Can chickenpox be fatal in a healthy patient?

Chickenpox Can Be Fatal in Healthy Patients

Yes, chickenpox can be fatal even in healthy patients, though this is rare. While chickenpox is generally a self-limiting disease in healthy children, it carries increased risks of serious complications and death in adults, infants, and immunocompromised individuals.

Mortality Risk in Healthy Individuals

• During the pre-vaccine era (1970-1994), varicella was recorded as the underlying cause of approximately 105 deaths annually in the United States 1
• 89% of varicella deaths among children and 75% of varicella deaths among adults occurred in persons without severe underlying immunocompromising medical conditions 1
• The case-fatality rate for varicella in adults is 25 times higher than in children aged 12 months-4 years 1

Risk Factors for Severe Disease

• Age: Adults aged >20 years were 13 times more likely to be hospitalized with varicella than children aged 5-9 years 1
• Smoking: Smokers have a significantly higher risk of developing varicella pneumonia (p<.002) 2
• Pregnancy: Varicella during pregnancy can lead to congenital varicella syndrome and other adverse outcomes for both mother and infant 1

Common Complications That Can Lead to Death

• Pneumonia: Varicella pneumonia is the most common serious complication in adults, occurring in approximately 28.4% of hospitalized adult patients 2

  • Mortality rate for varicella pneumonia can reach 17.2%, increasing to 45.5% in patients requiring mechanical ventilation 2

• Neurological complications: Including encephalitis and meningitis (8.8% of hospitalized adults) 2

• Secondary bacterial infections:

  • Skin and soft tissue infections, especially invasive group A streptococcal infections 1
  • Septicemia occurs in approximately 10.7% of hospitalized adult patients 2

• Rare but severe complications:

  • Varicella gangrenosa - a rare but life-threatening dermatological complication that can occur even in healthy individuals 3
  • Acute respiratory distress syndrome (ARDS) - occurs in approximately 6.8% of hospitalized adult patients 2
  • Hepatic failure (1.9%) and renal failure (2.9%) 2

Prevention and Treatment

• Varicella vaccine has significantly reduced the incidence, complications, and mortality associated with chickenpox since its introduction in 1995 1
• Early treatment with intravenous acyclovir can be life-saving in cases of varicella pneumonia and other severe complications 4
• Adults with severe varicella should be hospitalized and treated aggressively with antiviral therapy and supportive care 2

Clinical Pearls and Pitfalls

• Do not dismiss chickenpox as a benign childhood illness when it occurs in adults, as it carries significantly higher risks 2
• Early recognition and prompt treatment of complications are crucial for preventing mortality 5
• The most common causes of death from varicella include pneumonia, central nervous system complications, secondary bacterial infections, and hemorrhagic conditions 1
• Laboratory abnormalities are common in adult chickenpox patients, with elevated liver enzymes (51.9%) and thrombocytopenia (42.1%) being the most frequent findings 2

While chickenpox vaccination has dramatically reduced the incidence and mortality of the disease, clinicians should remain vigilant about the potential for severe complications, particularly in adults, even those who were previously healthy.