Chickenpox: Difference between revisions

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==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 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]]
==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==
==Prognosis==

Revision as of 15:44, 27 January 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Prognosis

Chickenpox infection is milder in young children, and symptomatic treatment, with a sodium bicarbonate baths or antihistamine medication may ease itching.[1] 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. [2]

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. [3] Inflammation of the brain, or encephalitis, can occur in immunocompromised individuals, although the risk is higher with herpes zoster.[4]Necrotizing fasciitis[5] 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

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.[6]

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

References

  1. Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O (2002). "The burden of uncomplicated cases of chickenpox in Israel". J. Infect. 45 (1): 54–7. PMID 12217733.
  2. US Centers for Disease Control and Prevention. "Varicella Treatment Questions & Answers". CDC Guidelines. CDC. Retrieved 2007-08-23.
  3. "Definition of Chickenpox". MedicineNet.com. Retrieved 2006-08-18.
  4. "Is Necrotizing Fasciitis a complication of Chickenpox or of Cutaneous Vasculitis?". atmedstu.com. Retrieved 2008-01-18.
  5. Chaves SS, Gargiullo P, Zhang JX; et al. (2007). "Loss of vaccine-induced immunity to varicella over time". N Engl J Med. 356 (11): 1121&ndash, 9. PMID 17360990.

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