Difference between revisions of "Varicella"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
(Management)
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==Management==
 
==Management==
 
===Supportive Care===
 
===Supportive Care===
*Tylenol, antihistamine, oatmeal baths
+
*[[Tylenol]], [[antihistamine]], oatmeal baths
 
*Avoid aspirin in young children due to the risk of [[Reye syndrome]]
 
*Avoid aspirin in young children due to the risk of [[Reye syndrome]]
  
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*Patients receiving short, intermittent, or aerosolized courses of corticosteroids
 
*Patients receiving short, intermittent, or aerosolized courses of corticosteroids
  
Other cases to consider acyclovir
+
Other cases to consider [[acyclovir]]
*Also onsider in <ref>Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.</ref>:
+
*Also consider in <ref>Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.</ref>:
 
*Pregnancy<ref name="cdc">CDC Chicken pox acyclovir treatment [http://www.cdc.gov/chickenpox/hcp/persons-risk.html#acyclovir]</ref>
 
*Pregnancy<ref name="cdc">CDC Chicken pox acyclovir treatment [http://www.cdc.gov/chickenpox/hcp/persons-risk.html#acyclovir]</ref>
 
====Immunocompetent Adult====
 
====Immunocompetent Adult====
*Acyclovir 800mg PO q6hrs daily x 5 days OR
+
*[[Acyclovir]] 800mg PO q6hrs daily x 5 days OR
*Valacyclovir 1000mg PO q8hrs daily x 14 days OR
+
*[[Valacyclovir]] 1000mg PO q8hrs daily x 14 days OR
*Famiciclovir 500mg PO q8hrs x 14 days
+
*[[Famiciclovir]] 500mg PO q8hrs x 14 days
 
====Immunocompromised Adult====
 
====Immunocompromised Adult====
*Acyclovir 10mg/kg IV q8hrs x 7 days
+
*[[Acyclovir]] 10mg/kg IV q8hrs x 7 days
 
====At risk children <12yo child based on AAP criteria====
 
====At risk children <12yo child based on AAP criteria====
*Acyclovir 20mg/kg PO q6hrs daily x 5 days
+
*[[Acyclovir]] 20mg/kg PO q6hrs daily x 5 days
*Acyclovir 10mg/kg IV q8hrs daily x 7 days
+
*[[Acyclovir]] 10mg/kg IV q8hrs daily x 7 days
  
 
==Complications==
 
==Complications==

Revision as of 00:01, 26 February 2017

Background

Clinical Features

Male with varicella rash: lesions in various stages of development
Classic blister during early stage of lesion development
  • Pruritic generalized vesicular exanthem with mild systemic manifestations
  • Usually affects children <10y

Rash

  • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
  • Within 24hr rash becomes vesicular (on erythematous base)
  • Palms/soles spared
  • Lesions in various stages of development

Differential Diagnosis

Pediatric Rash

Vesiculobullous rashes

Febrile

Afebrile

Varicella zoster virus

Evaluation

  • Typically made on clinical features

Management

Supportive Care

Antivirals

  • Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended [1]
  • However, evidence shows decreased days of fever and number of lesions[2]

AAP recommends antiviral treatment (within 24hrs) for patients at risk of increased illness severity:

  • Any patient older than 12 years of age
  • Patients with chronic cutaneous or pulmonary disorders
  • Patients receiving long-term salicylate therapy
  • Patients receiving short, intermittent, or aerosolized courses of corticosteroids

Other cases to consider acyclovir

  • Also consider in [3]:
  • Pregnancy[4]

Immunocompetent Adult

Immunocompromised Adult

At risk children <12yo child based on AAP criteria

Complications

  • Can include encephalitis, otitis media, pneumonia, hepatitis, strep/staph superinfection of ruptured vesicles
  • Perinatal infection in neonates may develop serious illness

See Also

Pediatric Rashes

References

  1. Arvin AM: Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis 2002; 13:12.
  2. Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.
  3. Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.
  4. CDC Chicken pox acyclovir treatment [1]