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Varicella Pneumonia
General Considerations
- Caused by Varicella-zoster virus (VZV)
- Spread via the respiratory route or direct contact with skin lesions, the VZV is highly contagious
- Primary infection produces chickenpox; reactivation results in zoster (shingles)
- Varicella pneumonia complicates about 2-10% of cases of VZV infection in adults
- It rarely occurs in those under age 19
- Pneumonia is a rare but significant complication
- May occur in otherwise healthy adults
- Immunocompromised hosts
- Pregnant women
- Life-threatening
- More severe in smokers
Clinical Findings
- Fever
- Chills
- Nonproductive cough
- Rhinitis
- Myalgias
- Headaches
- Fatigue
- Characteristic rash
Imaging Findings
- Originally produces patchy, diffuse air space consolidation that can be rapidly progressive
- Coalesces near hila
- May have adenopathy and pleural effusion
- In about 30%, it produces widespread nodules
- Numerous, small, punctate calcifications may remain in 2%
Differential Diagnosis
- Histoplasmosis
- Alveolar microlithiasis
Treatment
- Supportive care
- Respiratory isolation until skin lesions heal,
- Acyclovir
Complications
- Secondary bacterial infections
- Encephalitis
- Hepatitis
- Reye syndrome (with aspirin use)
Prognosis
- In the overall population, mortality rates have declined
- But in immunosuppressed, the rate is 15-18%
- In pregnant women in second/third trimesters, mortality rate can be as high as 41%
 
Healed Varicella Pneumonia. Frontal and lateral chest radiographs demonstrate
innumerable small, punctate calcifications throughout both lungs characteristic of healed
Varicella pneumonia in the proper clinical situation.
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