complications

Last reviewed 01/2023

Pulmonary involvement:

• between 5 and 14% of adults will have pulmonary involvement
• pneumonia - particularly in adults; also pneumonia caused by the chicken pox virus itself
  • the risk is increased in pregnant women, the immunocompromised, those with pre-existing lung disease (not including asthma), and smokers (2)

Central nervous system involvement:

• cerebellar ataxia – usually seen during the recovery period
• encephalitis:
  • rarely seen in adults (2)
  • classically presenting with ataxia 3 to 4 days after onset of rash, although sometimes up to 8 days, often affecting the cerebellum
  • 80% make a full recovery

Secondary bacterial infections:

• bacterial infection of lesions
• common organisms include Staphylococcus aureus or Group A Streptococci
• skin and soft tissue infection, osteomyelitis, septicaemia or toxic shock syndrome may occur (2)

Haemorrhagic complications

• pulmonary and gastrointestinal bleeding
• intra-cerebral haemorrhage
• disseminated intravascular coagulation (2)

In pregnancy:

• considerable maternal morbidity
• congenital varicella syndrome in 10% if infected in first 20 weeks of gestation

Less common complications include

• arthritis, glomerulonephritis, myocarditis, and purpura fulminans (3)

Reference:

• (1) Department of Health 2006. The green book - Varicella  
• (2) Tunbridge AJ et al. Chickenpox in adults - Clinical management. Journal of Infection 2008;57:95e102
• (3) Gershon AA. Varicella-Zoster Virus Infections. Pediatrics in Review.2008;29:5-11