Primary varicella presents with pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. Reactivation of the virus can present as shingles. Common complications of chickenpox are bacterial infections of the skin and soft tissues in children and pneumonia in adults. Chickenpox is rarely fatal. Pregnant women and immunocompromised patients are at a higher risk of developing varicella pneumonia.

If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: ^[1]

• Generalized vesicular rash develops within 24 hours
• Fever
• Malaise
• Pharyngitis
• Loss of appetite

• Infection in adults can cause VZV pneumonia

The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.^[2][3][1]

Common complications associated with chickenpox in immunocompetent individuals include:^{[2][4][5][3][6][7]}

• Toxic shock syndrome
• Viral pneumonia
• Zoster paresis
• Post-herpetic neuralgia)
• VZV meningoencephalitis
• VZV vasculopathy
• VZV and giant cell arteritis
• VZV-induced stromal keratitis
• Necrotizing fasciitis
• Septicemia
• Osteomyelitis
• Bacterial pneumonia
• Cerebellar ataxia
• Encephalitis
• Hemorrhagic conditions
• Septic arthritis

Common complications associated with chickenpox in immunosupressed individuals include:

• Hemorrhagic complications
• Febrile purpura
• Malignant chickenpox with purpura (mortality rate of greater than 70%)
• Anaphylactoid purpura

• Chickenpox is rarely fatal except if the patient develops varicella pneumonia.
• Prognosis in the immunocompromised is poor.
• Varicella zoster virus remains dormant in nerves which can be reactivated later in life, resulting in shingles. It is most commonly seen in the immunocompromised and the elderly.

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