Chickenpox: Difference between revisions

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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
__NOTOC__
{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name        = Chickenpox |
   Name        = Chickenpox |
   Image      = Child with chickenpox.jpg |
   Image      = Child with chickenpox.jpg |
   Caption    = Child with varicella disease |
   Caption    = Child with varicella disease |
  ICD10      = {{ICD10|B|01| |b|00}}  |
  ICD9        = {{ICD9|052}} |
  DiseasesDB    = 29118 |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 001592 |
  eMedicineSubj  = |
  eMedicineTopic = |
  eMedicine_mult = |
  MeshName      = Chickenpox |
  MeshNumber    = C02.256.466.175 |
}}
}}
{{Chickenpox}}
{{Chickenpox}}
{{CMG}}
 
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
 
{{CMG}} {{ARK}}
 
{{SK}} Varicella zoster; Chicken pox; VZV


==[[Chickenpox overview|Overview]]==
==[[Chickenpox overview|Overview]]==


==[[Chickenpox historical perspective|Historical Perspective]]==
==[[Chickenpox historical perspective|Historical Perspective]]==
==[[Chickenpox classification|Classification]]==


==[[Chickenpox pathophysiology|Pathophysiology]]==
==[[Chickenpox pathophysiology|Pathophysiology]]==


==[[Chickenpox epidemiology and demographics|Epidemiology & Demographics]]==
==[[Chickenpox causes|Causes]]==
 
==[[Chickenpox differential diagnosis|Differentiating Chickenpox from other Diseases]]==
 
==[[Chickenpox epidemiology and demographics|Epidemiology and Demographics]]==


==[[Chickenpox risk factors|Risk Factors]]==
==[[Chickenpox risk factors|Risk Factors]]==
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==[[Chickenpox screening|Screening]]==
==[[Chickenpox screening|Screening]]==


==[[Chickenpox causes|Causes]]==
==[[Chickenpox natural history|Natural History, Complications and Prognosis]]==
 
==[[Chickenpox differential diagnosis|Differentiating Chickenpox]]==
 
==[[Chickenpox natural history|Complications & Prognosis]]==


==Diagnosis==
==Diagnosis==
[[Chickenpox history and symptoms|History and Symptoms]] | [[Chickenpox physical examination|Physical Examination]] | [[Chickenpox staging|Staging]] | [[Chickenpox laboratory tests|Laboratory tests]] | [[Chickenpox electrocardiogram|Electrocardiogram]]  | [[Chickenpox x ray|X Rays]] | [[Chickenpox CT|CT]] | [[Chickenpox MRI|MRI]] [[Chickenpox echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Chickenpox other imaging findings|Other images]] | [[Chickenpox other diagnostic studies|Alternative diagnostics]]
[[Chickenpox history and symptoms|History and Symptoms]] | [[Chickenpox physical examination|Physical Examination]] | [[Chickenpox laboratory findings|Laboratory Findings]] | [[Chickenpox chest x ray|Chest X Ray]] | [[Chickenpox other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
[[Chickenpox medical therapy|Medical therapy]] | [[Chickenpox surgery|Surgical options]] | [[Chickenpox primary prevention|Primary prevention]]  | [[Chickenpox secondary prevention|Secondary prevention]] | [[Chickenpox cost-effectiveness of therapy|Financial costs]] | [[Chickenpox future or investigational therapies|Future therapies]]
[[Chickenpox medical therapy|Medical Therapy]] | [[Chickenpox primary prevention|Primary Prevention]]  | [[Chickenpox secondary prevention|Secondary Prevention]] | [[Chickenpox cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Chickenpox future or investigational therapies|Future or Investigational Therapies]]


==Diagnosis==
==Case Studies==
The diagnosis of varicella is primarily clinical. In a non-immunized individual with typical [[prodrome|prodromal]] symptoms associated with the appropriate appearing rash occurring in "crops", no further investigation would normally be undertaken.
[[Chickenpox case study one|Case #1]]


If further investigation is undertaken, confirmation of the diagnosis can be sought through either examination of the fluid within the vesicles, or by testing blood for evidence of an acute immunologic reposnse. Vesicle fluid can be examined with a Tsanck smear, or better with examination for [[direct fluorescent antibody]]. The fluid can also be "cultured", whereby attempts are made to grow the virus from a fluid sample. Blood tests can be used to identify a response to acute infection (IgM) or previous infection and subsequent immunity (IgE).<ref>McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed., 2007, Chapter 54.
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Prenatal diagnosis of foetal varicella infection can be performed using [[ultrasound]], though a delay of 5 weeks following primary maternal infection is advised. A [[polymerase chain reaction|PCR]] (DNA) test of the mother's [[amniotic fluid]] can also be performed, though the risk of [[spontaneous abortion]] due to the [[amniocentesis]] procedure is higher than the risk of the baby developing foetal varicella syndrome.<ref name=pregnancy/>
 
==Signs and symptoms==
Chickenpox is a highly contagious disease that spreads from person to person by direct contact or through the air from an infected person's coughing or sneezing. Touching the fluid from a chickenpox [[blister]] can also spread the disease. A person with chickenpox is contagious from one to two days before the rash appears until all blisters have formed scabs. This may take 5-10 days.<ref name="DermNet NZ">{{cite web | author=New Zealand Dermatological Society | title=Chickenpox (varicella) | url=http://www.dermnetnz.org/viral/varicella.html | date=14 Jan 2006 | accessdate=2006-08-18}}</ref>
It takes from 10-21 days after contact with an infected person for someone to develop chickenpox.<ref name="CDCP-diseaseFAQs">{{cite web | work=Varicella Disease (Chickenpox) | title=General questions about the disease | url=http://www.cdc.gov/nip/diseases/varicella/faqs-gen-disease.htm | date=December 2 2001 | publisher=CDCP | accessdate=2006-08-18}}</ref>
 
The chickenpox lesions (blisters) start as a two to four millimeter red [[papule]] which develops an irregular outline (a ''rose petal''). A thin-walled, clear vesicle (''dew drop'') develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chickenpox. After about eight to 12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust. The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after seven days sometimes leaving a crater-like scar. Although one lesion goes through this complete cycle in about seven days, another hallmark of chickenpox is the fact that new lesions crop up every day for several days. Therefore it may be a week before new lesions stop appearing and existing lesions crust over. Children are not to be sent back to school until all lesions have crusted over.<ref>{{cite web | author=Heather Brannon | title=Chicken Pox - Varicella Virus Infection | url=http://dermatology.about.com/cs/chickenpox/a/chickenpox.htm | date=December 25, 2005 | accessdate=2006-08-18}}</ref>
 
Chickenpox is highly contagious and is spread through the air when infected people cough or sneeze, or through physical contact with fluid from lesions on the skin. [[Herpes zoster|Zoster]], also known as shingles, is a reactivation of chickenpox and may also be a source of the virus for susceptible children and adults. It is not necessary to have physical contact with the infected person for the disease to spread. Those infected can spread chickenpox before they know they have the disease - even before any rash develops. People with chickenpox, in fact, can infect others from about two days before the rash develops until all the sores have crusted over, usually four or five days after the rash starts.
 
===Infection in Pregnancy and Neonates===
Varicella infection in pregnant women can lead to viral transmission via the placenta and infection of the foetus. If infection occurs during the first 28 weeks of gestation, this can lead to foetal varicella syndrome (also known as congenital varicella syndrome). Effects on the foetus can range in severity from underdeveloped toes and fingers to severe anal and bladder malformation. Possible problems include:
* Damage to brain: [[encephalitis]], [[microcephaly]], [[hydrocephaly]], [[aplasia]] of brain
* Damage to the eye (optic stalk, optic cap, and lens vesicles), [[microphthalmia]], [[cataracts]], [[chorioretinitis]], [[optic atrophy]]
* Other neurological disorder: damage to cervical and lumbosacral [[spinal cord]], motor/sensory deficits, absent deep [[tendon reflex]]es, anisocoria/[[Horner's syndrome]]
* Damage to body: [[hypoplasia]] of upper/lower extremities, anal and bladder [[sphincter]] dysfunction
* Skin disorders: ([[cicatricial]]) skin lesions, [[hypopigmentation]]
 
Infection late in gestation or immediately post-partum is referred to as neonatal varicella. Maternal infection is associated with premature delivery.  The risk of the baby developing the disease is greatest following exposure to infection in the period 7 days prior to delivery and up to 7 days post-partum. The nenoate may also be exposed to the virus via infectious siblings or other contacts, but this is of less concern if the mother is immune. Newborns who develop symptoms are at a high risk of pneumonia and other serious complications of the disease. <ref name="pregnancy">{{cite web | author=Royal College of Obstetricians and Gynaecologists | title=Chickenpox in Pregnancy | url=http://www.rcog.org.uk/resources/Public/pdf/greentop13_chickenpox0907.pdf | date=September 2007 | accessdate=2008-04-12}}</ref>
 
==Treatment==
[[Chickenpox]] infection tends to be milder the younger a child is and symptomatic treatment, with  a little [[sodium bicarbonate]] in baths or [[antihistamine]] medication to ease itching,<ref>{{cite journal |author=Somekh E, Dalal I, Shohat T, Ginsberg''''' GM''''', Romano O |title=The burden of uncomplicated cases of chickenpox in Israel |journal=J. Infect. |volume=45 |issue=1 |pages=54-7 |year=2002 |pmid=12217733 |doi=}}</ref> and [[paracetamol]] (acetaminophen) to reduce fever, are widely used. Ibuprofen can also be used on advice of a doctor. However, [[aspirin]] or products containing aspirin must <i>not</i> be given to children with chickenpox (or any fever-causing illness), as this risks causing the serious and potentially fatal [[Reye's Syndrome]]. <ref>{{cite web | author=US Centers for Disease Control and Prevention | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/dis-faqs-gen-treatment.htm | title=Varicella Treatment Questions & Answers | work=CDC Guidelines | publisher=CDC | accessdate=2007-8-23}}</ref>
 
There is no evidence to support the effectiveness of topical application of [[calamine lotion]], a topical barrier preparation containing zinc oxide in spite of its wide usage and excellent safety profile.<ref>{{cite journal |author=Tebruegge M, Kuruvilla M, Margarson I |title=Does the use of calamine or antihistamine provide symptomatic relief from pruritus in children with varicella zoster infection? |journal=Arch. Dis. Child. |volume=91 |issue=12 |pages=1035-6 |year=2006 |pmid=17119083 |doi=10.1136/adc.2006.105114 |url=http://adc.bmj.com/cgi/content/extract/91/12/1035 |format-Abstract}}</ref>.
 
It is important to maintain good hygiene and daily cleaning of skin with warm water to avoid secondary bacterial infection.  [[Infection]] in otherwise healthy adults tends to be more severe and active; treatment with antiviral drugs (e.g. [[acyclovir]]) is generally advised. Patients of any age with depressed immune systems or extensive eczema are at risk of more severe disease and should also be treated with antiviral medication. In the U.S., 55 percent of chickenpox deaths are in the over-20 age group, even though they are a tiny fraction of the cases.
 
==Prognosis==
 
Chickenpox infection is milder in young children, and symptomatic treatment, with a [[sodium bicarbonate]] baths or [[antihistamine]] medication may ease itching.<ref>{{cite journal |author=Somekh E, Dalal I, Shohat T, Ginsberg''''' GM''''', Romano O |title=The burden of uncomplicated cases of chickenpox in Israel |journal=J. Infect. |volume=45 |issue=1 |pages=54-7 |year=2002 |pmid=12217733 |doi=}}</ref> [[Paracetamol]] (acetaminophen) is widely used to reduce fever.  [[Aspirin]], or products containing aspirin, must not be given to children with chickenpox (or any fever-causing illness), as this risks causing the serious and potentially fatal [[Reye's Syndrome]]. <ref>{{cite web | author=US Centers for Disease Control and Prevention | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/dis-faqs-gen-treatment.htm | title=Varicella Treatment Questions & Answers | work=CDC Guidelines | publisher=CDC | accessdate=2007-08-23}}</ref>
 
In adults, the disease can be more severe, though the incidence is much less common. Infection in adults is associated with greater morbidity and mortality due to [[pneumonia]], [[hepatitis]] and [[encephalitis]]. In particular, up to 10% of pregnant women with chickenpox develop pneumonia, the severity of which increases with onset later in gestation. In England and Wales, 75% of deaths due to chickenpox are in adults. <ref name=pregnancy/> Inflammation of the brain, or [[encephalitis]], can occur in immunocompromised individuals, although the risk is higher with [[herpes zoster]].<ref>{{cite web | title=Definition of Chickenpox | url=http://www.medterms.com/script/main/art.asp?articlekey=2702 | publisher=MedicineNet.com | accessdate=2006-08-18}}</ref>[[Necrotizing fasciitis]]<ref>{{cite web | title=Is Necrotizing Fasciitis a complication of Chickenpox or of Cutaneous Vasculitis?|url=http://www.atmedstu.com/exam%20plus/Is%20Necrotizing%20Fasciitis%20a%20complication%20of%20Chickenpox%20or%20of%20Cutaneous%20Vasculitis.php|publisher=atmedstu.com | accessdate=2008-01-18}}</ref> is also a rare complication.
 
Secondary bacterial infection of skin lesions, manifesting as impetigo, cellulitis, and erysipelas, is the most common complication in healthy children. Disseminated primary varicella infection, usually seen in the immunocompromised or adult populations, may have high morbidity. Ninety percent of cases of varicella [[pneumonia]] occur in the adult population. Rarer complications of disseminated chickenpox also include [[myocarditis]], [[hepatitis]], and [[glomerulonephritis]].
 
Hemorrhagic complications are more common in the immunocompromised or immunosuppressed populations, although healthy children and adults have been affected. Five major clinical syndromes have been described: febrile purpura, malignant chickenpox with purpura, postinfectious purpura, purpura fulminans, and anaphylactoid purpura. These syndromes have variable courses, with febrile purpura being the most benign of the syndromes and having an uncomplicated outcome. In contrast, malignant chickenpox with purpura is a grave clinical condition that has a mortality rate of greater than 70%. The etiology of these hemorrhagic chickenpox syndromes is not known.
 
==Vaccination==
{{main|Varicella vaccine}}
A [[varicella vaccine]] has been available since 1995 to inoculate against the disease.  Some countries require the varicella vaccination or an exemption before entering elementary school.  Protection is not lifelong and further vaccination is necessary five years after the initial immunization.<!--
  --><ref>{{cite journal | author=Chaves SS, Gargiullo P, Zhang JX, ''et al.'' | title=Loss of vaccine-induced immunity to varicella over time | journal=N Engl J Med | year=2007 | volume=356 | issue=11 | pages=1121&ndash;9 | id=PMID 17360990}}</ref>
 
In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all NHS healthcare personnel had determined their immunity and been immunised if they were non-immune and have direct patient contact.  Population-based immunization against varicella is not otherwise practiced in the UK, because of lack of evidence of lasting efficacy or public health benefit.
 
'''Normal Reactions to vaccine are'''
*Fever of 101.9 (38.9 C) up to 42 days after Injection
*Soreness, inching at the site of injection within 2 days
*Rash occurring at site of injection anywhere form 8 to 19 days after injection. If this happens you are considered contagious.
*Rash on other parts of body anywhere from 5 to 26 days after injection. If this happens you are considered contagious.
'''What to do should reaction occur'''
 
Control fever and lessen discomfort, take medication containing [[acetaminophen]], (AKA paracetamol) such as
*[[Panadol]],
*Tempra,
*[[Tylenol]].
 
==References==
{{Reflist|2}}
 
==Additional Reading==
* {{cite web | author=Bernstein, Henry | url=http://www.familyeducation.com/experts/advice/0,1183,25-26758,00.html | title=Who Discovered Chickenpox? | work=Pediatrics Questions and Answers | publisher=Family Education Network | accessdate=2005-10-16}}
* {{cite web | title=Chickenpox (Varicella) Vaccine | url=http://www.vaccineinformation.org/varicel/qandavax.asp | month=October | year=2005 | publisher=Immunization Action Coalition | accessdate=2006-06-12}}
* {{cite web | author= U.S. Census Bureau | authorlink=United States Census Bureau | title=Countries Ranked by Popn: 2006 | url=http://www.census.gov/cgi-bin/ipc/idbrank.pl | work = International Data Base | accessdate=2005-10-16}}
* {{cite journal | author=Centers for Disease Control and Prevention (CDC) | authorlink=Centers for Disease Control and Prevention  | title=Varicella-related deaths--United States, January 2003-June 2004. | journal=MMWR Morb Mortal Wkly Rep | volume=54 | issue=11 | pages=272-4 | year=2005 | id=PMID 15788992 | url=http://www.cdc.gov/mmwr/PDF/wk/mm5411.pdf | format=PDF}}
* {{cite journal | author=Thomas S, Wheeler J, Hall A | title=Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study. | journal=Lancet | volume=360 | issue=9334 | pages=678-82 | year=2002 | id=PMID 12241874 | url=http://image.thelancet.com/extras/01art6088web.pdf | format=PDF}}
* {{cite journal | author=Jeff Aronson | title=When I Use a Word...Chickenpox | journal=BMJ | volume=321 | issue=7262 | page=682 | year=2000 |  url=http://www.bmj.com/cgi/content/full/321/7262/682 | format=web}}
 
==External links==
{{commonscat|Chickenpox}}
* {{cite web | title=Varicella Disease (Chickenpox): Varicella, although a common disease, can be dangerous and even deadly. | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/default.htm | date=May 26, 2005 | publisher=[[Centers for Disease Control and Prevention|CDC]]}}


{{Viral diseases}}
[[Category:Disease]]
[[es:Varicela]]
[[Category:Up-To-Date]]
[[fr:Varicelle]]
[[Category:Dermatology]]
[[ja:水痘]]
[[pt:Varicela]]
[[ro:Varicelă]]
[[ru:Ветряная оспа]]
[[vi:Bệnh thủy đậu]]
[[zh:水痘]]
 
[[Category:Viral diseases]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Poxviruses]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Overview complete]]
[[Category:Pulmonology]]
 
[[pl:Ospa wietrzna]]
 
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Latest revision as of 20:53, 29 July 2020

Template:DiseaseDisorder infobox

Chickenpox Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Aravind Reddy Kothagadi M.B.B.S[2]

Synonyms and keywords: Varicella zoster; Chicken pox; VZV

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chickenpox from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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