VARICELLA ZOSTER INFECTIONS / CHICKEN POX

1. DEFINITION
 Varicella = generalized vesicular eruption of the skin and mucous membranes. Often in
children
 Herpes zoster (shingles) = sporadic, incapacitating disease of elderly or
immunocompromised individuals that is characterized by pain and vesicular rash
limited in distribution to the skin innervated by a single sensory ganglion.
 Shares many characteristics with HSV, including (1) the ability to establish latent
infection of neurons and recurrent disease, (2) the importance of cell-mediated
immunity in controlling and preventing serious disease, and (3) the characteristic
blister-like lesions.
2. Structure and Replication
 dsDNA Herpesviridae
 VZV has the smallest genome of the human herpesviruses.
3. Patogenesis and Immunity
a. Varicella Zoster
 Acquired by inhalation (mucosa of the upper respiratory tract or the conjunctiva)
 Primary infection begins in tonsil  primary viremia  liver and spleen
 Secondary viremia = involving infected mononuclear cells transports virus to the skin,
where the typical rash develops  epithelial swelling, ballooning degeneration,
production of vesicles
 Multiple stages of vesicles (usianya nggak sama) ; all stages of macules, papules,
vesicles, and crusts may be seen at one time
 Person become infectious 48h before rash appearance and 4 – 5 days after the vesicles
crusted
 After infection, virus become latent in dorsal ganglia
b. Herpes Zoster
 Acute inflammation of the sensory nerves and ganglia.
 Often only a single ganglion may be involved.
 The distribution of lesions in the skin corresponds closely to the areas of innervation
from an individual dorsal root ganglion
4. Laboratory Diagnosis
 Cowdry type A intranuclear inclusion body
  PCR, ELISA
5. Treatment, Prevention, Control
 Acyclovir, Famcyclovir, Valacyclovir  VZV require larger dose of ACV
 VZIG for immunodeficient patients
 Live attenuated vaccine for OKA strain