Chickenpox occurred at an early age under conditons of Guatemalan rural village life, much more in preschool than school children and notably in the first two years of life. Acute diarrheal disease was a complication in 29 of 50 patients less than 5 years old. It was not observed in school children or adolescents. Among preschool children with chickenpox whose weight for age was above the community average, 12.5% developed diarrhea compared with 80% among the malnourished.
Chickenpox had a measurable deteriorating effect on nutritional state as judged by altered protein metabolism and loss of weight during the attack. In the presence of a complicating diarrhea, the infection precipitated kwashiorkor in 5 of 27 patients with pre-existing malnutrition, of whom one died. As generally mild an infectious disease as chickenpox has the capacity to interact synergistically with malnutrition to produce serious disability. The effect is exaggerated when chickenpox is the end event in a series of infectious diseases.
Senior Lecturer (Epidemiology), Clinical Research Center, Department of Nutrition and Food Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139.
Professor of Nutrition and Head, Department of Nutrition and Food Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139.