Chicken pox; treatment, stages and causes

Chickenpox

Varicella zoster virus (VZV) is a dermotropic and neurotropic virus causing primary infection, usually in childhood, which may reactivate in later life. It is spread by aerosol and direct contact and is highly infectious. Disease in children is usually better tolerated than in adults, pregnant women and the immunocompromised.

The incubation period is 11–20 days, after which a vesicular eruption begins , often on mucosal surfaces first, followed by rapid dissemination in a centripetal fashion. New lesions occur in crops every 2–4 days, accompanied by fever. The rash progresses within 24 hrs from small pink macules to vesicles and pustules, which then crust. Infectivity lasts from 2 to 4 days before the rash appears until the last crusts separate. Diagnosis is clinical but may be confirmed by PCR of vesicular fluid.

Chickenpox

Complications include:

Secondary bacterial infection of rash (due to scratching)

 Selflimiting Cerebellar ataxia.

Congenital abnormalities if maternal disease is contracted in the first trimester.

Pneumonitis, which may be fatal.

Antiviral agents such as aciclovir and famciclovir are not required for uncomplicated childhood chickenpox. They are used when patients present within 24–48 hrs of vesicle onset, in all patients with complications, including pregnant women. Immunosuppressed patients require prolonged treatment, initially parenteral. Human VZV immunoglobulin may attenuate infection in highly susceptible contacts of chickenpox sufferers such as the immunosuppressed and pregnant women. VZV vaccine, now in use in the USA, offers effective protection.

Phases of chickenpox

Chickenpox creates in stages. Before the rash shows up, there might be: weakness or an overall sensation of being unwell (disquietude)  fever that keeps going 3-5 days and is normally under 102 °F (39 °C ). 

  • loss of hunger
  • Muscle or joint hurts
  • Cold-like side effects like a hack or runny nose
  • Cerebral pain

After these side effects, the accompanying will occur:

A bothersome rash will introduce on the face, body, or inside the mouth. The rash will create in spots and in some cases can likewise show up on the eyelids or the privates. The seriousness of the rash can change.

The rash will form into liquid filled rankles that will turn overcast. These rankles make require 3-5Trusted Source days to mend. As there might be many rankles, some might mend sooner than others.

The rankles will become scabs. The scabs will tumble off after with regards to seven days.

Chickenpox

Shingles (herpes zoster)

This is produced by reactivation of latent VZV from the dorsal root ganglion of sensory nerves and most commonly involves the 67 thoracic dermatomes  and the ophthalmic division of the trigeminal nerve.

Burning discomfort develops in the affected dermatome, followed 3–4 days later by a vesicular rash. There may be viraemia and distant ‘satellite’ lesions. Severe, extensive or prolonged disease suggests underlying immunosuppression, e.g. HIV. Chickenpox may be caught from shingles but not vice versa.

Complications

Ophthalmic trigeminal involvement: may lead to corneal ulceration and requires ophthalmology review. 

Ramsay Hunt syndrome: facial palsy, ipsilateral loss of taste and buccal ulceration, and a rash in the external auditory canal. 

Postherpetic neuralgia: can be difficult to treat but may respond to amitriptyline or gabapentin.

Myelitis/encephalitis: rare. Early therapy with aciclovir helps to limit early- and late-onset pain and to prevent the development of postherpetic neuralgia.

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