When Chickenpox occurs in adult patients with kidney disease, it follows
a deadly course and carries a very high risk of morbidity and mortality.
Patients with kidney disease are more likely to develop shingles. Kidney
patients non-immune to varicella (i.e., never had Chickenpox and/or are
varicella seronegative) should be given two doses of vaccine 4–8 weeks
apart or a second dose if they previously received only 1 dose. Infections
contribute to as much as 30-36% of morbidity in patients on long-term
Varicella Infection in Cancer Patients
The clinical presentation and complication rates of Chickenpox in cancer
patients are similar to the normal population. Varicella infection while
receiving chemotherapy can cause a therapy delay in 70% of the patients.
There is also a higher risk of varicella infection in immunosuppressed
adults. Children with leukemia and other malignancies receiving
prolonged anticancer therapy run a high risk of contracting Chickenpox.
Chickenpox in Transplant Patients
Primary varicella infection/Chickenpox remains a potentially fatal
infection in adult renal transplant recipients. It may present with
complications ranging from allograft rejections, hepatitis, pancreatitis,
pneumonia, and death. Attention should be directed towards prevention
by the identification and immunization of at-risk patients before
transplantation. Varicella vaccination in the high-risk groups, especially
during the pre-ESRD stage, can possibly decrease the number of patients
with varicella infection.
Chickenpox in Diabetic Patients
Patients with diabetes mellitus were associated with a
1.6-fold increased risk for the development of herpes zoster.
Varicella showed a more aggressive course in diabetic patients compared
to healthy individuals. It can increase the duration of illness in diabetic
patients. Additionally, the incidence of undiagnosed diabetes is high among
Chickenpox patients, which may be due to the impairment of immunity in
diabetes. Hence, routine screening for diabetes mellitus in Chickenpox
patients is recommended.
Lai et al. Medicine (Baltimore). 2021 Apr;100(16):e25292.