Difference between revisions of "Varicella"
(→Differential Diagnosis) |
(→Clinical Features) |
||
| Line 8: | Line 8: | ||
*Pruritic generalized vesicular exanthem with mild systemic manifestations | *Pruritic generalized vesicular exanthem with mild systemic manifestations | ||
*Usually affects children <10y | *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== | ==Differential Diagnosis== | ||
Revision as of 18:36, 23 July 2016
Contents
Background
- Caused by varicella zoster virus causing varicella (chicken pox) and later zoster (Shingles)
- Contagious until last lesion crusts over
Clinical Features
- 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
- Drug rash
- Erythema Infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-Schonlein Purpura (HSP)
- Herpangina
- Herpes simplex virus
- Infectious Mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella German measles)
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella
- Smallpox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Bullous impetigo
- Localized distribution
Varicella zoster virus
- Varicella (Chickenpox)
- Herpes zoster (Shingles)
- Herpes zoster ophthalmicus
- Herpes zoster oticus (Ramsay Hunt syndrome)
Diagnosis
- Typically made on clinical features
Management
Supportive Care
- Tylenol, antihistamine, oatmeal baths
- Avoid aspirin in young children due to the risk of Reye syndrome
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
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, otitis media, pneumonia, hepatitis, strep/staph superinfection of ruptured vesicles
- Perinatal infection in neonates may develop serious illness
See Also
References
- ↑ Arvin AM: Antiviral therapy for varicella and herpes zoster. Semin Pediatr Infect Dis 2002; 13:12.
- ↑ Klassen TP, et al. Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev. 2005; (4):CD002980.
- ↑ Drugs for non-HIV viral infections. Treat Guidel Med Lett. 2007; 5(59):59-70.
- ↑ CDC Chicken pox acyclovir treatment [1]