What are the potential complications of chickenpox that I should monitor for in my patients?

When monitoring patients with chickenpox, you should be aware of several potential complications:

• Bacterial Superinfection: This is a common complication, affecting 32% of children and 17% of adults admitted to hospital with chickenpox in one UK study ¹ (Bovill, 1998). Monitor for a sudden high-grade fever (pyrexia), especially after initial improvement, along with redness (erythema) and tenderness surrounding the original chickenpox lesions ¹.
• Dehydration: Encourage and monitor fluid intake ¹. Advise patients to seek medical attention if signs of dehydration develop, such as reduced urine output, lethargy, cool peripheries, or reduced skin turgor ¹.
• Serious Complications: Less common but severe complications include pneumonia, encephalitis, and severe secondary bacterial infection of the skin ¹. If these are suspected, the patient should be admitted to hospital ¹.

Patients at increased risk of complications include:

• Adults: Adults are more likely to develop complications than children ¹.
• Smokers and those with chronic conditions: People who smoke, have severe lung or cardiovascular disease, or a chronic skin disorder are particularly at risk ¹ (PHE, 2015; Kimberlin, 2018).
• Pregnant Women: Pregnant women are at higher risk of serious complications, such as fulminating varicella pneumonia, with the risk being greatest in the second and early third trimesters ¹ (PHE, 2015). There is also a small risk of fetal varicella syndrome if chickenpox develops in the first 28 weeks of pregnancy ¹ (RCOG, 2015).
• Immunocompromised Individuals: This includes people receiving cancer treatment, high doses of oral steroids, or those with conditions that reduce immunity ¹.
• Infants: Infants aged 4 weeks or less are also at increased risk ¹.

It is important to advise patients to seek urgent medical advice if their condition deteriorates or if they develop any of these complications ¹.