CHICKEN POX

Chickenpox is a viral infection caused by the herpes varicella zostervirus. Chickenpox is an airborne disease . It’s spread in droplets inhaled into the respiratory tract. Complications are rare but serious, and can occur in previously healthy children.

Electron micrograph of a Varicella (Chickenpox...

Electron micrograph of a Varicella (Chickenpox) Virus. Varicella or Chickenpox, is an infectious disease caused by the varicella-zoster virus, which results in a blister-like rash, itching, tiredness and fever. (Photo credit: Wikipedia)

Chickenpox tends to affect children under ten. Most children have had the infection by this age.

Varicella simplex (Chickenpox) on a child Skul...

Varicella simplex (Chickenpox) on a child Skull. (Photo credit: Wikipedia)

In older children and adults, chickenpox can be more severe. It’s more common in late winter and spring. Children who are immunosuppressed (for example, on steroids) are particularly vulnerable to complications, as are newborn babies who may catch the infection from their mother in late pregnancy.

The back of a 30-year old male suffering from ...

The back of a 30-year old male suffering from chickenpox. This is on the 5th day since the rash's development. Pocks are starting to crust over. (Photo credit: Wikipedia)

Pathophysiology:

  1. Incubation Period ( 0 to 15 days: primary viremia) : Infection of upper respiratory mucosa with virus containing droplets. Then virus spreads to regional lymph nodes, where it replicates. Virus spreads to the liver and spleen.
  2. Contagious period ( 16 to25 days: secondary viremia) : Infection of the skin leads to appearance of vesicular rash.
  3. Viral Latency ( 26 to more than 40 days) : Viruses enter cutaneous neurons and migrates to ganglia, where they enter a latent state.

Prevention:

A live, attenuated vaccine that was approved in 1995 for use in the United States by children one year of age or older is now recommended as one of the routine childhood vaccines. It is also indicated for non-immune adults at risk of being exposed to contagious individuals. Most people who get chickenpox vaccine will not get chickenpox. But if someone who has been vaccinated does get chickenpox, it is usually very mild. They will have fewer blisters, are less likely to have a fever, and will recover faster.

Treatment:

  • Drink plenty of waters and avoid salty foods.
  • Stop the scratching. Antihistamines may reduce the itching.
  • Cool clothing to avoid sweating.
  • Paracetamol is helpful to lower the fever.
  • Anti viral treatment:  Aciclovir is an antiviral medicine that is sometimes given to people with chickenpox especially those who are immunocompromised. Ideally, aciclovir needs to be started within 24 hours of the rash appearing. It does not cure chickenpox, but it makes the symptoms less severe. You normally need to take the medicine as tablets five times a day for seven days. If you are taking aciclovir, make sure you drink plenty of fluids. Side effects are rare but can include nausea and diarrhoea.Aciclovir may be prescribed to:
    • pregnant women
    • adults, if they visit their GP within 24 hours of the rash appearing
    • newborn babies
    • people with a weakened immune system (the body’s defence system)
  • Immunoglobulin treatment: Immunoglobulin is a solution of antibodies that is taken from healthy donors. Varicella-zoster immunoglobulin (VZIG) contains antibodies to the chickenpox virus.It is not used to treat chickenpox but to protect people who are at high risk of developing a severe chickenpox infection. This includes:
    • pregnant women
    • newborn babies
    • people with weakened immune systems

    In the case of pregnant women, immunoglobulin treatment also reduces the risk of the unborn baby becoming infected.

    As the supply of VZIG is limited, it will only be considered if a high-risk person has:

    • been significantly exposed to the virus – significant exposure could be face-to-face contact with someone who has chickenpox
    • been in the same room for 15 minutes with someone who has chickenpox
    • had a blood test to confirm that they’ve not had chickenpox before

    In some cases, newborn babies may be given immunoglobulin treatment without having a blood test first.

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