Paytubí C, Negredo E, Ferrer S, Monmany J, Barrio J L
Servicios de Medicina Interna y Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona.
An Med Interna. 2001 Jun;18(6):312-6.
In the adult, the primary infection by the varicella-zoster virus acquires an unusual severity due to several complications, the most frequent of them being pneumonia. We study the main characteristics of nine patients diagnosed of pneumonia varicellosa.
Clinical, therapeutic and evolutive features of 9 adult patients, both immunocompetents and immunodepressed, diagnosed of pneumonia varicellosa are retrospectively reviewed, in the last ten years, at Hospital de Sant Pau, Barcelona. Diagnosis of varicella was established on the basis of the typical rash in the context of a feverish illness. The antecedents of smoking habit, pregnancy and underlying disease, evaluating especially arterial blood and platelet count at entrance, are assessed.
Nine patients (4 males and 5 women; mean age 38 years) were included in the study. Seventy-eight percent of patients were smokers of more than 20 cigarettes a day; one met criteria of simple chronic bronchitis, another suffered ankylosing spondylitis and three were known carriers of human immunodeficiency virus. None of the female patients was pregnant. Respiratory symptoms began from the third and fifth day after the skin rash, and the most common symptoms were cough (89%), dyspnea (67%) and hemoptysis (22%). Arterial blood gas determination showed hypoxemia in four patients (45%). Chest X-ray revealed an interstitial pattern predominantly at both bases, with a case of right pleural effusion. Intravenous acyclovir was started in 6 patients, foscarnet in one and symptomatic therapy in two patients. All patients had a favourable clinical course, none of them requiring entrance to the Intensive Care Unit.
Adult patients with varicella pneumonia that suffer respiratory insufficiency, thrombocytopenia or are carriers of base illnesses must be early treated with intravenous acyclovir. However, despite clinical, biological and radiological recovery is earlier with such treatment, the evolution seems equally favourable if it is only conducted, for instance, symptomatic therapy with antithermic and antihistaminic compounds.
在成年人中，水痘 - 带状疱疹病毒的原发性感染由于多种并发症而具有异常的严重性，其中最常见的是肺炎。我们研究了9例诊断为水痘性肺炎患者的主要特征。
回顾性分析过去十年间在巴塞罗那圣保罗医院诊断为水痘性肺炎的9例成年患者（包括免疫功能正常和免疫抑制者）的临床、治疗及病情演变特征。根据发热性疾病背景下的典型皮疹确诊水痘。评估吸烟习惯、妊娠及基础疾病史，尤其入院时的动脉血气和血小板计数。
9例患者（4例男性和5例女性；平均年龄38岁）纳入研究。78%的患者每天吸烟超过20支；1例符合单纯慢性支气管炎标准，另1例患有强直性脊柱炎，3例已知为人类免疫缺陷病毒携带者。女性患者均未怀孕。呼吸道症状在皮疹出现后的第3天至第5天开始出现，最常见的症状为咳嗽（89%）、呼吸困难（67%）和咯血（22%）。动脉血气测定显示4例患者（45%）存在低氧血症。胸部X线显示主要在双肺底部的间质型，1例伴有右侧胸腔积液。6例患者开始静脉使用阿昔洛韦，1例使用膦甲酸钠，2例进行对症治疗。所有患者临床过程良好，均无需进入重症监护病房。
患有呼吸功能不全、血小板减少或患有基础疾病的成人水痘肺炎患者必须尽早静脉使用阿昔洛韦治疗。然而，尽管这种治疗能使临床、生物学和影像学恢复更早，但如果仅进行例如使用退热和抗组胺化合物的对症治疗，病情演变似乎同样良好。
