Respiratory complications in children hospitalized with varicella

The aim of the study was to retrospectively determine the incidence and clinical course of varicella-related respiratory complications in children during the 6-year period 2005-2010. We attempted to identify the predisposing factors and outcome of such complications. Clinical records of 237 children treated in an academic hospital of the Medical University in Wroclaw, Poland were reviewed, taking into consideration the reason for referral to the hospital, duration of hospitalization, and diagnosis. There were 28 (11.8 %) children (mean age 2.8 ± 2.8 years) in the cohort hospitalized with varicella-related respiratory complications. The infants younger than 1 year predominated (9/28). None of the children were previously immunized against varicella. Admission occurred 5.0 ± 2.8 days after the first symptoms of varicella. The source of infection was an older sibling in 13/28 cases. The mean duration of hospitalization was 5.4 ± 2.0 days. The main symptoms were fever (20/28), cough (26/28), tachypnea (11/28), and dyspnea (7/28). Chest X-ray was performed in eight children, confirming pneumonia in six cases. Based on blood gases, chest X-ray, and clinical symptoms, pneumonia was diagnosed in 15/28 and acute bronchitis in 8/28 children. Intravenous antiviral therapy with acyclovir was administered in 16/28 and antibiotics in 14/28 children. In two cases, oxygen therapy was required and one child presented respiratory failure treated in the Intensive Care Unit. We conclude that respiratory tract involvement in the course of varicella infection in children is relatively common. Age less than 1 and an infected older sibling seem major risk factors for respiratory complications.