Difference between revisions of "Varicella"

(sources added)
(Treatment)
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==Treatment==
 
==Treatment==
 +
===Supportive Care===
 
*Tylenol, antihistamine, oatmeal baths
 
*Tylenol, antihistamine, oatmeal baths
**No Aspirin (may predispose to Reye's Syndrome)
+
*Avoid aspirin in young children due to the risk of [[Reye syndrome]]
*Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended in Tintinallli 7th ed
+
 
 +
===Corticosteroids===
 +
*Routine use of antiretrovirals for uncomplicated cases in immunocompetent children is not recommended <ref>Arvin AM: Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis 2002; 13:12.</ref>
 
*However, evidence shows decreased days of fever and number of lesions<ref>Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.</ref>
 
*However, evidence shows decreased days of fever and number of lesions<ref>Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.</ref>
**Consider Acyclovir20 mg/kg (up to 800 mg) PO q6hrs x 5 days for children >12 y/o
+
 
*Immunocompromised<ref>Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.</ref>:
+
===Antivirals===
**≤12 yrs - Acyclovir 20 mg/kg IV q8hrs x 7-10 days
+
AAP recommends antiviral treatment (within 24hrs) for patients at risk of increased illness severity:
**>12 yrs - Acyclovir 10 mg/kg IV q8hrs x 7 days
+
*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 onsider 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>
 +
====Immunocompetent Adult====
 +
*Acyclovir 800mg PO q6hrs daily x 5 days OR
 +
*Valacyclovir 1000mg PO q8hrs daily x 14 days OR
 +
* Famiciclovir 500mg PO q8hrs x 14 days
 +
====Immunocompromised Adult====
 +
*Acyclovir 10mg/kg IV q8hrs x 7 days
 +
====At risk children <12yo child based on AAP criteria====
 +
*Acyclovir 20mg/kg PO q6hrs daily x 5 days
 +
*Acyclovir 10mg/kg IV q8hrs daily x 7 days
  
 
==Complications==
 
==Complications==

Revision as of 01:02, 26 April 2015

Background

Diagnosis

Male with varicella rash: lesions in various stages of development
Classic blister during early stage of lesion development
  • Pruritic generalized vesicular exanthem w/ mild systemic manifestations
  • Usually affects children <10y
  • Rash
    • Starts on trunk or scalp as pruritic, red macules, spreads to extremities
    • W/in 24hr rash becomes vesicular (on erythematous base)
    • Palms/soles spared
    • Lesions in various stages of development

Differential Diagnosis

Pediatric Rash

Treatment

Supportive Care

  • Tylenol, antihistamine, oatmeal baths
  • Avoid aspirin in young children due to the risk of Reye syndrome

Corticosteroids

  • 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]

Antivirals

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 onsider in [3]:
  • Pregnancy[4]

Immunocompetent Adult

  • Acyclovir 800mg PO q6hrs daily x 5 days OR
  • Valacyclovir 1000mg PO q8hrs daily x 14 days OR
  • Famiciclovir 500mg PO q8hrs x 14 days

Immunocompromised Adult

  • Acyclovir 10mg/kg IV q8hrs x 7 days

At risk children <12yo child based on AAP criteria

  • Acyclovir 20mg/kg PO q6hrs daily x 5 days
  • Acyclovir 10mg/kg IV q8hrs daily x 7 days

Complications

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

See Also

Pediatric Rashes

Source

  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]