Ospa wietrzna naprawdę bywa groźna. This is the first prospective nationwide study of severe complications of varicella in immunologically healthy children. Related to 14 025 867 children up to the age of 16, a crude incidence of severe chickenpox complications of 8.5/100 000 could be calculated. The actual hospitalization rate attributable to complicated chickenpox is probably much higher, because this calculation refers to a population theoretically at risk and not the truly susceptible individuals. The results of this study demonstrate considerable morbidity with a comparatively high rate of encephalitis, osteomyelitis, and pyogenic arthritis. Although infectious complications were present in only 38.6% of the reported cases, they contributed disproportionately to the cases with chronic sequelae. Looking at these cases in more detail, S pyogenes involvement was identified as the major risk factor for invasive disease with an unfavorable long-term outcome. (...) According to US data, approximately 95% of cases, 66% of hospitalizations, and 45% of varicella-related deaths occur among people who are younger than 20 years, with most cases occurring in children who are younger than 10 years. Despite a public perception of varicella infection as being a harmless childhood affliction, different complications may occur. The range of complications was previously thought to depend on the immune status and underlying diseases, such as chronic cutaneous or pulmonary disorders and immunosuppressive therapies. Immunocompromised individuals, especially those with T-cell defects, are at increased risk of dissemination of the virus to the internal organs, including lungs, liver, brain, heart, and kidneys. However, healthy individuals may experience complications as well, and not limited to infection beyond adolescence, as forthcoming research from the United States is showing. The more common and comparatively benign complications include otitis media, subclinical hepatitis, cerebellar ataxia, and bacterial superinfection of the rash. The last can be troubling if group A β-hemolytic streptococci (GABHS) are inoculated into the skin break, leading to cellulitis, an increased chance of systemic spread with bacteremia, and occasionally necrotizing fasciitis. Recent observations of the epidemic nature of invasive disease attributable to GABHS after varicella in child care centers have been reported from the United States. Transient bacteremia may cause pneumonia, pyogenic arthritis, and osteomyelitis. Rare complications of varicella in immunologically healthy hosts include encephalitis, myocarditis and pericarditis, pancreatitis, orchitis, bleeding diatheses, and nephritis. This study was conducted to collect data regarding the epidemiology of severe varicella complications in immunologically healthy children (...) The most frequent complications were neurologic, which were reported in 73 children (61.3%); cerebellitis was the leading diagnosis (n = 48), followed by encephalitis (n = 22), meningitis (n = 2), and central facial palsy (n = 1). A total of 46 (38.6%) infectious complications were identified. Superinfections of the skin were present in 31 (26.0%), pyogenic arthritis was present in 5 (4.2%), osteomyelitis was present in 4 (3.3%), necrotizing fasciitis was present in 3 (2.5%), orbital cellulitis was present in 2 (1.6%), and pneumonia was present in 1 (0.8%). Streptococcus pyogenes was the leading cause of bacterial infections (18 cases [15.1%]), with invasive disease in 6 patients (8.4%) and linked to 4 of 8 cases with defect healing. Infectious complications were reported in the majority in younger children up to 4 years of age, whereas neurologic complications occurred more frequently in an older age range. Five children experienced thrombocytopenia or severe anemia. There was no bleeding disorder, no fatality, and no case of Reye syndrome reported during the 1-year observation period. In total, 8 (6.7%) of 119 patients reported having long-term sequelae, 6 attributable to infectious complications and 2 to persistent deficits after neurologic complications. pediatrics.aappublications.org/content/108/5/e79.long
Posted on: Thu, 15 Jan 2015 09:23:32 +0000
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