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    Varicella (Chicken Pox) : IAP UG Teaching Slides 2015 16

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    sindhiya
    Varicella, also known as chickenpox, is caused by the varicella zoster virus. It is highly contagious and spreads through direct contact or through airborne droplets. The rash starts on the face and trunk and spreads centripetally, presenting as macules, papules and tear-drop vesicles that are intensely pruritic. Risk factors for severe disease include infants under 1 month old, immunocompromised individuals, and pregnant women. Treatment focuses on relieving itching and fever. Vaccination provides protection, and passive immunization with VZIG can prevent disease in high-risk groups after exposure. Complications include secondary bacterial infections and, rarely, encephalitis, pneumonia or

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    Varicella (Chicken Pox) : IAP UG Teaching Slides 2015 16

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    sindhiya
    6 views15 pages
    Varicella, also known as chickenpox, is caused by the varicella zoster virus. It is highly contagious and spreads through direct contact or through airborne droplets. The rash starts on the face and trunk and spreads centripetally, presenting as macules, papules and tear-drop vesicles that are intensely pruritic. Risk factors for severe disease include infants under 1 month old, immunocompromised individuals, and pregnant women. Treatment focuses on relieving itching and fever. Vaccination provides protection, and passive immunization with VZIG can prevent disease in high-risk groups after exposure. Complications include secondary bacterial infections and, rarely, encephalitis, pneumonia or

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    Varicella, also known as chickenpox, is caused by the varicella zoster virus. It is highly contagious and spreads through direct contact or through airborne droplets. The rash starts on the face and trunk and spreads centripetally, presenting as macules, papules and tear-drop vesicles that are intensely pruritic. Risk factors for severe disease include infants under 1 month old, immunocompromised individuals, and pregnant women. Treatment focuses on relieving itching and fever. Vaccination provides protection, and passive immunization with VZIG can prevent disease in high-risk groups after exposure. Complications include secondary bacterial infections and, rarely, encephalitis, pneumonia or

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    6 views15 pages

    Varicella (Chicken Pox) : IAP UG Teaching Slides 2015 16

    Uploaded by

    sindhiya
    Varicella, also known as chickenpox, is caused by the varicella zoster virus. It is highly contagious and spreads through direct contact or through airborne droplets. The rash starts on the face and trunk and spreads centripetally, presenting as macules, papules and tear-drop vesicles that are intensely pruritic. Risk factors for severe disease include infants under 1 month old, immunocompromised individuals, and pregnant women. Treatment focuses on relieving itching and fever. Vaccination provides protection, and passive immunization with VZIG can prevent disease in high-risk groups after exposure. Complications include secondary bacterial infections and, rarely, encephalitis, pneumonia or

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    of 15

    VARICELLA 

    (CHICKEN POX)

    IAP UG Teaching slides 2015‐16 1
    CHICKEN POX

        EPIDEMIOLOGY
    •Agent – Varicella Zoster Virus
    •Reservoir ‐ Humans
    •Transmission – Direct contact, Airborne
    •Period of infectivity – 2 days before the onset of rash 
    until all the lesions are crusted
    •Secondary attack rate ‐ 90%
    •Age ‐ 5‐9 years   
    •Season – Jan ‐ May

    IAP UG Teaching slides 2015‐16 2
    CLINICAL PRESENTATION

    • Incubation period ‐ 11 to 21 days
    • Prodromal phase – Mild fever for 1‐2 days
    • Eruptive phase ‐ 
    ‐   Rash initially on face and trunk
    ‐   Centripetal distribution                
    -Macule ‐ papule‐ tear drop vesicles – cloudy & 
        crusting                                        
    -Pleomorphism ‐ presence of lesions in different stages of 
    development at the same time                              
    ‐    Intensely pruritic                                 
    ‐   Lesions also occur on mucosae  recovery in one week                    

    IAP UG Teaching slides 2015‐16 3
    PLEOMORPHIC RASH OF CHICKEN POX

    IAP UG Teaching slides 2015‐16 4
    RISK FACTORS FOR SEVERE VARICELLA

    • First month of life  ‐ especially if the mother is 
    seronegative
    • Delivery before 28 weeks of gestation
    • Adolescence and adulthood
    • Immunocompromised state 
    • Pregnancy: Pregnant women have high risk of severe 
    varicella, especially pneumonia

    IAP UG Teaching slides 2015‐16 5
    DIAGNOSIS

    • Mainly Clinical                                
    • IgM antibody and PCR assay
    • Virus isolation

    IAP UG Teaching slides 2015‐16 6
    TREATMENT

    •Antipruritic Agents 
        ‐ Topical calamine lotion
        ‐ Oral antihistamines      
       
    •Antipyretics
        ‐ Paracetamol is drug of choice
        ‐ Avoid using Aspirin
                                                                                 
    •Acyclovir
        Not routinely given except for severe cases
    IAP UG Teaching slides 2015‐16 7
    PREVENTION
                              
    •Active Immunization‐ at 15 months of age followed by 
    2nd dose 3 months later  
         
    •Passive Immunization (VZIG)
         ‐ Post exposure prophylaxis for high risk 
            individuals 
         ‐ Newborns , Seronegative pregnant 
           women  
         ‐ Immunocompromised patients

    IAP UG Teaching slides 2015‐16 8
    COMPLICATIONS

    •Secondary bacterial infection 
        ‐ Staphylococcus aureus and Streptococcus
        ‐ Persistent fever 
    •Encephalitis (typically post infectious with cerebellar 
    involvement)
    •Pneumonia
    •Disseminated hemorrhagic chicken pox
    •Arthritis, hepatitis, pancreatitis, nephritis

    IAP UG Teaching slides 2015‐16 9
    PERINATAL VARICELLA

    Time of maternal infection  Consequences in fetus / 
    neonate
    Early pregnancy             Spontaneous abortion, 
    (first 20wks)  fetal varicella  syndrome
    At any stage Intra‐uterine deaths, 
    Herpes Zoster in 1st yr of 
    life
    Near term Congenital varicella or                  
    Neonatal varicella

    IAP UG Teaching slides 2015‐16 10
    CONGENITAL VARICELLA SYNDROME

    • Occurs in 2% of children born to mother developing 
    varicella in 1st or 2nd trimester
    • Manifest as – IUGR, microcephaly, cortical atrophy, 
    limb hypoplasia, micro‐opthalmia, cataracts, 
    chorioretinitis, cutaneous scarring
    • Fetal injury risk is unrelated to severity of maternal 
    disease
    • Zoster exposure during pregnancy is not associated 
    with fetal injury

    IAP UG Teaching slides 2015‐16 11
    NEONATAL VARICELLA

    • Neonatal varicella can be a serious illness
    – depending upon the timing of maternal varicella and 
    delivery 
    • If the mother develops varicella within 5 days before  
    or 2 days after delivery, the baby is exposed to the 
    secondary viremia of the mother, baby acquires the 
    virus transplacentally 
    • But acquires no protective antibodies because of 
    insufficient time for antibodies to develop in the 
    mother
    • In these circumstances, neonatal varicella is likely to 
    be severe and disseminated 
    IAP UG Teaching slides 2015‐16 12
    SHINGLES

    • Some people who have had chickenpox may develop 
    shingles later in life 
    • Shingles or zoster caused by a reactivation of the 
    same varicella virus that causes chickenpox
    • Usually presents as a painful vesicular rash tending 
    to occur on one side of the body, usually on the 
    trunk or face – one or more dermatomes 
    • There may be pain, numbness or tingling in the area 
    2‐4 days prior to the rash, which can persist 
    sometimes for as long as a year after the rash is gone

    IAP UG Teaching slides 2015‐16 13
    HERPES ZOSTER

    IAP UG Teaching slides 2015‐16 14
    Thank You

    IAP UG Teaching slides 2015‐16 15 15

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