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Shingles and chicken pox in the adult: markers of severity

García-Castrillo Riesgo L, Julián Jiménez A, Mariné Blanco M

Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Servicio de Urgencias, Complejo Hospitalario de Toledo, Spain. Dirección Médica, Hospital La Moraleja, Madrid, Spain.

Background and objective: Diseases caused by the varicella-herpes virus in adults
(chicken pox and shingles) only occasionally become serious. We sought markers that
could be used in the hospital emergency department to identify adults with serious
infections requiring admission.
Methods: The REVAVAZ multicenter register of adults with varicella-zoster virus
infections who came to hospital emergency departments for care was used to identify
variables associated with severity. Clinical and comorbidity factors underwent univariate
analysis to detect attributes associated with admission in each varicella-herpes virus
Results: A total of 363 cases of chicken pox and 1240 cases of Herpes Zoster were
registered in 2009 and 2010; 6.9% of the adults with chicken pox and 4.2% of the
adults with Herpes Zoster were admitted. Among patients with chicken pox, 71% of
those under immunosuppressive treatment were admitted (P<.01); 38.9% of those with
chest pain, 22.8% of those with cough, and and 66.7% of those with shortness of
breath were admitted (P<.01). Among patients with Herpes Zoster, 53.8% were
admitted for concomitant diseases; 82.4% of the patients with chronic obstructive
pulmonary disease were hospitalized. Also admitted with Herpes Zoster were 27.2% of
those with fever, 18.3% of those with chills, and 11.9% of those with muscle pain
(P<.01). A total of 45.5% of those with neuropathy, 57.1% with respiratory disease, and
64.3% with disseminated varicella-herpes virus disease (P<.01) were admitted.
Conclusions: Adults with more severe chicken pox infections are those with respiratory
symptoms and under immunosuppressive therapy. Patients with Herpes Zoster are
admitted because of exacerbation of some concomitant disease process, especially
COPD; Herpes Zoster symptoms are usually more severe in these patients.

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