Chickenpox natural history: Difference between revisions
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{{Chickenpox}} | {{Chickenpox}} | ||
==Overview== | ==Overview== | ||
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 | 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]]. | ||
==Natural History== | ==Natural History== | ||
| Line 20: | Line 20: | ||
===Complications in Immunocompetent=== | ===Complications in Immunocompetent=== | ||
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> | |||
*[[Toxic shock syndrome]] | *[[Toxic shock syndrome]] | ||
*[[Viral pneumonia]] | *[[Viral pneumonia]] | ||
*Zoster [[paresis]] | *Zoster [[paresis]] | ||
*[[Post-herpetic neuralgia]]) | *[[Post-herpetic neuralgia]]) | ||
*VZV [[meningoencephalitis]] | *[[VZV]] [[meningoencephalitis]] | ||
*VZV [[Vasculopathies|vasculopathy]] | *[[VZV]] [[Vasculopathies|vasculopathy]] | ||
*VZV and [[giant cell arteritis]] | *[[VZV]] and [[giant cell arteritis]] | ||
*VZV-induced [[stromal]] [[keratitis]] | *[[VZV]]-induced [[stromal]] [[keratitis]] | ||
*[[Necrotizing fasciitis]] | *[[Necrotizing fasciitis]] | ||
*[[Septicemia]] | *[[Septicemia]] | ||
*[[Osteomyelitis]] | *[[Osteomyelitis]] | ||
| Line 36: | Line 36: | ||
*[[Cerebellar ataxia]] | *[[Cerebellar ataxia]] | ||
*[[Encephalitis]] | *[[Encephalitis]] | ||
*[[Hemorrhagic]] conditions | *[[Hemorrhagic]] conditions | ||
*[[Septic arthritis]] | *[[Septic arthritis]] | ||
===Complications in Immunocompromised=== | ===Complications in Immunocompromised=== | ||
Common complications associated with [[chickenpox]] in [[Immunosupression|immunosupressed]] individuals include: | |||
* [[Hemorrhagic]] complications | * [[Hemorrhagic]] complications | ||
* [[Febrile]] [[purpura]] | * [[Febrile]] [[purpura]] | ||
* [[Malignant]] [[chickenpox]] with [[purpura]] ([[mortality rate]] of greater than 70%) | * [[Malignant]] [[chickenpox]] with [[purpura]] ([[mortality rate]] of greater than 70%) | ||
* [[anaphylactoid purpura| | * [[anaphylactoid purpura|Anaphylactoid purpura]] | ||
==Prognosis== | ==Prognosis== | ||
*[[Chickenpox]] is rarely [[fatal]] except if the patient develops varicella [[pneumonia]]. | *[[Chickenpox]] is rarely [[fatal]] except if the patient develops varicella [[pneumonia]]. | ||
*Prognosis in the [[Immunodeficiency|immunocompromised]] is poor. | *[[Prognosis]] in the [[Immunodeficiency|immunocompromised]] is poor. | ||
*[[Varicella zoster virus]] remains dormant in [[Nerve|nerves]] which can be reactivated later resulting in [[shingles]]. It is most commonly seen in the [[immunocompromised]] and the elderly. | *[[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. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Pulmonology]] | ||
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]
- Generalized vesicular rash develops within 24 hours
- Fever
- Malaise
- Pharyngitis
- Loss of appetite
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]
- Toxic shock syndrome
- Viral pneumonia
- Zoster paresis
- Post-herpetic neuralgia)
- VZV meningoencephalitis
- VZV vasculopathy
- VZV and giant cell arteritis
- VZV-induced stromal keratitis
- Necrotizing fasciitis
- Septicemia
- Osteomyelitis
- Bacterial pneumonia
- Cerebellar ataxia
- Encephalitis
- Hemorrhagic conditions
- Septic arthritis
Complications in Immunocompromised
Common complications associated with chickenpox in immunosupressed individuals include:
- Hemorrhagic complications
- Febrile purpura
- Malignant chickenpox with purpura (mortality rate of greater than 70%)
- Anaphylactoid purpura
Prognosis
- Chickenpox is rarely fatal except if the patient develops varicella pneumonia.
- Prognosis in the immunocompromised is poor.
- Varicella zoster virus remains dormant in nerves which can be reactivated later in life, resulting in shingles. It is most commonly seen in the immunocompromised and the elderly.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 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.
- ↑ 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.
- ↑ de Benedictis FM, Osimani P (2008). "Necrotising fasciitis complicating varicella". Arch Dis Child. 93 (7): 619. doi:10.1136/adc.2008.141994. PMID 18567772.
- ↑ 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.
- ↑ 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.