Varicella-zoster virus pneumonia in an adult population: Has mortality decreased?

Eusebi Chiner*a, Irene Ballesterb, Isabel Betllochb, José Blanquerc, M. Carmen Aguard, Rafael Blanquere, Estrella Fernández-Fabrellase, Ada Luz Andreua, Marisa Brionesf & Francisco Sanzga Pneumology Section, Hospital Universitario San Juan de Alicanteb Dermatology Section, Hospital General de Alicantec Respiratory Intensive Care Unit, Hospital Clínico Universitario de Valenciad Pneumology Service, Hospital General de Castellóne Pneumology Service, Hospital Universitario Dr. Peset, Valenciaf Pneumology Service, Hospital Clínico Universitario de Valenciag Pneumology Service, Hospital General Universitario de Valencia, SpainCorrespondence: E. Chiner Vives, Sección de Neumología, Hospital Universitario San Juan de Alicante, Carretera Alicante-Valencia sn, 03550 San Juan de Alicante, Spain. Tel: 134 965 938644. Fax: 134 965 658750. E-mail: chiner_eus@gva.esAbstractVaricella-zoster virus (VZV) pneumonia is one of the most serious complications of this infection in adults. The objective of this study was to analyze the epidemiological and clinical characteristics in a large sample of patients with VZV pneumonia. This was a 10-y retrospective, descriptive, observational study. We studied 46 patients with VZV pneumonia, 21 men and 25 women, with a mean age 36 ±11 y. A contact with an index case was observed in 57%, 76 were active smokers, 6.5% consumed drugs and 2 women were pregnant. The symptoms were: fever (83%), cough (83%), dyspnoea (63%), pleuritic pain (70%), and haemoptysis (6%) and started 3–5 days after the onset of blisters, except in 11% in whom respiratory symptoms appeared first. Arterial blood gases showed a mean PO2/FiO2 of 308 ±101 and 30 patients had a PO2 of <55 mmHg − 11 of these (4%) were admitted to the ICU, 8 required mechanical ventilation. Comparison of patients in the ICU with those on the general ward showed differences in the duration of fever (6.1 ± 4.2 vs 3.2 ± 1.1 days, p <0.001), mean stay (16.8±9.3 vs 7.2±2.4 days, p <0.001) and complications such as acute renal failure (p = 0.01) and acute respiratory failure (p < 0.001). Despite the severity of disease, no patient died. Once diagnosed, 98% were treated with acyclovir, combined with steroids in 6 and with antibiotics in 3 complicated with bacterial pneumonia. The prevalence for the period was 0.33 cases/100,000 inhabitants/y. In conclusion, VZV pneumonia has a severe course and accounts for a high percentage of admissions to the intensive care unit. The absence of mortality may be related to early treatment with acyclovir. Smoking was a risk factor for VZV pneumonia.