Varicella zoster

Topic Completed: 1 September 2011

Minor changes: 7 August 2020

Copyright: 2003-2021,, Inc.

PubMed search: varicella zoster pneumonia

Elliot Weisenberg, M.D.
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Cite this page: Weisenberg E. Varicella zoster. website. Accessed October 28th, 2021.
Clinical features
  • Overwhelmingly a benign disease in childhood (Eur J Clin Microbiol Infect Dis 2011;30:435)
  • Adults with infection have 25× risk of children in developing pneumonia; occurs in 10% - 15% of adult patients (Ann Thorac Med 2007;2:163)
  • Greatest risk of severe disease in immunosuppressed patients, especially bone marrow transplant recipients, patients with chronic lung disease, pregnant women and neonates
  • Incidence has declined with effective treatment, but is increasing due to unvaccinated individuals
  • Diagnosis usually apparent from skin lesions and clinical history, but immunohistochemistry, culture or PCR may be necessary to rule out HSV
  • Pneumonia usually occurs 2 - 7 days after rash appears
  • Pulmonary calcifications may occur after recovery
  • Untreated pneumonia has 10% - 40% mortality rate
Gross description
  • Heavy, firm and purple lungs
  • May have hemorrhagic lesions on pleura resembling skin lesions
Microscopic (histologic) description
  • Necrosis of bronchial and alveolar epithelium, acute inflammation and hemorrhage, eosinophilic nuclear inclusions and rare multinucleated cells at edge of necrotic foci
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