CHICKEN POX ( VARICELLA)

INTRODUCTION
 Varicella( Chicken pox) and Herpes Zoster:

two distinct diseases caused by Varicella Zoster virus.

 varicella-zoster virus (VZV), (HHV-3), one

of the eight herpes viruses known to affect humans  Primary infection results in chicken pox  Re-activation may result in shingles

Name origin
 The skin appeared to be picked by chickens  Resembles the seeds of Chick Peas  Most common explanation is that its not that

dangerous so it s a chicken version of Pox.

 Pox is another word for a curse, which is what it

was believed to be in medieval times.

Transmission
 Persons to person contact or sneezing/coughing  Contact with fluid from a chicken pox blister  Incubation period: 7-21 days ; can be prolonged

in immunocompromised individuals and those who have taken post exposure trt with a varicella antibody containing product.

Clinical Features
 Mild prodrome precedes the onset of rash in

adults; 1-2 days of fever and malaise

 In children rash usually the first sign of disease  Healthy children ; mild course of disease

malaise, pruritus and temp upto 102^F

 Adults more severe disease and more chance of

complications

Rash

Rash
 Generalised and pruritic  Evolves from macules

papules
Over 5-6 days

vesicles

Non infectious  Centripetal distribution: lesions dried crusts

concentrated on trunk  Lesions can also occur on mucoud membranes of the oropharynx, respiratory tract, vagina conjunctiva and cornea.  Multiple crops : pleomorphism

Management
 Minimize fever and discomfort: Antipyretic medicines, Cool

baths and soothing lotions  Chickenpox is not usually treated with a specific antiviral compound . Antiviral medication may be appropriate for older patients, in whom the disease tends to be more severe.  Isolation Acyclovir Therapy  Healthy nonpregnant persons >13 years of age  Children >12 months with chronic cutaneous or pulmonary disorders or on salicylate therapy  Children receiving short intermittent or aerosolized steroids  IV in Immunocompromised children and adults with viralmediated complications  Not recommended for post-exposure prophylaxis

complications
 Certain groups are more likely to have

   

complications.: adults, infants, adolescents and people with weak immune systems from either illnesses or from medications such a long-term steroids. Bacterial infections of the skin and soft tissues in children : streptococcal and staphylococcal Bacterial pneumonia CNS: Cerebellar ataxia, Encephalitis, Aseptic meningitis Reyes Syndrome:Asprin taken in acute illness

Communicability
 Less contagious than measles but more than

mumps or rubella

 Period of communicability extends from 1-2

days before the rash through the first 4-5 days or until lesions have formed crust.

Congenital VZV infection

 Maternal varicella infection in the first 20

weeks of gestation
 Constellation of abnormalities : low birth

weight, hypoplasia of extremities, skin scarring, localised muscular atrophy, encephalitis, cortical atrophy, chorioretinits and microcephaly

Recurrent disease(Herpes zoster)

 Reactivation of latent VZV  Trigerred due to aging, immunosuppression,

intrauterine exposure.  Also varicella infection at a young age( less than 18 mnths)  Dermatomal distribution ( trunk or the fifth cranial nerve most common)  2-4 days prior to eruption there may be pain and paresthesias.

prevention
 Vaccination : effectiveness of 70- 86%  1 dose >13 yrs of age ; 2 doses in adults and

adolescents 4-8 wks apart, subcutaneous  Schedule : 12-24 mnths for early childhood immunization  Contraindications : Pregnancy; reaction to previous dose, advance immune disorder or cellular immune deficiency; symptomatic HIV infection; severe illness  Adverse reaction : mild illness with rash

Post Exposure Prophylaxis

 Varicella vaccine :Susceptible persons following

exposure to varicella and for out break control ; administered within 72 hrs-120hrs prevents/modifies disease  Varicella Zoster Immune Globulin : most effective within 96 hrs of exposure
    

Newborns whose mothers have chickenpox 5 days prior to 2 days after delivery Children with leukemia or lymphoma who have not been vaccinated Persons with cellular immunodeficiencies or other immune problems Persons receiving drugs, including steroids, that suppress the immune system Pregnant women

Thank you