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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


  • Supportive care
  • Respiratory isolation until skin lesions heal,
  • Acyclovir


  • Secondary bacterial infections
  • Encephalitis
  • Hepatitis
  • Reye syndrome (with  aspirin use)


  • 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%

Varicella PneumoniaVaricella Pneumonia

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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