Varicella: Difference between revisions
 
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*Caused by [[varicella zoster virus]] causing varicella (chicken pox) and later zoster ([[Shingles]])  
*Caused by [[varicella zoster virus]] causing varicella (chicken pox) and later zoster ([[Shingles]])  
*Contagious until last lesion crusts over
*Contagious until last lesion crusts over
**Fluid from open vesicles contains live virus <ref name="Bode">Sara Bode; Contagious Exanthematous Diseases. ''Quick References 2022''; 10.1542/aap.ppcqr.396150</ref>
*Incubation period is 10-21 days with symptoms starting around day 14 <ref name="Bode"/>
{{Herpes viruses}}


==Clinical Features==
==Clinical Features==
[[File:Vicki Pandit - Howrah 2014-04-06 9845.jpg|thumb|Chickenpox rash on face.]]
[[File:Varicela Rash.jpg|thumbnail|Male with varicella rash: lesions in various stages of development]]
[[File:Varicela Rash.jpg|thumbnail|Male with varicella rash: lesions in various stages of development]]
[[File:Chickenpox blister.jpg|thumbnail|Classic blister during early stage of lesion development]]
[[File:Chickenpox blister.jpg|thumbnail|Classic blister during early stage of lesion development]]
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*Starts on trunk or scalp as pruritic, red macules, spreads to extremities
*Starts on trunk or scalp as pruritic, red macules, spreads to extremities
*Within 24hr rash becomes vesicular (on erythematous base)
*Within 24hr rash becomes vesicular (on erythematous base)
**Often referred to as "dew drop on a rose petal" <ref name="Bode"/>
*Palms/soles spared
*Palms/soles spared
*Lesions in various stages of development
*Lesions in various stages of development
*The number of lesions can vary; usually 300 or less but can be more than 2,000 <ref name="Bode"/>
===Complications===
*Can include [[encephalitis]], [[otitis media]], [[pneumonia]], [[hepatitis]], [[strep]]/[[staph]] [[cellulitis|superinfection]] of ruptured vesicles
*Perinatal infection in neonates may develop serious illness


==Differential Diagnosis==
==Differential Diagnosis==
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==Disposition==
==Disposition==
*Most often discharge
*Secondary bacterial infection most common cause of hospitalization in kids
*Pneumonia most common cause of hospitalization in adults<ref>Reynolds MA, Watson BM, Plott-Adams KK, et al. Epidemiology of varicella hospitalizations in the United States, 1995-2005. J Infect Dis. 2008;197 Suppl 2:S120-S126. doi:10.1086/522146</ref>


==Vaccine==
==Vaccine==
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**Ideally given within 3-5 days of exposure in immunocompetent patients
**Ideally given within 3-5 days of exposure in immunocompetent patients
**If immunocompromised patient is being given VZIG, varicella vaccine should be administered ≥5 months after VariZIG administration<ref>CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(No. RR-4).</ref>
**If immunocompromised patient is being given VZIG, varicella vaccine should be administered ≥5 months after VariZIG administration<ref>CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(No. RR-4).</ref>
==Complications==
*Can include encephalitis, otitis media, pneumonia, hepatitis, strep/staph superinfection of ruptured vesicles
*Perinatal infection in neonates may develop serious illness


==See Also==
==See Also==
[[Pediatric Rashes]]
*[[Pediatric Rashes]]
*[[Varicella zoster virus]]


==References==
==References==

Latest revision as of 21:13, 12 July 2023

Background

  • Caused by varicella zoster virus causing varicella (chicken pox) and later zoster (Shingles)
  • Contagious until last lesion crusts over
    • Fluid from open vesicles contains live virus [1]
  • Incubation period is 10-21 days with symptoms starting around day 14 [1]

Herpes Virus Types

Clinical Features

Chickenpox rash on face.
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)
    • Often referred to as "dew drop on a rose petal" [1]
  • Palms/soles spared
  • Lesions in various stages of development
  • The number of lesions can vary; usually 300 or less but can be more than 2,000 [1]

Complications

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 [2]
  • However, evidence shows decreased days of fever and number of lesions[3]

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 [4]:
  • Pregnancy[5]

Immunocompetent Adult

Immunocompromised Adult

At risk children <12yo child based on AAP criteria

VZIG

  • Initiate VZIG alongside acyclovir for inpatient treatment of child or adult
  • For immunocompromised child with exposure, give as post-exposure prophylaxis if[6]:
    • Within 10 days window of exposure
    • VZIG given IM as 125 IU/10 kg of body weight
      • Up to max of 625 IU
      • Minimum dose 62.5 IU for patients weighing ≤ 2.0 kg
      • Minimum dose 125 IU for weight 2.1 - 10.0 kg
  • VZIG may prolong incubation period ≥1 week
    • Must have patient closely follow up for signs and symptoms for 28 days after exposure
    • If signs or symptoms of varicella occur, antiviral therapy must be started immediately

Disposition

  • Most often discharge
  • Secondary bacterial infection most common cause of hospitalization in kids
  • Pneumonia most common cause of hospitalization in adults[7]

Vaccine

  • Introduced in 2006. Prior to introduction, incidence prior to adolescence approached 90% in US
  • Vaccine is 85% effective against all disease, 90% effective against severe disease (greater than 1000 lesions)
  • Typically given at age 5 in USA
  • Post-exposure prophylaxis:
    • Ideally given within 3-5 days of exposure in immunocompetent patients
    • If immunocompromised patient is being given VZIG, varicella vaccine should be administered ≥5 months after VariZIG administration[8]

See Also

References

  1. ↑ 1.0 1.1 1.2 1.3 Sara Bode; Contagious Exanthematous Diseases. Quick References 2022; 10.1542/aap.ppcqr.396150
  2. ↑ Arvin AM: Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis 2002; 13:12.
  3. ↑ Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.
  4. ↑ Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.
  5. ↑ CDC Chicken pox acyclovir treatment [1]
  6. ↑ CDC. MMWR - updated recommendations for use of VariZIG - United States, 2013. July 19, 2013 / 62(28);574-576.
  7. ↑ Reynolds MA, Watson BM, Plott-Adams KK, et al. Epidemiology of varicella hospitalizations in the United States, 1995-2005. J Infect Dis. 2008;197 Suppl 2:S120-S126. doi:10.1086/522146
  8. ↑ CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(No. RR-4).
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