https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
268
UDC 616.9-036.3
CHARACTERISTICS OF VARICELLA INCIDENCE AMONG
ADULTS IN THE BUKHARA REGION
Keldiyorova Zilola Doniyorovna
keldiyorova.zilola@bsmi.uz
ORCID:
https://orcid.org/0000-0002-0662-5787
Bukhara State Medical Institute
Chickenpox is one of the most widespread highly contagious infections,
with a susceptibility rate of 95-100%. Against the backdrop of decreasing incidence
of "controllable" infections, the significance of chickenpox in the structure of
infectious pathology increases. Infection with the Varicella Zoster virus (VZV),
typically occurring in adulthood, leads to lifelong latent persistence of the pathogen
in the div of the person who has recovered from chickenpox, with a high
probability of endogenous reactivation years later, often resulting in the
development of such severe, debilitating diseases as herpes zoster (shingles) [4,5].
The prevalence is 60 million cases annually. According to the WHO, 4.2 million
severe and complicated cases of chickenpox are hospitalized annually, and 4,200
cases lead to death worldwide.
The most severe complication of chickenpox in adults is encephalitis.
Although the disease is characterized in the overwhelming majority of cases by a
benign course, the high intensity of the chickenpox epidemic process results in
significant economic losses, primarily associated with the temporary loss of
productivity of parents caring for sick children. The occurrence of chickenpox
outbreaks complicates the work of children's and educational institutions. Against
the backdrop of high incidence, even rare complications and fatalities cause
significant social and economic damage [3].
https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
269
The modern epidemic process of chickenpox is characterized by a tendency
of the infection to "adult," especially among the urban population. Every year, 5-
6% of cases involve adults, and 3-5% of cases involve adolescents aged 15-17. The
risk of complications and fatalities from chickenpox in adults is 10-20 times higher
than in children. There is an increased likelihood of infection among pregnant
women, which subsequently raises the risk of intrauterine infection of newborns.
The incidence of infections during pregnancy per 100,000 births is 10-20 cases.
Developmental defects are found in less than 0.1% of cases among children
infected in utero [1,4]. According to foreign sources, the incidence of clinically
diagnosed neonatal chickenpox is 1 in 200-1500 newborns, while the congenital
chickenpox syndrome occurs in 1 in 40,000-80,000 newborns. Therefore, in the
context of an epidemic surge in incidence, including among adolescents, there is a
high likelihood of developing congenital chickenpox, which determines the social
significance of this infection [2]. Congenital chickenpox should be suspected if the
Varicella Zoster virus infects the fetus in utero or intranatally. Specific
manifestations of congenital chickenpox are called congenital chickenpox
syndrome.
Chickenpox contracted by a woman between the 8th and 20th weeks of
pregnancy results in fetal death or stillbirth in 30% of cases. In 60% of surviving
children, hypoplastic skeletal defects and neurological anomalies develop, while
25% have anomalies of the eyes, genitourinary system, and gastrointestinal tract.
If infection occurs during the second half of pregnancy, the infant may develop a
latent infection, leading to shingles in the first few years of life [1,5]. If the mother
has shingles, the congenital chickenpox syndrome occurs in the fetus relatively
rarely, as the fetus is protected by antibodies received from the mother [4].
Mortality from pneumonia due to chickenpox in adults reaches 10% [5]. The
highest risk of severe outcomes is found in individuals with immunodeficiency of
any origin, affecting the cellular component of immunity. This is particularly
https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
270
characteristic of patients with HIV infection and those with chronic diseases
(diabetes, autoimmune disorders, bronchial asthma, acute leukemia, systemic
connective tissue diseases).
In Bukhara, over the past 10 years, there has been a trend towards an increase
in the incidence of chickenpox both among children and adults, with an incidence
rate of 151.6 per 100,000 population. Between 2014 and 2024, 130 patients with
chickenpox were hospitalized in the infectious diseases department of the Bukhara
Oblast Infectious Diseases Hospital. It should be noted that there has been an
increase in the proportion of severe cases of chickenpox, with the development of
purulent-inflammatory complications in 15% of cases. Most hospitalizations
occurred between October and April.
The admission of patients during the autumn-spring period is often related to
immune system characteristics in the winter and spring, when the div lacks
vitamins and minerals due to changes in diet, reduced physical activity, and
insufficient sunlight. Our data coincides with the findings of other authors [1,2],
who suggest that during the winter-spring period, under the appropriate
temperature conditions, the virus can cause epidemics among susceptible
individuals.
Research Objective
To analyze the features of the clinical course of chickenpox in adults
undergoing inpatient treatment in Bukhara Oblast Infectious Diseases Hospital.
Materials and Methods
Under our observation, there were 76 patients with medium-severe
chickenpox aged 18 to 35 years, who were hospitalized in the infectious diseases
hospital. The selection of patients was conducted through continuous observation
https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
271
as they were admitted to the hospital, excluding secondary infection with another
virus.
Inclusion criteria for the study included: male and female patients with a
temperature of ≥37.5°C in combination with intoxication symptoms (weakness,
chills, div aches, headache), catarrhal symptoms (sore throat), exanthema
(polymorphic
rash),
and
informed
consent
from
the
patient.
The majority of patients were male (48 patients, 66.3%), with 28 female patients
(33.7%). The age distribution of the examined group was as follows: 47 patients
(61.8%) were aged 18-20 years, 23 patients (30.3%) were aged 21-30 years, and 6
patients (7.49%) were aged 31-35 years.
Results
The diagnosis of chickenpox was made based on complaints, medical history,
and objective data. A high level of suspicion for chickenpox was noted among
primary healthcare providers, which reflected in a large number of correct
diagnoses (79.6%) upon hospital admission. However, there were some
misdiagnoses, particularly when patients were seen early in the disease when the
rash had not yet fully developed (20.4%). Two patients (2.6%) did not have
referrals and were diagnosed directly in the emergency department.
The epidemiological history revealed that 56 patients (76.8%) had contact with
individuals with chickenpox. Of these, 24 (28.4%) had contact with sick children,
12 (15.8%) with infected coworkers, and 50 (65.8%) were hospitalized due to both
clinical and epidemiological indications. In 9 cases (11.8%), no direct contact with
patients was found.
The onset of disease in 54 (68%) patients was acute, and in 22 patients (32%),
it was subacute with a prodromal period lasting 1 to 3 days. During the prodromal
period, patients experienced weakness, temperature rises to 37-37.5°C, dizziness,
https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
272
sore throat, and loss of appetite. Following this, the temperature rose to 38-39°C.
The
febrile
period
lasted
from
4.9±1.8
to
6.8±2.0
days.
Hospitalization occurred during the eruption period (days 2-4) in 72.4% (55
patients) of cases, although some patients were hospitalized later (on days 5-6) in
13.2% (10 patients) of cases.
The eruption period began mainly with several maculopapular elements
localized on the scalp (48.5%), in the postauricular areas (22.8%), or both
simultaneously (28.5%). Over the next 1-4 days, the rash spread to the face, neck,
torso, and upper and lower limbs. In 53 patients (69.7%), the rash on the lower
limbs was sparse. Within hours, the rash evolved into vesicles with clear contents.
Fifty percent of patients (38) experienced enanthema, accompanied by throat pain,
burning, and difficulty swallowing. Five patients (6.6%) developed
blepharoconjunctivitis, leading to tearing, grittiness, and pain in the eyes. By days
3-4, the rash became polymorphic, including maculopapular-vesicular elements,
which gradually dried out and formed crusts. The crusts typically fell off by days
9-11.
Thirty-five percent of patients (27) had an extremely abundant rash that
covered almost the entire face and torso. The rash had a distinctive feature of rapid
and abundant pustulation, accompanied by a significant temperature rise (39-
40°C). Seven patients (9.2%) had such severe pyoderma that antibacterial therapy
was required. All patients exhibited lymphadenopathy, predominantly involving
submandibular and posterior cervical lymph nodes.
Severe chickenpox occurred in 8 patients (10.5%) and was associated with
complications, including pneumonia in two patients. The severe form of the disease
was characterized by a high fever (39-40°C) from the first days of illness,
pronounced intoxication, headache, dizziness, nausea, repeated vomiting, sleep
disturbances, severe weakness, and a lack of appetite. The rash was also extremely
https://scientific-jl.com/luch/
Часть-44_ Том-2_ Май-2025
273
abundant, typically with pustulation. Severe cases were seen in patients with
preexisting conditions (diabetes, bronchial asthma).
Conclusions
1.
Chickenpox in adults is generally more severe than in children.
2.
Chickenpox in adults begins with a prolonged prodromal period and
pronounced symptoms of intoxication.
3.
Chickenpox in adults is characterized by abundant polymorphic rashes, with
the eruption phase lasting from 5 to 8 days, and 64.5% of patients experience skin
itching.
4.
In 35.5% of cases, the rash was pustular in nature.
5.
In 50% of cases, enanthema with sclera and conjunctivitis was observed.
6.
Severe cases of chickenpox are complicated by pneumonia, encephalitis,
hepatitis, and other complications.
References
1.
Kuzmina T.Yu., Tikhonova Yu.S., Tikhonova E.P., et al. Features of the
course of chickenpox in adults. // Siberian Medical Review. 2013; 2 (80): 72-76.
2.
Sitnik T.N., Shteinke L.V., Gabbasova N.V. Chickenpox: "grown-up"
infection. Epidemiology and Vaccinoprophylaxis 2018; 18 (5): 54-59.
3.
Chistenko G.N., Guzovskaya T.S. Epidemiological features of chickenpox
incidence in Belarus. // Sanitary Doctor. 2015; 4: 30-37.
4.
Skripchenko E.Yu. Modern views on the features of chickenpox in children
and opportunities for specific prevention / E.Yu. Skripchenko, G.P. Ivanova, N.V.
Skripchenko, et al. // Practical Medicine. 2021. Vol. 19. No. 2. Pp. 8-13.
5.
Peredelskaya E.A. Clinical and epidemiological characteristics of
chickenpox in children aged 0-17 years in the city of Barnaul / E.A. Peredelskaya,
T.V. Safyanova, M.M. Druсhanov // Journal of Infectology. 2021. Vol. 13. No. 1.
Pp. 66-70.
