Accident and Emergency
Nagi Giumma Barakat in Get Through, 2006
This can be transmitted via close contact, droplets and/or through soiled materials. Ninety percent of adults are seropositive to human herpesvirus 3 (varicella zoster virus, VZV). The incubation period is 14–17 days. The primary infection will cause chickenpox, with prodromal symptoms of mild fever and eruption of a vesicular rash, more so on the trunk. After that, the virus remains dormant in the dorsal root ganglia, and, if activated, will cause shingles. In early pregnancy, it may cause abortion. Varicella zoster immunoglobulin (VZIG) may be given to high-risk patients, and IV aciclovir can be given to acutely infected high-risk people and can reduce the period of infection. In neonates, aciclovir can be given for 14 days. The use of aspirin in children with chickenpox should be avoided, as this can lead to Reye’s syndrome. It is a good idea to test for VZ antibodies in patients who are going to have chemotherapy or who are immuncompromised, and in pregnant women who are likely to come into contact with chickenpox and have no clear history of a VZ infection. A live, attenuated vaccine is available and can be given from the ages of 9 months to 12 years as one dose; this will give at least 6 years’ immunity in immunocompetent children.
Case 53: A Teenager with a Rash
Layne Kerry, Janice Rymer in 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A clinical diagnosis of chickenpox was made. The patient was isolated in a negative pressure room. Intravenous aciclovir and antibiotics (co-amoxiclav, clarithromycin and a one-off dose of gentamicin) were prescribed. A chest x-ray showed bilateral lung infiltrates and multiple nodular lesions throughout the lung fields (Figure 53.1), consistent with varicella pneumonia. Over the next 8 hours, the patient became increasingly tachycardic and her blood pressure fell to 80/60 mm Hg. Intravenous fluids were given and the doctors noted that the patient was cool and clammy to touch. Her respiratory rate (RR) increased to 30 breaths per minute and she required 35% oxygen to maintain oxygen saturations of 96%. She was taken to the intensive treatment unit and required mechanical ventilation for 2 days.
Infection and immunology
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
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.
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.
Varicella vaccination in Italy and Germany – different routes to success: a systematic review
Published in Expert Review of Vaccines, 2020
Florence Kauffmann, Angela Bechini, Paolo Bonanni, Giacomo Casabona, Peter Wutzler
Varicella, also known as chickenpox, is a highly contagious disease resulting from primary infection with the varicella-zoster virus (VZV), usually during childhood [1]. Although generally benign and self-limiting, acute varicella can be complicated by secondary bacterial infection of the skin, pneumonia, encephalitis, cerebellar ataxia, arthritis, appendicitis, hepatitis, glomerulonephritis, pericarditis, and orchitis [2]. Most epidemiological studies show that, in temperate climates, more than 90% of adolescents or young adults are seropositive for VZV [3]. VZV remains latent in sensory ganglia, and its reactivation results in herpes zoster (HZ; shingles) [4,5]. Both varicella and HZ are associated with a significant medical, social, and economic burden on the healthcare system [6–11].
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).
Related Knowledge Centers
- Encephalitis
- Fatigue
- Fever
- Herpesviridae
- Pneumonia
- Varicella Zoster Virus
- Infection
- Headache
- Vaccine-Preventable Disease
- Skin Condition