chicken pox by dr amjad

7/31/2019 Chicken Pox by Dr Amjad

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CHICKEN POX


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DESCRIPTION

Chicken pox is a common childhood disease caused

by the varicella zoster virus (VZV) also known as

human herpes virus 3

It is very contagious and usually occurs duringchildhood (normally 5-9) , but you can get it at any

time in your life.

It is most common at the end of winter and the

beginning of Spring.


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Description

Infects about 70% of all children by 18.

The rash and fever last for about five days.

Most children handle the chicken pox well and recoverwithout any problem within a week.

Infants less than 6 months old are usually protectedfrom it as long as their mother carries the antibody tothis virus.

A healthy child less than 13 years old generally has a

very mild illness. After chickenpox immunity is life-long.


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Pathogenesis

VZV is a DNA virus.

INCUBATION PERIOD is 14-15days.

Initial site of infection is the conjunctivae orupper respiratory tract.

The virus then replicates for about 4 to 6 days

at a local site in the head or neck.


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Pathogenesis

Thereafter, virus is transmitted throughout the body

(primary viremia).

Virus is released in large amounts 1 week later after

a second replication (secondary viremia) and invadesthe cutaneous tissues.

When the virus leaves the capillaries and enters the

epidermis, vesicles of chicken pox appear on the skin.


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TRANSMISSION

It is transmitted by droplets in respiratory secretions.

Air currents from an infected child to a suspected

child carry these water droplets. It is contagious from 24-48 hours before the rash

appears and while uncrusted vesicles are present,

which is usually 3-7days.


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CLINICAL FEATURES

Chicken pox often begins with fever,

running nose,

body aches

and loss of appetite.

Some kids have a fever, abdominal pain, sore throat,headache, or a vague sick feeling a day or 2 beforethe rash appears.

These symptoms may last for a few days, and feverusually stays in the range of 100102 F .

Child becomes a febrile by the end of first week.


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CHICKEN POX RASHThe characteristic feature of chickenpox is the vesicle. Chickenpox causes a red, itchy skin rash that usually

begins along the hairline on the face, then appears insuccessive crops over the trunk and then theextremities.

Rash begins as red macules that progress to tinyvesicles with surrounding erythema (dew drops on arose petal), formpustules, become crusted,scabbedoverand leave no scar.

The rash continues to break out for the first 1 to 5days, so spots at various stages of development maybe present at the same time.

The rash may be more extensive or severe in kids whohave skin disorders such as eczema.


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LESIONs


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COMPLICATIONS

In healthy children, chickenpox is a mild disease.Adults are 25% more likely to have significantcomplications. Common complications affecting bothchildren and adults include

1)Bacterial infection of a vesicular lesion

it is the most frequent complication. Commoninfecting organisms are Group A streptococcus andStaphylococcus.

2)Viral sequelae of chickenpox

Most common is pneumonitis (cough, dyspnoea,tachypnoea, cyanosis )


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complications(continue)

3)Neurologic complications.

Children most commonly develop an inflammation of thebalance center of the brain calledacute cerebellar ataxia.

Adults more commonly develop a more generalized braininflammation ("encephalitis") delirium and seizures.

4)Reyes syndrome

This rare childhood complication of chickenpox is most

commonly associated with the administration ofaspirin. A

rapid progression ofnausea, vomiting, headache and

delirium that may progress to coma is a common pattern

of deterioration.
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Complications(continue)

5)Purpura fulminansIt is large ecchymosis that appears on the legs and

may occasionally progress to haemorrhagic

gangrene.

6)Rare complications: hepatitis, rthritis, pericarditis,

glomerulonephritis, orchitis and encephalitis.


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DIAGNOSIS

Diagnosis is usually apparent on clinical examination(characteristic vesicular rash).

Leukocyte countsare normal or low. Leukocytosissuggests secondary bacterial infection.

OnX-ray in varicella pneumonia there are numerousbilateral nodular densities and hyperinflation.

Virus can be identified by obtaining samples of thevesicle fluidfor inoculation in cell culture.


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Differential diagnosis

Varicella like rashes may be present in:

Coxsackie-virus infection. There are few lesions andthere is no crusting.

Impetigo: There are fewer lesions, perioral orperipheral lesions, and no classic vesicles. Lesionsrespond to antimicrobial agents.

Papular urticaria: there is history of insect bite andrash is non-vesicular.

Scabies: there are burrows and no typical vesicles.


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Treatment

the diseased until the rash crusts.

Preventing ScratchingScratching increases the risk of secondarybacterial infections. All

patients with chicken pox should have their nails trimmed short.

by frequent baths or, once the fever has subsided, showers. Cool, wet compresses

or tepid water baths help to relieve itching.

LotionsThe most common lotion used for chicken pox is Calamine lotion.

may be used to help relieve the itching.

Diphenhydramine (Benadryl)

hydroxyzine (Atarax)loratadine (Claritin), certrizine (Zyrtec), andfexofenadine (Allegra)
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Treatment(continue)

Give acetaminophen regularly to help relieve pain if child hasmouth blisters.

Never use aspirin to reduce pain or fever in kids withchickenpox because aspirin has been associated with the

serious disease Reye syndrome, which can lead to liver failureand even death.

Anti-viralAcycloviris used for severe Varicella infections involving the lungs orthe brain and in persons with a depressed immune system.

; Secondary bacterial pneumonia is

treated with antibiotics.
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PREVENTION

Immunization .Children receive 2doses of traditional

chickenpox vaccine. The first should be given when

child is 12-15month old, second dose when they are

4-6years old. People aged 13 and older who have not received the

vaccine and have not had chickenpox should get 2

doses,4-8weeks apart.


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Prevention

Chickenpox is contagious from about 2 days beforethe rash appears until all the blisters are crusted over.

A child with chickenpox should be kept out of schooluntil all blisters have dried, usually about 1 week.

Children between 12 and 18 months should receive a

dose of chickenpox vaccine. and a booster shot at 4to 6 years old.

The vaccine is about 70% to 85% effective atpreventing mild infection, and more than 95%

effective in preventing moderate to severe forms ofthe infection.


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Child exposed to chickenpox

If the child has had chickenpox or has been vaccinated,

nothing needs to be done.

Susceptible person (one who has never had chickenpox)

receive the chickenpox vaccine as soon as possible afterbeing exposed to the virus.

Vaccine may prevent illness or reduce the seriousness of

the disease, if given within 3 to 5 days following

exposure. Even if the person was not infected with the chickenpox

virus from the exposure, receiving the vaccination will

prevent future disease.


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Preventive Treatment after Exposure

Varicella Zoster Immune Globulin (VZIG) Only offers temporary protection

Recommended for:

Newborns whose mothers have chickenpox 5 days prior to 2days after delivery

Children with leukemia or lymphoma who have not beenvaccinated

Persons with cellular immunodeficiency's or other immuneproblems

Persons receiving drugs, including steroids, that suppress theimmune system

Pregnant women


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Prevention

If a pregnant woman contracts chickenpox during the

first or second trimester, there is a small risk that her

child will be born with a congenital malformation.

When a pregnant woman contracts the diseasewithin 5 days of delivery, there is a high risk of the

newborn having serious disease.


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SHINGLES(HERPES ZOSTER)


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Shingles

A person usually has only one episode of chickenpox,but VZV remains in the dorsal root ganglion cells in alatent state for decades. As immunity decreases inlate adulthood, the virus may reactivate and cause

herpes zoster or shingles. More common after age 50 and the increases risk

with age.

Shingles is contagious. If you come in contact with

someone with Shingles and you havent had ChickenPox yet, you will get Chicken Pox and not Shingles

There is no vaccine for Shingles.


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THANKS

chicken pox by dr amjad

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