Severe Varicella Pneumonia in an Immunocompetent Infant: A Case Report

Abstract

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.

Keywords

varicella-zoster virus - pneumonia - children - immunocompetent

• References

• 1 Xu ST. Varicella [in Chinese]. Zhongguo Yi Miao He Mian Yi 2009; 15 (1) 78-82
• 2 Rebahi H, Mouaffak Y, Soraa N, Younous S. Chickenpox complicated by pneumococcal meningitis: a rare coinfection. Arch Pediatr 2014; 21 (11) 1226-1228
• 3 Mohsen AH, Peck RJ, Mason Z, Mattock L, McKendrick MW. Lung function tests and risk factors for pneumonia in adults with chickenpox. Thorax 2001; 56 (10) 796-799
• 4 Kaneko T, Ishigatsubo Y. Varicella pneumonia in adults. Intern Med 2004; 43 (12) 1105-1106
• 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 (10) 931-935
• 6 Piqueras AA, Otero RM, Pérez-Tamarit D, Asensi BF, Diosdado ON, Santos DM. Hospitalizations for varicella in the Hospital Infantil La Fe, Valencia,Spain, 2001-2004 [in Spanish]. An Pediatr (Barc) 2005; 63 (2) 120-124
• 7 Gowin E, Wysocki J, Michalak M. Don't forget how severe varicella can be—complications of varicella in children in a defined Polish population. Int J Infect Dis 2013; 17 (7) e485-e489
• 8 Hervás D, Henales V, Yeste S, Figuerola J, Hervás J. How frequent is varicella-associated pneumonia in children?. Eur J Clin Microbiol Infect Dis 2011; 30 (3) 435-437
• 9 Kuchar E, Miskiewicz K, Szenborn L, Nitsch-Osuch A. Respiratory complications in children hospitalized with varicella. Adv Exp Med Biol 2013; 788: 97-102
• 10 Pérez Llorens JC, Crusells Canales MJ, Araiz Burdio JJ, Letona Carbajo S, Millastre Benito A, Cuesta Muñoz J. Adult respiratory distress syndrome secondary to varicella pneumonia in an immunocompetent male [in Spanish]. Med Interna 1994; 11 (4) 189-191
• 11 Mermelstein RH, Freireich AW. Varicella pneumonia. Ann Intern Med 1961; 55: 456-463
• 12 Rodríguez Borregán JC, Domínguez Artiga MJ, Miñambres E , et al. Varicella pneumonia in adults: 30 cases [in Spanish]. Med Interna 2003; 20 (12) 612-616
• 13 Fraser R, Muller N, Colman N, Pare P. Fraser and Pare's Diagnosis of Diseases of The Chest. 14th ed. Philadelphia, PA: WB Saunders; 1999: 999-1004
• 14 Menéndez R, Perpiñá M, Torres A. Evaluation of nonresolving and progressive pneumonia. Semin Respir Infect 2003; 18 (2) 103-111
• 15 Rañó A, Agustí C, Jimenez P , et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax 2001; 56 (5) 379-387
• 16 Solé Violán J, Fernández JA, Benítez AB, Cardeñosa Cendrero JA, Rodríguez de Castro F. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med 2000; 28 (8) 2737-2741
• 17 Fagon JY, Chastre J, Wolff M , et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med 2000; 132 (8) 621-630
• 18 Mandell LA, Wunderink RG, Anzueto A , et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl. 02) S27-S72
• 19 Ortqvist A, Kalin M, Lejdeborn L, Lundberg B. Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990; 97 (3) 576-582
• 20 Torres A, Puig de la Bellacasa J, Rodriguez-Roisin R, Jimenez de Anta MT, Agusti-Vidal A. Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis 1988; 138 (1) 117-120
• 21 Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest 2004; 125 (2) 712-722
• 22 Pachon J, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia. Etiology, prognosis, and treatment. Am Rev Respir Dis 1990; 142 (2) 369-373
• 23 Sörensen J, Forsberg P, Håkanson E , et al. A new diagnostic approach to the patient with severe pneumonia. Scand J Infect Dis 1989; 21 (1) 33-41
• 24 Torres A, Serra-Batlles J, Ferrer A , et al. Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 1991; 144 (2) 312-318
• 25 Torres A, el-Ebiary M. Invasive diagnostic techniques for pneumonia: protected specimen brush, bronchoalveolar lavage, and lung biopsy methods. Infect Dis Clin North Am 1998; 12 (3) 701-722
• 26 Bradley JS, Byington CL, Shah SS , et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53 (7) e25-e76
• 27 Ogilvie MM. Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998; 36 (Suppl. 01) 31-38
• 28 Haake DA, Zakowski PC, Haake DL, Bryson YJ. Early treatment with acyclovir for varicella pneumonia in otherwise healthy adults: retrospective controlled study and review. Rev Infect Dis 1990; 12 (5) 788-798
• 29 Oh HM, Chew SK. Varicella pneumonia in adults—clinical spectrum. Ann Acad Med Singapore 1996; 25 (6) 816-819
• 30 Lee S, Ito N, Inagaki T , et al. Fulminant varicella infection complicated with acute respiratory distress syndrome, and disseminated intravascular coagulation in an immunocompetent young adult. Intern Med 2004; 43 (12) 1205-1209
• 31 Saraya M, Amal A. Dexamethasone as adjunctive therapy for treatment of varicella pneumonia. Egypt J Chest Dis Tuberculos 2012; 61 (3) 9-13