Outcome of chicken pox in adult immunocompetent patients
Keywords:
Chicken pox, immunocompetent adults, evolution of disease, complicationsAbstract
Objective To observe the outcome of chicken pox in adult immunocompetent patients. Patients and methods In this cross-sectional analytical study, during a period of 14 months starting from May 2003 to Jun 2004, 200 adult patients aged between 15 and 40 were hospitalized and observed for the evolution of chicken pox after carefully fulfilling the exclusion and inclusion criteria. Patients were assessed by history, clinical examination and relevant laboratory investigations. The disease was subjectively categorized as mild, moderate and severe according to the intensity of eruption. Number of days required till resolution of infection was noted. Treatment was prescribed as per the protocol according to the severity of disease. Complications were noted among all the patients. Results 181 (90.5%) of our patients had mild/moderate infection and were treated symptomatically, while 19 (9.5%) had severe eruption and were given acyclovir. Mean age of patients was 23.3±5.41 years (range 15-40 years). 183 (90.3%) were males and 17 (9.5%) were females. Mean resolution time was 7.75 (+/-3.12) days in mild/moderate cases and 7.68 (+/-3.86) days in severe cases. 4 (2%) cases of bacterial superinfection and 1 (0.5%) case of varicella pneumonia was diagnosed and treated. Conclusion Chicken pox in adult patients in our population presents as a mild infection in majority of the patients. The rate of complications is low as compared to western population.References
Mohsen AH, McKendrick M. Varicella pneumonia in adults. Eur Respir J 2003; 21: 886-91.
Wharton M. The epidemiology of varicella-zoster virus infections. Infect Dis Clin North Am 1996; 10: 571-81.
Choo PW, Donahue JG, Manson JE, Platt R. The epidemiology of varicella and its complications. J Infect Dis 1995; 172: 706-12.
Akram DS, Qureshi H, Mahmud A et al. Seroepidemiology of varicella-zoster in Pakistan. Southeast Asian J Trop Med Public Health 2000; 31: 646-9.
Saha SK, Darmstadt GL, Hanif M, Khan R. Seroepidemiology of varicella-zoster virus in Bangladesh. Ann Trop Paediatr 2002; 22: 341-5.
Barnett ED, Christiansen D, Figueira M. Seroprevalence of measles, rubella, and varicella in refugees. Clin Infect Dis 2002; 35: 403-8.
Lokeshwar MR, Agrawal A, Subbarao SD et al. Age related seroprevalence of antibodies to varicella in India. Indian Pediatr 2000; 37: 714-9.
Klassen TP, Belseck EM, Wiebe N, Hartling L. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev 2002; *(4):CD002980.
Fleming DM, Cross KW, Cobb WA, Chapman RS. Gender difference in the incidence of shingles. Epidemiol Infect 2004; 132: 1-5.
Galil K, Brown C, Lin F, Seward J. Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J 2002; 21: 931-5.
Snoeck R, Andrei G, De Clercq E. Current pharmacological approaches to the therapy of varicella zoster virus infections: a guide to treatment. Drugs 1999; 57: 187-206.
Nguyen H, Jumaan A, Seward J. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Eng J Med 2005; 335: 450-8.
Rentier B, Gershon AA for European Working Group on Varicella. Consensus: varicella vaccination of healthy children - a challenge for Europe. Pediatr Infect Dis J 2004; 23: 379-89.
Rawson H, Crampin A, Noah N. Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data. BMJ 2001; 323: 1091-3.
Bhave SY. Controversies in chicken-pox immunization. Indian J Pediatr 2003; 70: 503-7.
Bari A, Rehman S. Hematological abnormalities in adult patients of chicken pox. J Pak Assoc Dermatol 2004; 14: 193-7.
Bhatti MA, Manglani CB, Khan MA. Fatal case of chickenpox in an Adult: A case report. J Pak Med Assoc 2004; 54: 104-6.
Ho BC, Tai DY. Severe adult chickenpox infection requiring intensive care. Ann Acad Med Singapore 2004; 33: 84-8.
Balfour HH Jr, Edelman CK, Anderson RS et al. Controlled trial of acyclovir for chickenpox evaluating time of initiation and duration of therapy and viral resistance. Pediatr Infect Dis J 2001; 20: 919-26.
