Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Severe varicella-zoster virus pneumonia: a multicenter cohort study

Authors: Adrien Mirouse, Philippe Vignon, Prescillia Piron, René Robert, Laurent Papazian, Guillaume Géri, Pascal Blanc, Christophe Guitton, Claude Guérin, Naïke Bigé, Antoine Rabbat, Aurélie Lefebvre, Keyvan Razazi, Muriel Fartoukh, Eric Mariotte, Lila Bouadma, Jean-Damien Ricard, Amélie Seguin, Bertrand Souweine, Anne-Sophie Moreau, Stanislas Faguer, Arnaud Mari, Julien Mayaux, Francis Schneider, Annabelle Stoclin, Pierre Perez, Julien Maizel, Charles Lafon, Frédérique Ganster, Laurent Argaud, Christophe Girault, François Barbier, Lucien Lecuyer, Jérôme Lambert, Emmanuel Canet

Published in: Critical Care | Issue 1/2017

Login to get access

Abstract

Background

Pneumonia is a dreaded complication of varicella-zoster virus (VZV) infection in adults; however, the data are limited. Our objective was to investigate the clinical features, management, and outcomes of critically ill patients with VZV-related community-acquired pneumonia (VZV-CAP).

Methods

This was an observational study of patients with VZV-CAP admitted to 29 intensive care units (ICUs) from January 1996 to January 2015.

Results

One hundred and two patients with VZV-CAP were included. Patients were young (age 39 years (interquartile range 32–51)) and 53 (52%) were immunocompromised. Time since respiratory symptom onset was 2 (1–3) days. There was a seasonal distribution of the disease, with more cases during spring and winter time. All but four patients presented with typical skin rash on ICU admission. Half the patients received mechanical ventilation within 1 (1–2) day following ICU admission (the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) = 150 (80–284), 80% with acute respiratory distress syndrome (ARDS)). Sequential Organ Failure Assessment (SOFA) score on day 1 (odds ratio (OR) 1.90 (1.33–2.70); p < 0.001), oxygen flow at ICU admission (OR 1.25 (1.08–1.45); p = 0.004), and early bacterial co-infection (OR 14.94 (2.00–111.8); p = 0.009) were independently associated with the need for mechanical ventilation. Duration of mechanical ventilation was 14 (7–21) days. ICU and hospital mortality rates were 17% and 24%, respectively. All patients were treated with aciclovir and 10 received adjunctive therapy with steroids. Compared to 60 matched steroid-free controls, patients treated with steroids had a longer mechanical ventilation duration, ICU length of stay, and a similar hospital mortality, but experienced more ICU-acquired infections.

Conclusions

Severe VZV-CAP is responsible for an acute pulmonary involvement associated with a significant morbidity and mortality. Steroid therapy did not influence mortality, but increased the risk of superinfection.
Appendix
Available only for authorised users
Literature
1.
2.
Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348(20):1953–66.CrossRefPubMed
3.
Beigel JH, Farrar J, Han AM, et al. Avian influenza A (H5N1) infection in humans. N Engl J Med. 2005;353(13):1374–85.CrossRefPubMed
4.
Perez-Padilla R, de la Rosa-Zamboni D. Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009;361(7):680–9.CrossRefPubMed
5.
Influenza Investigators ANZIC, Webb SAR, Pettilä V, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009;361(20):1925–34.CrossRef
6.
7.
Johnstone J, Majumdar SR, Fox JD, et al. Viral infection in adults hospitalized with community-acquired pneumonia: prevalence, pathogens, and presentation. Chest. 2008;134(6):1141–8.CrossRefPubMed
8.
Johansson N, Kalin M, Tiveljung-Lindell A, et al. J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010;50(2):202–9.CrossRefPubMed
9.
Widmer K, Zhu Y, Williams JV, et al. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206(1):56–62.CrossRefPubMedPubMedCentral
10.
Wiemken T, Peyrani P, Bryant K, et al. Incidence of respiratory viruses in patients with community-acquired pneumonia admitted to the intensive care unit: results from the Severe Influenza Pneumonia Surveillance (SIPS) project. Eur J Clin Microbiol Infect Dis. 2013;32(5):705–10.CrossRefPubMed
11.
Choi S-H, Hong S-B, Ko G-B, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med. 2012;186(4):325–32.CrossRefPubMed
12.
Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax. 2008;63(1):42–8.CrossRefPubMed
13.
Crowe JE. Human metapneumovirus as a major cause of human respiratory tract disease. Pediatr Infect Dis J. 2004;23(11 Suppl):S215–21.CrossRefPubMed
14.
Arnold JC, Singh KK, Spector SA, et al. Human bocavirus: prevalence and clinical spectrum at a children’s hospital. Clin Infect Dis. 2006;43(3):283–8.CrossRefPubMed
15.
van der Hoek L, Pyrc K, Berkhout B. Human coronavirus NL63, a new respiratory virus. FEMS Microbiol Rev. 2006;30(5):760–73.CrossRefPubMed
16.
17.
Schildgen O, Müller A, Allander T, et al. Human bocavirus: passenger or pathogen in acute respiratory tract infections? Clin Microbiol Rev. 2008;21(2):291–304.CrossRefPubMedPubMedCentral
18.
Lee J, Storch GA. Characterization of human coronavirus OC43 and human coronavirus NL63 infections among hospitalized children <5 years of age. Pediatr Infect Dis J. 2014;33(8):814–20.CrossRefPubMed
19.
Galante O, Avni YS, Fuchs L, et al. Coronavirus NL63-induced adult respiratory distress syndrome. Am J Respir Crit Care Med. 2015;193(1):100–1.CrossRef
20.
Waring JJ, Neubuerger K, Geever EF. Severe forms of chickenpox in adults: with autopsy observations in a case with associated pneumonia and encephalitis. Arch Intern Med. 1942;69(3):384–408.CrossRef
21.
Weber DM, Pellecchia JA. Varicella pneumonia: study of prevalence in adult men. JAMA. 1965;192(6):572–3.CrossRefPubMed
22.
23.
Miliauskas JR, Webber BL. Disseminated varicella at autopsy in children with cancer. Cancer. 1984;53(7):1518–25.CrossRefPubMed
24.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.CrossRefPubMed
25.
Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefPubMed
26.
Definition Task Force ARDS, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33.
27.
Buttgereit F, Silva JAPD, Boers M, et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis. 2002;61(8):718–22.CrossRefPubMedPubMedCentral
28.
Domínguez-Cherit G, Lapinsky SE, Macias AE, et al. Critically ill patients with 2009 influenza A(H1N1) in Mexico. JAMA. 2009;302(17):1880–7.CrossRefPubMed
29.
30.
Gershon AA, Steinberg SP, Gelb L. Clinical reinfection with varicella-zoster virus. J Infect Dis. 1984;149(2):137–42.CrossRefPubMed
31.
Junker AK, Angus E, Thomas EE. Recurrent varicella-zoster virus infections in apparently immunocompetent children. Pediatr Infect Dis J. 1991;10(8):569–75.CrossRefPubMed
32.
Junker K, Avnstorp C, Nielsen CM, et al. Reinfection with varicella-zoster virus in immunocompromised patients. Curr Probl Dermatol. 1989;18:152–7.CrossRefPubMed
33.
Junker AK, Tilley P. Varicella-zoster virus antibody avidity and IgG-subclass patterns in children with recurrent chickenpox. J Med Virol. 1994;43(2):119–24.CrossRefPubMed
34.
Lemiale V, Lambert J, Canet E, et al. Identifying cancer subjects with acute respiratory failure at high risk for intubation and mechanical ventilation. Respir Care. 2014;59(10):1517–23.CrossRefPubMed
35.
Adda M, Coquet I, Darmon M, et al. Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure. Crit Care Med. 2008;36(10):2766–72.CrossRefPubMed
36.
Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med. 2001;27(11):1718–28.CrossRefPubMed
37.
38.
Aebi C, Ahmed A, Ramilo O. Bacterial complications of primary varicella in children. Clin Infect Dis. 1996;23(4):698–705.CrossRefPubMed
39.
Mer M, Richards GA. Corticosteroids in life-threatening varicella pneumonia. Chest. 1998;114(2):426–31.CrossRefPubMed
40.
Adhami N, Arabi Y, Raees A, et al. Effect of corticosteroids on adult varicella pneumonia: cohort study and literature review. Respirol Carlton Vic. 2006;11(4):437–41.CrossRef
41.
Anwar SK, Masoodi I, Alfaifi A, et al. Combining corticosteroids and acyclovir in the management of varicella pneumonia: a prospective study. Antivir Ther. 2014;19(2):221–4.CrossRefPubMed
42.
Gagnon S, Boota AM, Fischl MA, et al. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A double-blind, placebo-controlled trial. N Engl J Med. 1990;323(21):1444–50.CrossRefPubMed
43.
Bozzette SA, Sattler FR, Chiu J, et al. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1990;323(21):1451–7.CrossRefPubMed
44.
Wan Y-D, Sun T-W, Liu Z-Q, et al. Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Chest. 2016;149(1):209–19.CrossRefPubMed
45.
Delaney JW, Pinto R, Long J, et al. The influence of corticosteroid treatment on the outcome of influenza A(H1N1pdm09)-related critical illness. Crit Care. 2016;20:75.CrossRefPubMedPubMedCentral
Metadata
Title
Severe varicella-zoster virus pneumonia: a multicenter cohort study
Authors
Adrien Mirouse
Philippe Vignon
Prescillia Piron
René Robert
Laurent Papazian
Guillaume Géri
Pascal Blanc
Christophe Guitton
Claude Guérin
Naïke Bigé
Antoine Rabbat
Aurélie Lefebvre
Keyvan Razazi
Muriel Fartoukh
Eric Mariotte
Lila Bouadma
Jean-Damien Ricard
Amélie Seguin
Bertrand Souweine
Anne-Sophie Moreau
Stanislas Faguer
Arnaud Mari
Julien Mayaux
Francis Schneider
Annabelle Stoclin
Pierre Perez
Julien Maizel
Charles Lafon
Frédérique Ganster
Laurent Argaud
Christophe Girault
François Barbier
Lucien Lecuyer
Jérôme Lambert
Emmanuel Canet
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1731-0

Other articles of this Issue 1/2017

Critical Care 1/2017 Go to the issue

Research

Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Research

Effects of neurally adjusted ventilatory assist on air distribution and dead space in patients with acute exacerbation of chronic obstructive pulmonary disease

Research

Impact of Gram stain results on initial treatment selection in patients with ventilator-associated pneumonia: a retrospective analysis of two treatment algorithms

Research

Double carbapenem as a rescue strategy for the treatment of severe carbapenemase-producing Klebsiella pneumoniae infections: a two-center, matched case–control study

Research

The impact of post-operative sepsis on mortality after hospital discharge among elective surgical patients: a population-based cohort study

Letter

No-touch methods of terminal cleaning in the intensive care unit: results from the first large randomized trial with patient-centred outcomes