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Bacterial complications of primary varicella in children
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Insights
Bacterial infections following chickenpox (varicella) are serious, especially in young children. Early detection of complications like shock and bacteremia is crucial for better outcomes and highlights the need for widespread chickenpox immunization.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Varicella (chickenpox) can lead to severe bacterial infections.
- Young children, particularly those under 5, are most vulnerable.
- Hospitalized children with varicella complications often present with skin infections or more severe deep-seated infections.
Purpose of the Study:
- To analyze the demographics, clinical features, and bacteriology of bacterial complications in children hospitalized with varicella.
- To identify factors influencing patient outcomes, including mortality.
- To emphasize the importance of varicella prevention strategies.
Main Methods:
- Retrospective analysis of 84 pediatric patients hospitalized for varicella complications between 1985 and 1995.
- Review of patient demographics, clinical presentations, laboratory data (including bacteremia and thrombocytopenia), and treatment outcomes.
- Comparison of invasive infection rates before and after 1990.
Main Results:
- Skin infections (73%) and deep-seated infections/shock (27%) were common complications.
- Deep-seated infections were associated with thrombocytopenia, bacteremia, prolonged fever, extended hospitalization, intensive care, and fatal outcomes.
- Group A beta-hemolytic streptococcus and Staphylococcus aureus were the primary bacterial isolates.
- An increasing trend in invasive streptococcal infections was observed after 1990.
Conclusions:
- Bacterial infections significantly complicate varicella in hospitalized children.
- Thrombocytopenia and bacteremia are critical indicators of severe complications.
- The findings support the necessity of universal immunization against varicella to prevent severe sequelae.
Abstract:
Bacterial complications of varicella in 84 patients younger than 16 years of age (48 females; median age, 2.9 years) who required hospitalization between 1985 and 1995 were retrospectively analyzed. The purpose of the study was to describe demographics, clinical manifestations, bacteriology, and factors affecting outcome. Seventy-six percent of patients were younger than 5 years of age. The eldest children in households were significantly underrepresented (P = .00025). Skin infections occurred in 61 patients (73%), and deep-seated infections and/or shock occurred in 23 (27%). The latter complications were significantly associated with thrombocytopenia (P = .011) and bacteremia (P = .014) at the time of admission, prolonged fever (P = .001), prolonged hospitalization (P < .0001), intensive care management (P < .0001), and fatal outcome (P = .019). Group A beta-hemolytic streptococcus (59% of isolates) and Staphylococcus aureus (28%) were the predominant isolates. Before and after 1990, five (31%) of 16 and 13 (62%) of 21 streptococcal complications, respectively, were invasive infections (P = .09). These data underscore the need for universal immunization against chickenpox.