Clinical spectrum and outcomes of adult varicella (chickenpox) in India.

Abstract

Despite a recent rise in incidence, varicella in adults remains under-recognized, particularly in tropical regions, where prevalence is high. This study aims to delineate the clinical spectrum, evaluate organ involvement, and assess outcomes in adult Indian patients with varicella. A hospital-based retrospective study was conducted at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, between March 2016 and February 2020. Adult patients aged ≥15 years diagnosed with varicella were included. Diagnosis was based on the presence of a characteristic vesicular rash, epidemiological history of the recent exposure, and exclusion of alternative etiologies. Fifty patients (mean age 32 years, 31 males) were included. Organ dysfunction was seen in 34 (68%) patients, most commonly pneumonia (<i>n</i> = 17), hepatitis (<i>n</i> = 12), hemorrhagic complications (<i>n</i> = 12), acute meningoencephalitis or myelitis (<i>n</i> = 10). Multi-organ involvement was present in 12 (24%). In-hospital mortality was 18% (<i>n</i> = 9), highest among patients with pneumonia (41.2%) and hemorrhagic complications (41.7%). Advanced age was the only independent predictor of mortality (OR 1.144, <i>P</i> value 0.034). Twenty-three (46%) patients had underlying predisposing conditions, most commonly immunosuppressive therapy (<i>n</i> = 9) and hematological malignancy (<i>n</i> = 5). However, organ complications and outcomes were comparable regardless of the immune status. Only one case of breakthrough varicella was detected. Admissions peaked in March and April (<i>n</i> = 15), although cases were seen throughout the year. Varicella in adults is frequently associated with severe organ complications, particularly pneumonia, and substantial in-hospital mortality. These adverse outcomes occur even in previously healthy individuals, underscoring the need for heightened clinical vigilance, timely antiviral therapy, and strengthened preventive strategies in the adult population.