually discharged without major sequelae.
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Affiliation(s)
- Tmc Tong
- Tuen Mun Hospital, Department of Anaesthesia and Intensive Care, Tsing Chun Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Of Wong
- Tuen Mun Hospital, Department of Anaesthesia and Intensive Care, Tsing Chun Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Gwm Kwan
- Tuen Mun Hospital, Department of Anaesthesia and Intensive Care, Tsing Chun Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Kkc Chan
- Tuen Mun Hospital, Department of Anaesthesia and Intensive Care, Tsing Chun Koon Road, Tuen Mun, New Territories, Hong Kong
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Spezifische Infektionen. DIE INTENSIVMEDIZIN 2015. [PMCID: PMC7123516 DOI: 10.1007/978-3-642-54953-3_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Naveen Voore
- Internal Medicine Residency Program, MedStar Franklin Square Medical Center, Baltimore, MD, USA.
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Spezifische Infektionen. DIE INTENSIVMEDIZIN 2011. [PMCID: PMC7123933 DOI: 10.1007/978-3-642-16929-8_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In diesem Kapitel wird auf die Infektionen eingegangen, die nicht im Rahmen der einzelnen Erkrankungsentitäten in den übrigen Kapiteln behandelt werden. Der Schwerpunkt liegt dabei auf den Infektionen bzw. Erregern, die auch dem Intensivmediziner häufiger begegnen können. Fragestellungen außerhalb dieser Gruppe sollten mit Hilfe spezieller Literatur beantwortet werden, Hilfestellungen geben auch die Verweise auf Webseiten am Ende des Kapitels.
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Oh JY, Choi JW, Kim SJ, Shin C, Kim JH. Varicella-Zoster Virus Pneumonia in Immunocompetent Adults. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.4.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jee Youn Oh
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jung-Woo Choi
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se Joong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Tunbridge AJ, Breuer J, Jeffery KJM. Chickenpox in adults - clinical management. J Infect 2008; 57:95-102. [PMID: 18555533 DOI: 10.1016/j.jinf.2008.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/06/2008] [Accepted: 03/09/2008] [Indexed: 01/30/2023]
Abstract
Acute varicella zoster virus (VZV) infection, or chickenpox, is still perceived by many as a mild infection of childhood. However, chickenpox is increasingly common in adults and adolescents who together with immunosuppressed individuals are at a higher risk of severe infection. Antiviral therapy is available which both ameliorates symptoms and decreases the severity of chickenpox if administered early in the course of the infection. Passive immunisation with varicella zoster immunoglobulin (VZIG) may prevent or attenuate infection following exposure to varicella of an immunocompromised or pregnant individual or a neonate. Active immunisation is available and is universal in many developed countries. This review reflects current best practice in management of chickenpox in adults by specialist physicians in the UK. The accompanying flowchart has been formulated to guide emergency physicians and general practitioners through the decision-making process regarding treatment and admission for specialist care.
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Affiliation(s)
- A J Tunbridge
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX, Perella D, Mascola L, Seward JF. Varicella among adults: data from an active surveillance project, 1995-2005. J Infect Dis 2008; 197 Suppl 2:S94-S100. [PMID: 18419417 DOI: 10.1086/522155] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report detailed population-based data on varicella among adults. In 2 US varicella active surveillance sites with high vaccine coverage among young children, the incidence of varicella among adults declined 74% during 1995-2005. A low proportion (3%) of adults with varicella had been vaccinated, with no improvement over the decade of program implementation, suggesting that the decline was likely secondary to herd-immunity effects. Compared with children, adults had more severe varicella in terms of both clinical presentation and frequency of complications. However, <30% of adults with varicella were treated with acyclovir. Among adolescents, illness severity was intermediate between that in children and adults. Varicella cases are preventable through vaccination. As we enter the second decade of the varicella vaccination program in the United States, we need to ensure that susceptible adolescents and adults are adequately protected from varicella by vaccination and that those who acquire varicella are appropriately treated with effective antiviral treatment.
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Affiliation(s)
- Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Adhami N, Arabi Y, Raees A, Al-Shimemeri A, Ur-Rahman M, Memish ZA. Effect of corticosteroids on adult varicella pneumonia: cohort study and literature review. Respirology 2006; 11:437-41. [PMID: 16771913 DOI: 10.1111/j.1440-1843.2006.00870.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Varicella pneumonia (VP) is a serious entity associated with morbidity and mortality. There have been sporadic reports using corticosteroids in life-threatening VP. We report a case series of VP to examine the outcome and the effect of corticosteroid use. METHODS A retrospective chart review was conducted on all adult patients admitted to a tertiary care hospital with VP during a 14-year period. We documented oxygenation (SpO2, PaO2/FIO2) on admission and after 48 h, whether the patients were admitted to an intensive care unit (ICU), the use of mechanical ventilation, ICU and hospital length of stay (LOS) and patient outcome. We compared those patients who received corticosteroids with those who did not. RESULTS We identified 19 patients with VP. Ten received corticosteroids, in addition to antiviral and supportive treatment. Patients who received corticosteroids were significantly more hypoxaemic on admission and all were admitted to ICU with seven of them intubated. Only two of the nine in non-steroid group were intubated. Despite their greater severity, the corticosteroid group showed a much more rapid improvement in oxygenation and a trend towards shorter duration of mechanical ventilation. The duration of ICU and hospital LOS were not significantly different. All patients survived. CONCLUSIONS Corticosteroids in severe VP accelerate the physiological recovery and may shorten the duration of mechanical ventilation.
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Affiliation(s)
- Naeem Adhami
- Department of Intensive Care Medicine & Infection prevention & control, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
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Lambert C, McCue J, Portas M, Ouyang Y, Li J, Rosano TG, Lazis A, Freed BM. Acrolein in cigarette smoke inhibits T-cell responses. J Allergy Clin Immunol 2005; 116:916-22. [PMID: 16210070 DOI: 10.1016/j.jaci.2005.05.046] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 05/24/2005] [Accepted: 05/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cigarette smoking inhibits T-cell responses in the lungs, but the immunosuppressive compounds have not been fully identified. Cigarette smoke extracts inhibit IL-2, IFN-gamma, and TNF-alpha production in stimulated lymphocytes obtained from peripheral blood, even when the extracts were diluted 100-fold to 1000-fold. OBJECTIVE The objective of these studies was to identify the immunosuppressive compounds found in cigarette smoke. METHODS Gas chromatography/mass spectroscopy and HPLC were used to identify and quantitate volatile compounds found in cigarette smoke extracts. Bioactivity was measured by viability and production of cytokine mRNA and protein levels in treated human lymphocytes. RESULTS The vapor phase of the cigarette smoke extract inhibited cytokine production, indicating that the immunosuppressive compounds were volatile. Among the volatile compounds identified in cigarette smoke extracts, only the alpha,beta-unsaturated aldehydes, acrolein (inhibitory concentration of 50% [IC50] = 3 micromol/L) and crotonaldehyde (IC50 = 6 micromol/L), exhibited significant inhibition of cytokine production. Although the levels of aldehydes varied 10-fold between high-tar (Camel) and ultralow-tar (Carlton) extracts, even ultralow-tar cigarettes produced sufficient levels of acrolein (34 micromol/L) to suppress cytokine production by >95%. We determined that the cigarette smoke extract inhibited transcription of cytokine genes. The inhibitory effects of acrolein could be blocked with the thiol compound N-acetylcysteine. CONCLUSION The vapor phase from cigarette smoke extracts potently suppresses cytokine production. The compound responsible for this inhibition appears to be acrolein.
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Affiliation(s)
- Cherie Lambert
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA
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Obón Azuara B, Gutiérrez Cía I, Villanueva Anadón B, Luque Gómez P. [Severe varicella pneumonia in adults: admission in the hospital and critical care transfer]. Med Clin (Barc) 2005; 125:356-7. [PMID: 16185639 DOI: 10.1157/13078774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schvoerer E, Frechin V, Warter A, Gasser B, Jouin H, Gut JP, Stoll-Keller F. Persistent multiple pulmonary nodules in a nonimmunocompromised woman after varicella-related myelitis treated with acyclovir. J Clin Microbiol 2004; 41:4904-5. [PMID: 14532257 PMCID: PMC254342 DOI: 10.1128/jcm.41.10.4904-4905.2003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Persistent multiple pulmonary nodules were observed on the chest X ray of a nonimmunocompromised woman 6 months after she was treated with acyclovir for a varicella-related myelitis without respiratory symptoms. Early antiviral therapy given for varicella infections might decrease the intensity of clinical symptoms without actually preventing the occurrence of varicella-zoster virus-related lesions such as the persistent pulmonary nodules reported here.
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Affiliation(s)
- Evelyne Schvoerer
- Institut de Virologie de la Faculté de Médecine et Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
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Ahmed R, Ahmed QAA, Adhami NA, Memish ZA. Varicella pneumonia: another 'steroid responsive' pneumonia? J Chemother 2002; 14:220-2. [PMID: 12017381 DOI: 10.1179/joc.2002.14.2.220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Varicella-zoster virus (VZV) pneumonitis remains an often-fatal complication of VZV infection. Antiviral agents and supportive care are widely accepted therapies. Cautious use of corticosteroids in life-threatening VZV pneumonitis may be justified. Appropriate patient selection factors are as yet unidentified and the decision to commence corticosteroid therapy in this setting is clinical.
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Affiliation(s)
- R Ahmed
- Department of Critical Care Medicine, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
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