Failure to Diagnose Chicken Pox
Failure to Diagnose Chickenpox

Most of us who are "Generation X" and older have been exposed to chickenpox, also spelled chicken pox, or Varicella simplex, during our childhood. It used to be a relatively common infectious disease caught and survived by most children.

What is Chickenpox?

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3), one of the eight herpes viruses known to affect humans.

It starts with conjunctival and inflammation of mucus membrane symptoms, moderate fever and then characteristic spots appearing in two or three waves, mainly on the body and head rather than the hands and becoming itchy raw pox (pocks), small open sores which heal mostly without scarring.

Chickenpox has a two-week incubation period and is highly contagious by air transmission two days before symptoms appear. Following primary infection there is usually lifelong protective immunity from further episodes of chickenpox. Recurrent chickenpox is fairly rare but more likely in people with compromised immune systems.

Symptomatic treatment, with calamine lotion to ease itching and paracetamol (known in the US as acetaminophen) to reduce fever, is widely used.

Chickenpox, when properly diagnosed, is rarely fatal (usually from varicella pneumonia), with pregnant women and those with depressed immune systems being more at risk.

Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the fetus.

When Can Chickenpox be Deadly?

The real danger presents itself when an adult contracts chickenpox but has a weak immune system, or is immuncompromised because the adult is taken a steroid or other immune system suppressant for another ailment.

In these cases, the results, if not detected or diagnosed by a physician, can be disastrous, leading to permanent injury, and death.

The failure to diagnose chickenpox in an immunocompromised adult, and then prescribe appropriate treatment (i.e. discontinuing steroids or other immunosuppressant substances where the circumstances permit), which leads to catastrophic injury (details below) or death, may form the basis of a medical malpractice claim.

Symptoms and signs

Chickenpox is highly infectious and spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. Touching the fluid from a chickenpox blister can also spread the disease.

A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. This may take between 5-10 days. It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.

The chickenpox lesions (blisters) start as a 2-4 mm red papule which develops an irregular outline (rose petal). A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chickenpox.

After about 8-12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about 7 days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore, it may take about a week until new lesions stop appearing and existing lesions crust over.

Chicken Pox May Harm Unborn Children

Congenital defects may occur if the child's mother was exposed to VZV during pregnancy. Effects to the fetus may be minimal in nature but physical deformities range in severity from under developed toes and fingers, to severe anal and bladder malformation.

Possible problems include:

•        Damage to brain: encephalitis, microcephaly, hydrocephaly, aplasia of brain

•        Damage to the eye (optic stalk, optic cup, and lens vesicles), microphthalmia, cataracts, chorioretinitis, optic atrophy.

•        Other neurological disorder: damage to cervical and lumbosacral spinal cord, motor/sensory deficits, absent deep tendon reflexes, anisocoria/Horner's syndrome

•        Damage to body: hypoplasia of upper/lower extremities, anal and bladder sphincter dysfunction

•        skin disorders: zig zag (cicatricial) skin lesions, hypopigmentation

Dangers of Immunocompromised Adults

The mortality rate in immunocompromised patients with disseminated herpes zoster is 5-15%, with most deaths from pneumonia. Vaccines, unfortunately are less effective among these high-risk patients, as well as being more dangerous because it is an attenuated live virus (see last footnote), but clearly immunisation before immunocompromise would be desirable.

Complications of Adult Chickenpox

Chickenpox complications are more likely to occur in adults than in children. Despite the fact that adults account for only 5 percent of chickenpox cases per year, they account for a disproportionate number of deaths (55 percent) and hospitalizations (33 percent) compared to children.

Most complications of adult chickenpox are caused by an infection from bacteria. These bacteria can cause chickenpox complications that include:

• skin or soft tissue infections
• pneumonia
• bone infections (osteomyelitis)
• joint infections (septic arthritis)
• toxic shock syndrome

Other serious adult chickenpox complications directly related to the chickenpox virus can include:

• infection of the brain (encephalitis)
• bleeding problems
• cerebellar ataxia
• disseminated intravascular coagulation 
• • The affected person is often acutely ill and shocked with widespread hemorrhage (common bleeding sites are mouth, nose and venipuncture sites), extensive bruising, renal failure and gangrene.
  • The onset of DIC can be fulminant, as in endotoxic shock or amnioitic fluid embolism, or it may be insidious and chronic, as in cases of carcinomatosis.
  • This is a deadly condition, including bleeding from eyes, nose, and mouth.
  • The prognosis for those with DIC, regardless of cause, is often grim: Between 10% and 50% of patients will die. DIC with sepsis (infection) has a significantly higher rate of death than DIC associated with trauma.
  • One alternative interpretation of the acronym, "death is coming," refers to the lack of effective treatment options, and to the significant mortality associated with severe DIC.

Medical Malpractice Attorney

Medical malpractice may arise when a doctor fails to properly diagnose chickenpox or its complications in an immunocompromised adults, or develops life-threatening DIC.

We have seen this form of malpractice occur in the context of family physicians, internal medicine physicians who fail to stop prescribing steroids or other immuncompromising drugs, pain management doctors who prescribe eipdurals and steroids in the chickenpox infected patient, infectious disease specialists who cannot identify the underlying cause of the DIC, and so on.

Unfortunately, the consequences of medical malpractice in these circumstances can be catastrophic.

If you suspect that you or a family member has been a victim of medical malpractice, failure to diagnose chickenpox,  misadiagnosis of chicken pox, or other form of medical malpractice, then contact our personal injury law firm.

We provide aggressive, prompt, and ethical advocacy on behalf of individuals and families who have suffered serious personal injury, accident injury, and wrongful death. Contact us today