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Varicella

Chickenpox is a highly infectious, acute contagious disease predominantly of

children under 10 years old, though it may occur at any age. Peak incidence Mar May. It is characterised by feer and a rash, and is caused by aricella !oster irus

"round #0$ of people %ho come into contact %ill deelop the disease.

&ransmission is through 1' direct person to person contact (' airborne droplet

infection )' through contact %ith infected articles such as clothing and bedding

"round #0$ of adults oer the age of 1* years hae immunity for ++ in the -

/eactiation of latent ++ %ill result in shingles %hich is more common in adults

In ngland and ales, the incidence of chickenpox is approximately 1(#0cases per 100,000 person2years

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Varicella clinical features

&he incubation period is from 13 up to (1 days

chicken pox is infectious from a fe% days before the onset of rash deelops and not more than six days after

first lesions appear

the rash begins as macular lesions %hich deelop into papular, or esicular lesions 4filled %ith fluid' and later

becomes pustular

chickenpox rash has a centripetal distribution 2 mostly on the face and trunk and sparsely on the limbs

there is erythema around the lesions and they are intensely itchy

usually the rash peaks at around 3* hours in immunocompetent people

esicles dry and crust oer, and sometimes scar if scratched to excess oropharynx and genital tract

mucous membranes may be inoled as %ell

ne% lesions can emerge for up to 5 days

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In children under 10 years, the disease is usually mild and self limiting, but a more seereinfection can be seen in

1' adults 2 especially in pregnant %omen and in smokers since they are

at an increased risk of deeloping fulminanting aricella pneumonia

(' neonates

)' immunosupressed indiiduals there is an increased risk of deeloping

disseminated or haemorrhagic aricella

6igns of seere infections include7 respiratory symptoms 4clinical respiratory signs are often absent'. densely cropping esicles haemorrhagic rash bleeding from gums, haemoptysis, 8I bleeding any neurological changes 2 cerebellar signs, encephalopathy persisting feer %ith ne% esicles 9: days after onset

Varicella

8eneral recommendationis for school exclusion for 5 days from onset of rash

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Treatment

&reatment is usually symptomatic in milder disease paracetamol or ibuprofen can be gien to

reduce flu like symptoms, feer and pain

antivirals should be considered for patients %ho presents %ithin (323* hours of ne% esicles

4indicating an eoling disease' antiiral therapy should be continued for at least 1 %eek

ral aciclovirmay also be gien to 1' immuocompetent adults and older adolescents

(' Infants )' seere infection at any age 3' immunosuppression 5'seere cardiorespiratory

disease :' chronic skin disorder

Varicella zoster immune globulin4+I8' +I8 prophylaxis can be used in indiiduals %ho

complete all of the follo%ing criteria7 significant exposure to chickenpox or herpes !oster

a clinical condition that increases the risk of seere aricella, this includes immunosuppressed

patients, neonates and pregnant %omen

no antibodies to + irus

Immunosuppressed patients should be gien immunoglobulin to aricella !oster and acicloir

%ithin t%o days of contact %ith aricella. If they deelop chicken pox they should be treated %ith

acicloir.

"ntibiotics should be gien for secondary infectionsgpnotebook.co.uk


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Differential diagnosis

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Differential Diagnoses

;ullous Pemphigoid


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acute onset of feer greater than 101 >?

4)*.) >C' follo%ed by a rash characteri!ed

by firm, deep seated esicles or pustules in

the same stage of deelopment %ithoutother apparent cause.

+"/I@A"

2MaBor

2Minor

produce characteristic

cytoplasmic inclusions, the most important

of %hich are kno%n as8uarnieri bodies
https://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Guarnieri_bodieshttps://en.wikipedia.org/wiki/Guarnieri_bodieshttps://en.wikipedia.org/wiki/Cytoplasmichttps://en.wikipedia.org/wiki/Cytoplasmic


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&he morphologies are myriad and includemorbilliform, urticarial, papulosuamous,

pustular, and bullous. Medications can also

cause pruritus and dysesthesia %ithout an

obious eruption.


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Bullous pemphigoidis an acute or

chronic autoimmune

skin disease, inoling the formation ofblisters, more appropriately kno%n as

bullae, at the space bet%een the skin layers

epidermis and dermis. It is classified as a

type II hypersensitiity reaction.

Clinically, the earliest lesions may appear

urticarial

DikolskyEs sign is negatie unlike

pemphigus ulgaris %here it is positie.
http://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Skin_diseasehttp://en.wikipedia.org/wiki/Blistershttp://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Type_II_hypersensitivityhttp://en.wikipedia.org/wiki/Lesionhttp://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Nikolsky's_signhttp://en.wikipedia.org/wiki/Pemphigus_vulgarishttp://en.wikipedia.org/wiki/Pemphigus_vulgarishttp://en.wikipedia.org/wiki/Nikolsky's_signhttp://en.wikipedia.org/wiki/Urticariahttp://en.wikipedia.org/wiki/Lesionhttp://en.wikipedia.org/wiki/Type_II_hypersensitivityhttp://en.wikipedia.org/wiki/Dermishttp://en.wikipedia.org/wiki/Epidermis_(skin)http://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Bulla_(dermatology)http://en.wikipedia.org/wiki/Blistershttp://en.wikipedia.org/wiki/Skin_diseasehttp://en.wikipedia.org/wiki/Autoimmune_disorderhttp://en.wikipedia.org/wiki/Chronic_(medicine)http://en.wikipedia.org/wiki/Acute_(medicine)


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6cabies causes seere

itching that is usually %orse at night and a

rash %ith tiny blisters or sores

&here are four cardinal signs of scabies

Scabies
http://www.webmd.com/skin-problems-and-treatments/guide/default.htmhttp://www.webmd.com/skin-problems-and-treatments/tc/rash-age-12-and-older-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/tc/rash-age-12-and-older-topic-overviewhttp://www.webmd.com/skin-problems-and-treatments/guide/default.htm


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Common infection of the skin or mucosa

may affect the face and mouth 4orofacial

herpes', genitalia 4genital herpes'

=erpes 6implex


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MaBority of children recoer %ithout any complications but neonates, adults,

pregnant %omen and those %ho are immunocompromised may hae more

serious complications

Complications

Pulmonary inolementFF.5213$ of adults

CD6 inolementFF.cerebellar ataxia andGor encephalitis

6econdary bacterial infectionsF.inc osteomyelitis

=aemorrhagic complicationsF..8I bleeds,


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Varicella vaccination

+aricella accine is a lyophilised preparation %hich contains lie attenuated organismsof the @ka strain of aricella !oster irus.

should be administered as deep subcutaneous inBection and can be gien together %ith

other lie accines such as MM/

children from one year to under 1) years of ageH a single dose of aricella accine %ill

gie protection for around #0$ of children

children aged 1) years or older and adults 2 should receie t%o doses of aricella accine

four to eight %eeks apart, around 5$ %ill hae protection against clinical chickenpox 41'

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