(CHICKEN POX)

An acute, highly contagious exanthem. Most often occurs in

childhood.

Result of primary infection

of a susceptible individual.

EPIDEMIOLOGY
1.Worldwide in distribution,

whereas the proportion of susceptible adults is even higher in Asia, Africa, and the Middle East. 2.No difference in racial sexual susceptibility. or

3.Humans are the only known

reservoir.
4.Vectors play no role in

transmission.
5.The mean incubation period

is 14 or 15 days, with a rarge

of 10 to 23 days.

6.The major route by which

varicella is acquired and

transmitted is thought to be
the respiratory tract

7.Airborne droplets constitute

an important mechanism of

transmission, but can also be

spread by direct contact

ETIOLOGY

1.VZV is a member of the

herpes virus family.

2.There is serotype. only one VZV

3.A number of antigens are

present in the virion and produced infected cells. 4.Studies of molecular biology and its pathogenesis have

been hampered.

PATHOGENESIS
1.Entry of the virus is

through the mucosa of the upper respiratory tract and oropharynx.

2.Initial multiplication at this portal dissemination small amounts of virus blood and lymphatics (primary viremia) by cells of RES. 3.Incubating infection is partially contaired by innate host defenses and by developing immune responses.

4.Virus replication eventually overwhelms these still undeveloped defenses secondary viremia occurs (zweeks often infection) fever and malaise and disseminates throughout the body especially skin and mucous membranes.

5.Cyclic viremia is terminate after about 3 days. 6.Host immune responses terminate viremia and limit the progression of varicella lesions. 7.IgG, IgM, and IgA of VZV are detectable 2 to 5 days after onset of clinical varicella.

8.Reach maximum titers during second or third week decline slowly persist in low levels for life

9.Cell mediated immunity is more important than humoral immunity in recovery from varicella.

CLINICAL MANIFESTATIONS
Prodrome of Varicella 1.Uncommon in young children. 2.In older children and adults, rash preceded by 2 to 3 day of fever , chills, malaise, headache, anorexia, severe backache.

Rash of Varicella 1.Benigns on the face and scalp. 2.Spreads rapidy to the trunk, with relative sparing of the extremities. 3.Central in distribution. 4.More profuse in lows and protected parts of the body.

5.Rose colored macules papule vesicles pustules crusts. 6.Vesicle is superficial and thin walled like a drop of water 7.Vesicle can also develop in the mucous membranes 8.Fever that persist is proportional to the severity of rash.

COMPLICATIONS OF VARICELLA
1.Secondary bacterial infection of skin lesion (children). 2.Primary varicella pneumonia

(adult).

3.Congenital VZV infection :

asymptomatic
severe

infection
congenital

malformation.
4.Morbidity and mortality are

markedly
immuno

increased

in

compromised

patients.

5.CNS complication : Reyes syndrome. Acute cerebellar atoxia. Encephalitis or meningoencephalitis. Acute ascending or transverse myelitis. Guillain-barre syndrome. 6.Mild hepatitis.

PATHOLOGY
1.Histologically,
distinguished

cant
from

be

herpes

zoster.
2.Ballooning degeneration

(characteristic changes).

CLINICAL DIAGNOSIS
Characteristic diagnostic include: 1.The development papulo

vesikular eruption after a brief and mild (or absent) prodrome symptoms.

2.Appearance of lesions in crops with central distribution. 3.Rapid evolution of lesions. 4.Presence of lesions in all stages of development in any

area

throughout

the

acute

disease.

5.Presence of lesions in the

mucous membranes of the mouth.

LABORATORY DIAGNOSIS

1.Routine blood test are not

helpful. 2.Asymptomatic elevation in

ALT and AST.

3.Punch rediable 4.Defenitive isolation cultures.

biopsies for

more histologig from cell

examinations. diagnosis of virus in

5.Serologic tests.

TREATMENT
Antiviral agents :

Acyclovir.
Famciclovir. Laciclovir. Vidarabine. Foscarnet.

TREATMENT OF VARICELLA
1.Generally benign and selflimited. 2.Locally : Cool compresses. Calamine lotion. Orally : Antihistamines. Antipyretics. Antiviral agents.

PREVENTION & CONTROL

1.Passive immunization.

2.Chemoprophylactic.