Chickenpox natural history: Difference between revisions
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*[[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 immunocompromised is poor. | *Prognosis in the immunocompromised is poor. | ||
*Varicella zoster virus remains dormant in nerves which can be reactivated later in life causind shingles. This is mostly seen in the immunocompromised and the elderly. Unlike chickenpox which normally fully settles, shingles may result in persisting [[post-herpetic neuralgia]] pain. | *Varicella zoster virus remains dormant in nerves which can be reactivated later in life causind shingles. This is mostly seen in the immunocompromised and the elderly. Unlike chickenpox which normally fully settles, shingles may result in persisting [[post-herpetic neuralgia]] pain. | ||
Revision as of 00:23, 30 June 2017
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 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. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. Two of the most common complications associated with chickenpox are, bacterial infections of the skin and soft tissues in children and pneumonia in adults. Chickenpox is rarely fatal (usually from varicella pneumonia), with pregnant women and immunocompromised are more at risk. Repeated scratching of the itchy skin leads to bacterial infections such as cellulitis. In some cases, varicella infection can spread to the lungs causing pneumonia and can be fatal.
Natural History
If left untreated, in healthy children varicella manifestations develop within 15 days post exposure and typically present as: [1]
- Fever
- Malaise
- Pharyngitis
- Loss of appetite
- Generalized vesicular rash develops within 24 hours
- Infection in adults can cause VZV pneumonia
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
Some of the severe complications associated with chickenpox include:[2][4][5][3]
- Toxic shock syndrome
- Necrotizing fasciitis
- Septicemia
- Osteomyelitis
- Bacterial pneumonia
- Cerebellar ataxia
- Encephalitis
- Viral pneumonia
- Hemorrhagic conditions.
- Septic arthritis
Complications in Immunocompromised
- Hemorrhagic complications
- Febrile purpura
- Malignant chickenpox with purpura (mortality rate of greater than 70%)
- postinfectious purpura
- purpura fulminans
- Aanaphylactoid 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 causind shingles. This is mostly seen in the immunocompromised and the elderly. Unlike chickenpox which normally fully settles, shingles may result in persisting post-herpetic neuralgia pain.
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.