Chickenpox natural history: Difference between revisions
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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. | 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: | 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 | *Bacterial infections of the skin and soft tissues in children | ||
*[[Pneumonia]] in adults | *[[Pneumonia]] in adults | ||
Some of the severe complications associated with chickenpox include: | 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]] | *[[Toxic shock syndrome]] | ||
Revision as of 21:28, 24 October 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Natural History
In a typical scenario, a young child is covered in pox and out of school for a week. The first half of the week the child feels miserable from intense itching; the second half from boredom. Since the introduction of the chickenpox vaccine, classic chickenpox is much less common. Chickenpox is extremely contagious, and can be spread by direct contact, droplet transmission, and airborne transmission. Even those with mild illness after the vaccine may be contagious. The incubation period for varicella is 14 to 16 days after exposure to a varicella or a herpes zoster rash, with a range of 10 to 21 days. People become contagious 1 to 2 days before breaking out with pox. They remain contagious while uncrusted blisters are present. Once you catch chickenpox, the virus usually remains in your body for your lifetime, kept in check by the immune system.
Complications
The disease is usually mild, although serious complications sometimes occur.
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:[1][2][3]
- Bacterial infections of the skin and soft tissues in children
- Pneumonia in adults
Some of the severe complications associated with chickenpox include:[1][4][5][2]
- Toxic shock syndrome
- Necrotizing fasciitis
- Septicemia
- Osteomyelitis
- Bacterial pneumonia
- Septic arthritis]
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
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.
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.
Chickenpox infection is milder in young children, and symptomatic treatment, with a sodium bicarbonate baths or antihistamine medication may ease itching.[6] 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. [7]
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.[8]Necrotizing fasciitis[9] 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.
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ US Centers for Disease Control and Prevention. "Varicella Treatment Questions & Answers". CDC Guidelines. CDC. Retrieved 2007-08-23.
- ↑ "Definition of Chickenpox". MedicineNet.com. Retrieved 2006-08-18.
- ↑ "Is Necrotizing Fasciitis a complication of Chickenpox or of Cutaneous Vasculitis?". atmedstu.com. Retrieved 2008-01-18.