How frequent is varicella-associated pneumonia in children?
1Pediatric Department, Hospital Comarcal de Inca, Mallorca, Spain. dhmdhm@hotmail.com
Insights
Varicella pneumonia is rare in children, with most lower airway infections during chickenpox being bacterial pneumonia. This study highlights the low incidence of true varicella pneumonia in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Varicella (chickenpox) is typically mild in children but can cause severe illness in adults, with pneumonia being a common complication.
- Lower respiratory tract complications of varicella in children are understudied.
- Adult varicella pneumonia is a significant concern, prompting investigation into pediatric cases.
Purpose of the Study:
- To investigate the incidence and characteristics of pneumonia in children hospitalized with varicella.
- To differentiate between viral (varicella) pneumonia and secondary bacterial pneumonia in pediatric varicella cases.
- To analyze clinical presentation and outcomes of lower airway complications in children with varicella.
Main Methods:
- Retrospective review of clinical records of children hospitalized for varicella-associated pneumonia on the Island of Mallorca.
- Analysis of hospitalization rates, diagnostic criteria for pneumonia, and causative agents (viral vs. bacterial).
- Comparison of clinical timelines and patient outcomes (length of stay, oxygen requirement, ICU admission) between bacterial and viral pneumonia groups.
Main Results:
- Of 213 children hospitalized for varicella, 17 (8%) were diagnosed with pneumonia.
- The rate of varicella-associated pneumonia hospitalization was 4.3 per 10,000 varicella infections.
- Only one case (0.3 per 10,000 infections) was confirmed as varicella pneumonia; 53% were bacterial pneumonia.
- Bacterial pneumonia showed statistically significant longer delays from rash and fever onset to hospital admission compared to viral pneumonia.
- No significant differences in outcomes like length of stay or ICU admission were observed between bacterial and viral pneumonia.
Conclusions:
- Varicella pneumonia is an exceptionally rare complication in children.
- The majority of lower respiratory tract infections occurring during varicella in children are secondary bacterial pneumonias.
- Clinical management should consider the high prevalence of bacterial co-infections in pediatric varicella pneumonia cases.
Abstract:
Varicella is a frequent though mild infection in children, but it can cause important morbidity in adults. The most frequent complication in adults is varicella pneumonia. However, lower airway complications associated to varicella have been scarcely studied in children. We retrospectively reviewed the clinical records of the children hospitalized for varicella-associated pneumonia in the three public hospitals on the Island of Mallorca. We discovered that 17/213 (8%) children hospitalized for varicella were diagnosed of pneumonia. The rate of hospitalization for varicella complication due to pneumonia was 4.3 cases per 10,000 varicella infections. Only one patient was diagnosed of varicella pneumonia, which accounts for 0.3 cases per 10,000 varicella infections. Nine of 17 (53%) cases were classified as bacterial pneumonia. Statistical differences (p < 0.05) in the median time from rash (5.9 vs. 2.4 days) and fever (4.1 vs. 2.2 days) to admission were observed between bacterial and viral pneumonia. However, outcome differences measured by the median length of stay, need for oxygen, and admission to the intensive care unit were not observed. Varicella pneumonia is a very rare complication of varicella in children. Most of the lower airway infections in the course of varicella are associated to other co-infections.
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