VARICELLA

Yessi Oktiari
G0006026 dr. Nugrohoaji Dharmawan, SpKK, M.Kes

KEPANITERAAN KLINIK ILMU PENYAKIT KULIT DAN KELAMIN FAKULTAS KEDOKTERAN UNS/RSUD DR. MOEWARDI
SURAKARTA 2011

Definition
Varicella is the clinical syndrome caused by varicella-zoster virus (VZV) VZV is a double-stranded deoxyribonucleic acid virus included in the Alphaherpesviridae subfamily.

Pathogenesis
Usually acquired by the inhalation The virus infects the conjunctivae or the mucosae of the upper respiratory tract
Viral proliferation occurs in regional lymph nodes of the upper respiratory tract 2-4 days after initial infection; this is followed by primary viremia on postinfection days 4-6 A second round of viral replication occurs in the body's internal organs, most notably the liver and the spleen, followed by a secondary viremia 14-16 days post infection Characterized by diffuse viral invasion of capillary endothelial cells and the epidermis

Pathogenesis
VZV infection of cells of the malpighian layer produces both intercellular edema and intracellular edema, resulting in the characteristic vesicle
After primary infection, VZV is hypothesized to spread from mucosal and epidermal lesions to local sensory nerves

VZV then remains latent in the dorsal ganglion cells of the sensory nerves

Reactivation of VZV results in the clinically distinct syndrome of herpes zoster (shingles).

Clinical Features

Slight fever, headache, and itching round spots of different size Spots may have clear liquid inside. Some may be crusty. They will cover the whole body, but may be more on the trunk than arms and legs

Workup

The workup for chickenpox includes a Tzanck smear, vesicular fluid culture, serologic testing 1. Tzank smear Demonstrates multinucleated giant cells and epithelial cells

Workup
2.

3.

Vesicular fluid culture Provides a definitive diagnosis; however, culturing for VZV is technically difficult Serologic testing
Enzyme

immunoassay Indirect fluorescent antibody Complement fixation Fluorescent antibody to membrane assay Latex agglutination test

Treatment

Nonmedical Medical
Topical treatment

Plenty of rest Do not scratch Bathing carefully so that the vesicles do not rupture Soft food when there are many lesions in the mouth

In the vesicular stage can be given 2% salicylic powder or calamine shake powder to prevent rupture of the vesicle If the vesicles rupture/ crusting or ulceration can occur given an antibiotic ointment Menthol 2% or any other anti-pruritic

Treatment
Systemic treatment Symptomatic
Oral antihistamins, antipyretics

Antiviral

A randomized controlled trial of acyclovir treatment found that early treatment with oral acyclovir (800 mg five times a day for 5 days) reduce the maximum number of lesions and time of new lesion formation, compared with placebo

Complications
The most common complication is the secondary bacterial infection Encephalitis, pneumonia, carditis, glomerulonephritis, hepatitis, keratitis, conjunctivitis, otitis, arteritis, and blood disorders

Prevention
VaricellaZoster Virus Vaccination

Passive Immunization

Indicated for passive immunization to treat exposed, susceptible individuals at risk of complications from varicella

Prognosis

Varicella that affects a healthy child is usually a self-limited disease. Increased morbidity occurs in adult and immunocompromised populations.

CASE REPORT

Identity
Name Age Gender Address : Ms. Putri : 17 years : Female : Gulon, Jebres Surakarta

Health story

Chief complaint Rash in the face and hand Present illness From 3 days before the patient went to the hospital, the patient began to complain of a rash on his left cheek, accompanied by itching. There were more rash on hands and chest and appeared to contain liquids. Rash on the face broken and release clear discharge. Complaint accompanied by fever. The patient did not complain of fever and cough and cold. Patients did not consume drugs or something unusual before rash arise. No similar disease was found in the neighborhood. The patient claimed that she never suffered chickenpox before.

Past history and family history

No allergic history No atopic history No similar disease

Dermatovenerology status

Facial region: multiple discrete vesicles partially erythematous and crusty Anterior thorax region: multiple discrete vesicles partially erythematous and crusty Antebrachii region : multiple discrete vesicles

Differential Diagnosis
1.
2.

3.

Varicella Variola Herpes zoster

Workup

A Tzanck smear of vesicular fluid with Giemsa: (+) multinucleated giant cell

Working Diagnosis

Varicella

Treatment
Non medical Plenty of rest Do not scratch Bathe carefully so that the vesicles do not rupture Soft food when there are many lesions in the mouth

Treatment
Medical

Acyclovir 800 mg five times a day for seven days Salicyl acid talc Mebhydrolin napadisylate tablet 50 mg two times a day Fusidic acid cream two times a day

Prognosis

Ad vitam Ad sanam Ad fungsionam Ad cosmeticum

: bonam : bonam : bonam : bonam

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