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Education And Debate

Lesson of the Week: Potentially lethal bacterial infection associated with varicella zoster virus

BMJ 1996; 313 doi: (Published 03 August 1996) Cite this as: BMJ 1996;313:283
  1. Andrew J Pollard, action research fellowa,
  2. Austin Isaacs, senior house officera,
  3. E G Hermione Lyall, research fellowa,
  4. Nigel Curtis, clinician scientist fellowa,
  5. Kwan Lee, consultantb,
  6. Sam Walters, senior lecturera,
  7. Michael Levin, professora
  1. a Paediatric Infectious Diseases Unit, Department of Paediatrics, St Mary's Hospital Medical School, London W2 1NY
  2. b Department of Paediatrics, St Albans and Hemel Hempstead NHS Trust, Hemel Hempstead HP2 4AD
  1. Correspondence to: Dr Pollard.
  • Accepted 6 March 1996

Chickenpox is generally considered to be a benign self limiting illness in children. Indeed, mild secondary bacterial infection of the skin, of little clinical importance, is the most common complication of varicella virus infection.1 2 There has been a recent increase in reports of serious bacterial infections, however, both during or after chickenpox.

We reviewed the case notes of 13 children (mean age 30 months; seven boys, six girls) who presented to our unit over 12 months (1994-5) with bacterial sepsis associated with chickenpox. We also included one case (case 1) who died of group A streptococcal septicaemia at another hospital.

Occult bacterial infection with group A streptococcus or Staphylococcus aureus may complicate chickenpox and cause potentially lethal disease

Case report

An 11 month old girl was admitted with fever, poor feeding, and diarrhoea on the fourth day after the onset of chickenpox. She had a fever of 40°C and a haemorrhagic pustular rash. There was periorbital oedema and conjunctival injection with oral erythema and a 1 cm diameter black necrotic lesion around a vesicle on the dorsum of her left hand. There was no neurological or cardiovascular compromise at presentation.

Twenty four hours later she became shocked with a capillary refill time of four seconds, peripheral core temperature difference of 8°C, blood pressure of 75/40 mm Hg, and a pulse of 150 beats/min. She developed increasing oedema and required supplementary oxygen. Despite resuscitation with colloid and a course of antibiotics she continued to deteriorate and was intubated and mechanically ventilated. Inotropic support and large volumes of colloid were required to correct the shock.

Initial laboratory investigations indicated a haemoglobin concentration of 103 g/l, a white cell count of 7.2 × 109/l, and a platelet count of 119 x109/l with normal clotting. There was hyponatraemia with a …

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