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Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
In chickenpox the patient is infective 2 days before and 7 days after the onset of the rash and until all lesions are crusted. The lesions may be at different stages of maturity, i.e. macules, papules, vesicles and scabs may be seen simultaneously. Complications include encephalitis, secondary bacterial infection, thrombocytopenia, haemorrhagic lesions leading to purpura fulminans, myocarditis, pericarditis, myositis, hepatitis, glomerulonephritis, arthritis and Reye syndrome. Primary varicella pneumonia may be complicated by pleurisy with effusion, and calcification in the lungs has been reported following chickenpox. Varicella contacts can be protected by injection of zoster immune globulin, large amounts of human pooled globulin administered intravenously, or by antiviral therapy.
Varicella Zoster
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Contacts who are aged ≥12 months, not pregnant and not immunocompromised, have no history of chickenpox and who are susceptible to chickenpox are eligible for the live, attenuated varicella zoster vaccine. If the exposure was less then 5 days ago, then the vaccine should be administered. If the exposure was more than 5 days ago, then alternatively the patient can be monitored until day 21. If no symptoms have occurred by then, the vaccine can be given to prevent any future chickenpox.
EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
S Refer to hospital for assessment and oral aciclovir 800 mg tds for 7 daysA hospital assessment should be considered in women at high risk of severe or complicated chickenpox even in the absence of concerning symptoms or signs. Respiratory symptoms, neurological symptoms such as photophobia, seizures or drowsiness, a haemorrhagic rash or bleeding or a dense rash with or without mucosal lesions are indicative of potentially life-threatening chickenpox and are indications for referral to a hospital with intensive case access. If the woman smokes cigarettes, has chronic lung disease, is immunosuppressed (including those on systemic corticosteroids in the preceding 3 months) or is in the second half of pregnancy, a hospital assessment should be considered even in the absence of complications. (Chickenpox in Pregnancy. Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 13, January 2015)
Methylprednisolone and local anesthetic for long-term postherpetic neuralgia: a meta-analysis
Published in Journal of Dermatological Treatment, 2022
Yuan Zhang, Ye-Lin Gao, Li-Hua Zhang
HZ is an infectious skin disease caused by the varicella-zoster virus (VZV), which is latent in the dorsal root ganglia of the human spinal cord. VZV has neurophilic and cutaneous characters. When stimulated by various triggers, latent VZV gets reactivated and replicates into large numbers, causing an immune response in the peripheral sensory nerves and the unilateral dermatomes innervated by the nerves (14). Therefore, it results in erythema, clustered blisters, and neuralgia. Humans are the only hosts of VZV (15). The virus enters the bloodstream via the mucous membranes of the respiratory tract to form viremia. Initial infection in childhood can cause chickenpox and the virus can remain latent in the infected person for a long time. In adults, when immunity declines, the latent virus is activated, leading to the onset of the HZ (14). It is usually found in the parts innervated by the intercostal, cervical, trigeminal, and lumbosacral nerves. The lesions are arranged in bands occur on one side of the body, usually not exceeding the midline (16).
Prevention of viral infections in solid organ transplant recipients in the era of COVID-19: a narrative review
Published in Expert Review of Anti-infective Therapy, 2022
Paraskevas Filippidis, Julien Vionnet, Oriol Manuel, Matteo Mombelli
VZV belongs to the family of Alphaherpesvirinae and establish lifelong latency in cranial nerve and dorsal root ganglia. Primary infection is called varicella or chickenpox and manifests as disseminated, vesicular, pruritic rash with fever and can be rarely accompanied by more severe complications such as pneumonitis and meningo-encephalitis. Reactivation after primary infection is called herpes zoster (HZ) and consists in dermatomal vesicular, painful rash, which may affect multiple dermatomes or even be disseminated in immunocompromised patients [145]. As only 2–3% of adult SOT candidates are seronegative [146], primary VZV infection is rare in this population. By contrast, up to 50% children SOT candidates can be seronegative at the time of transplant, highlighting the need for pretransplant vaccination to avoid the risk for primary infection [147]. The incidence of HZ can range from 5.7% to 16.8% depending on the transplanted organ [139,148,149]. HZ may present at any time in SOT recipients, even years after transplantation. The risk of disseminated zoster and of non-mucocutaneous disease (keratitis, CNS infection) is increased in SOT recipients as compared to the general population [139].
Encouraging Vaccination Ethically: How Can Pox Parties for Grannies and Vaccine-Preventable Diseases Be Avoided?
Published in The American Journal of Bioethics, 2020
As they explain, chickenpox is caused by varicella zoster virus, and after people have recovered, the virus remains in nerve cells and can be reactivated as shingles. The Exogenous Boosting Hypothesis (EBH) posits that more circulating virus from not vaccinating against chickenpox will lead to lower rates of shingles. Chickenpox vaccination in many countries, including the UK, aims to protect those who are at most risk of serious illness. Those groups are targeted for vaccination, rather than the whole population. Malm and Navin highlight the importance of this vaccination by pointing to it being on the World Health Organization (WHO) list of essential medicines (WHO 2019). However, not all vaccines are equal, and it comes in a second section with the influenza vaccine (seasonal) and mumps vaccine. It is not a universal vaccine recommendation but applied to certain regions, in some high-risk populations, or as part of immunization programs with certain characteristics.