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

Objective: 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.

Methods: 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.

Results: Fifty patients (mean age 32 years, 31 males) were included. Organ dysfunction was seen in 34 (68%) patients, most commonly pneumonia ( = 17), hepatitis ( = 12), hemorrhagic complications ( = 12), acute meningoencephalitis or myelitis ( = 10). Multi-organ involvement was present in 12 (24%). In-hospital mortality was 18% ( = 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, value 0.034). Twenty-three (46%) patients had underlying predisposing conditions, most commonly immunosuppressive therapy ( = 9) and hematological malignancy ( = 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 ( = 15), although cases were seen throughout the year.

Conclusion: 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.