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{{Chickenpox}}
{{Chickenpox}}
==Overview==
==Overview==
* The varicella zoster virus (VZV) is a herpesvirus responsible for causing,
Primary [[Chickenpox|varicella]] presents with [[Pruritus|pruritic]] [[macules]], [[papules]], [[vesicles]], [[pustules]], and crusts, usually on the back, [[chest]], face, and [[abdomen]]. Reactivation of the [[virus]] can present as [[shingles]]. Common complications of [[chickenpox]] are [[bacterial]] [[Skin and soft-tissue infections|infections of the skin and soft tissues]] in children and [[pneumonia]] in adults. [[Chickenpox]] is rarely fatal. [[Pregnancy|Pregnant]] women and [[Immunodeficiency|immunocompromised]] patients are at a higher risk of developing varicella [[pneumonia]].
** Primary varicella (chickenpox) and
** Zoster ([[shingles]])


==Natural History==
==Natural History==
If left untreated, in healthy children [[Chickenpox|varicella]] manifestations develop within 15 days post exposure and typically present as: <ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>
*Generalized [[vesicular]] [[rash]] develops within 24 hours
*[[Fever]]
*[[Malaise]]
*[[Pharyngitis]]
*[[Loss of appetite]]


===Primary varicella (chickenpox)===
*[[Infection]] in adults can cause [[Varicella zoster virus|VZV]] [[pneumonia]]
* Primary varicella is a common childhood disease in Western countries, which presents as pruritic [[macules]], [[papules]], [[vesicles]], [[pustules]], and [[crusts]], usually on the back, chest, face, and abdomen.
* In immunocompetent children, chickenpox is generally a mild disease with little morbidity and rare mortality.
* Primary varicella is associated with more morbidity in adults. Following resolution of primary varicella, VZV persists in a latent form in dorsal ganglion cells for what is usually an extended period of time. For reasons that are still poorly understood, VZV can later start replicating in the ganglion, producing severe neuralgia and spread of the virus down the sensory nerve. Vesicles then appear on the skin in the distribution of this nerve, producing the characteristic dermatomal rash of shingles. The vesicles progress to pustules, then to crusts that eventually are lost. Scarring and changes in pigmentation can result, but the most frequent sequela of zoster is postherpetic neuralgia, which is usually most severe in the elderly.
* In immunocompromised patients can sometimes involve internal organs (eg, lungs, liver, brain) resulting in high rates of morbidity and mortality.
* Primary varicella or herpes zoster  Congenital VZV infection is uncommon but can result in severe congenital malformations.
* A Tzanck smear can be useful to demonstrate a herpesvirus infection, but confirmation of VZV as the cause of the infection requires at least one of the following tests: culture, serology, direct immunofluorescence staining, or molecular techniques. <ref name="pmid1390036">{{cite journal| author=Tyring SK| title=Natural history of varicella zoster virus. | journal=Semin Dermatol | year= 1992 | volume= 11 | issue= 3 | pages= 211-7 | pmid=1390036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1390036  }} </ref>
 
===Zoster (shingles)===
 
* Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. The risk of shingles increases as one gets older. About 50% all cases occur in men and women 60 years old or older. One in every three people develop shingles in their lifetime which is estimated at 1 million cases every year.
 
* Certain cancers like leukemia and lymphoma, human immunodeficiency virus ([[Human Immunodeficiency Virus (HIV)|HIV]]) positive individuals, and people on immunosuppressive drugs such as steroids and drugs given after organ transplantation have a greater risk of getting shingles.
 
* Shingles typically occurs only once in a person's lifetime. However, a person can have a second or even a third episode.


==Complications==
==Complications==
* The disease is usually mild, although serious complications sometimes occur.
The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are [[Bacteria|bacterial]] [[Skin and soft-tissue infections|infections of the skin and soft tissues]] in children and [[pneumonia]] in adults.<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref><ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>
 
* The pox are worse in children who have other skin problems, such as [[eczema]] or a recent [[sunburn]]. Complications are more common in those who are immunocompromised from an illness or medicines like [[chemotherapy]]. Some of the worst cases of [[chickenpox]] have been seen in children who have taken [[steroids]] during the incubation period, before they have any symptoms.
 
* There are quite a few complications associated with the chickenpox disease. Two of the most common complications are:<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref><ref name="pmid2829675">{{cite journal| author=Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD et al.| title=NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. | journal=Ann Intern Med | year= 1988 | volume= 108 | issue= 2 | pages= 221-37 | pmid=2829675 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2829675  }} </ref>


**Bacterial infections of the skin and soft tissues in children
===Complications in Immunocompetent===
**[[Pneumonia]] in adults
Common complications associated with [[chickenpox]] in [[Immunocompetent|immunocompeten]]<nowiki/>t individuals include:<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid10799624">{{cite journal| author=Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A| title=Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 5 | pages= E60 | pmid=10799624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10799624  }} </ref><ref name="pmid18567772">{{cite journal| author=de Benedictis FM, Osimani P| title=Necrotising fasciitis complicating varicella. | journal=Arch Dis Child | year= 2008 | volume= 93 | issue= 7 | pages= 619 | pmid=18567772 | doi=10.1136/adc.2008.141994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18567772  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref><ref name="pmid27188665">{{cite journal| author=Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D et al.| title=Varicella zoster virus infection. | journal=Nat Rev Dis Primers | year= 2015 | volume= 1 | issue=  | pages= 15016 | pmid=27188665 | doi=10.1038/nrdp.2015.16 | pmc=5381807 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27188665  }} </ref><ref name="pmid12585787">{{cite journal| author=Clark P, Davidson D, Letts M, Lawton L, Jawadi A| title=Necrotizing fasciitis secondary to chickenpox infection in children. | journal=Can J Surg | year= 2003 | volume= 46 | issue= 1 | pages= 9-14 | pmid=12585787 | doi= | pmc=3211661 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12585787  }} </ref>


* Some of the severe complications associated with chickenpox include:<ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue=  | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193  }} </ref><ref name="pmid10799624">{{cite journal| author=Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A| title=Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 5 | pages= E60 | pmid=10799624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10799624  }} </ref><ref name="pmid18567772">{{cite journal| author=de Benedictis FM, Osimani P| title=Necrotising fasciitis complicating varicella. | journal=Arch Dis Child | year= 2008 | volume= 93 | issue= 7 | pages= 619 | pmid=18567772 | doi=10.1136/adc.2008.141994 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18567772  }} </ref><ref name="pmid18419417">{{cite journal| author=Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX et al.| title=Varicella among adults: data from an active surveillance project, 1995-2005. | journal=J Infect Dis | year= 2008 | volume= 197 Suppl 2 | issue=  | pages= S94-S100 | pmid=18419417 | doi=10.1086/522155 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18419417  }} </ref>
*[[Toxic shock syndrome]]
*[[Viral pneumonia]]
*Zoster [[paresis]]
*[[Post-herpetic neuralgia]])
*[[VZV]] [[meningoencephalitis]]
*[[VZV]] [[Vasculopathies|vasculopathy]]
*[[VZV]] and [[giant cell arteritis]]
*[[VZV]]-induced [[stromal]] [[keratitis]]
*[[Necrotizing fasciitis]]
*[[Septicemia]]
*[[Osteomyelitis]]
*[[Bacterial pneumonia]]
*[[Cerebellar ataxia]]
*[[Encephalitis]]
*[[Hemorrhagic]] conditions
*[[Septic arthritis]]


**[[Toxic shock syndrome]]
===Complications in Immunocompromised===
**[[Necrotizing fasciitis]]
Common complications associated with [[chickenpox]] in [[Immunosupression|immunosupressed]] individuals include:
**[[Septicemia]]
* [[Hemorrhagic]] complications
**[[Osteomyelitis]]
* [[Febrile]] [[purpura]]
**[[Bacterial pneumonia]]
* [[Malignant]] [[chickenpox]] with [[purpura]] ([[mortality rate]] of greater than 70%)
**[[Septic arthritis]]
* [[anaphylactoid purpura|Anaphylactoid purpura]]
 
* Other complications include:
 
**[[Cerebellar ataxia]]
**[[Encephalitis]]
**[[Viral pneumonia]]
**[[Hemorrhagic]] conditions.
 
* 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.


==Prognosis==
==Prognosis==


*[[Chickenpox]] is rarely fatal (usually from varicella [[pneumonia]]), with pregnant women and those with a suppressed immune systems being more at risk. Pregnant women not known to be immune and who come into contact with chickenpox may need urgent treatment as the virus can cause serious problems for the baby. This is less of an issue after 20 weeks.
*[[Chickenpox]] is rarely [[fatal]] except if the patient develops varicella [[pneumonia]].
 
*[[Prognosis]] in the [[Immunodeficiency|immunocompromised]] is poor.
*Later in life, viruses remaining dormant in the nerves can reactivate causing localised eruptions of [[shingles]]. This occurs particularly  in people with compromised immune systems, such as the elderly, and perhaps even those suffering sunburn. Unlike chickenpox which normally fully settles, shingles may result in persisting [[post-herpetic neuralgia]] pain.
*[[Varicella zoster virus]] remains dormant in [[Nerve|nerves]] which can be reactivated later in life, resulting in [[shingles]]. It is most commonly seen in the [[immunocompromised]] and the elderly.
 
*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]].
 
*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. 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]]
 
*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]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 20:53, 29 July 2020


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

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Overview

Primary varicella presents with pruritic macules, papules, vesicles, pustules, and crusts, usually on the back, chest, face, and abdomen. Reactivation of the virus can present as shingles. Common complications of chickenpox are bacterial infections of the skin and soft tissues in children and pneumonia in adults. Chickenpox is rarely fatal. Pregnant women and immunocompromised patients are at a higher risk of developing varicella pneumonia.

Natural History

If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: [1]

Complications

The disease is usually mild, although serious complications sometimes occur. Two of the most common complications are bacterial infections of the skin and soft tissues in children and pneumonia in adults.[2][3][1]

Complications in Immunocompetent

Common complications associated with chickenpox in immunocompetent individuals include:[2][4][5][3][6][7]

Complications in Immunocompromised

Common complications associated with chickenpox in immunosupressed individuals include:

Prognosis

References

  1. ↑ 1.0 1.1 Straus SE, Ostrove JM, Inchauspé G, Felser JM, Freifeld A, Croen KD; et al. (1988). "NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention". Ann Intern Med. 108 (2): 221–37. PMID 2829675.
  2. ↑ 2.0 2.1 Gnann JW (2002). "Varicella-zoster virus: atypical presentations and unusual complications". J Infect Dis. 186 Suppl 1: S91–8. doi:10.1086/342963. PMID 12353193.
  3. ↑ 3.0 3.1 Marin M, Watson TL, Chaves SS, Civen R, Watson BM, Zhang JX; et al. (2008). "Varicella among adults: data from an active surveillance project, 1995-2005". J Infect Dis. 197 Suppl 2: S94–S100. doi:10.1086/522155. PMID 18419417.
  4. ↑ Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A (2000). "Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group". Pediatrics. 105 (5): E60. PMID 10799624.
  5. ↑ de Benedictis FM, Osimani P (2008). "Necrotising fasciitis complicating varicella". Arch Dis Child. 93 (7): 619. doi:10.1136/adc.2008.141994. PMID 18567772.
  6. ↑ Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D; et al. (2015). "Varicella zoster virus infection". Nat Rev Dis Primers. 1: 15016. doi:10.1038/nrdp.2015.16. PMC 5381807. PMID 27188665.
  7. ↑ Clark P, Davidson D, Letts M, Lawton L, Jawadi A (2003). "Necrotizing fasciitis secondary to chickenpox infection in children". Can J Surg. 46 (1): 9–14. PMC 3211661. PMID 12585787.


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